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Intermittent explosive disorder Definition Intermittent explosive disorder IED is a disorder characterized by impulsive acts of aggression, as contrasted with planned violent or aggressive acts.
The aggressive episodes may take the form of "spells" or "attacks," with symptoms beginning minutes to hours before the actual acting-out. The Diagnostic and Statistical Manual of Mental Disordersfourth edition, text revision also known as DSM-IV-TR is the basic reference work consulted by mental health professionals in determining the diagnosis of a mental disorder.
Description Intermittent explosive disorder was originally described by the eminent French psychiatrist Esquirol as a "partial insanity" related to senseless impulsive acts. Esquirol termed this disorder monomanies instinctivesor instinctual monomanias.
These apparently unmotivated acts were thought to result from instinctual or involuntary impulses, or from impulses related to ideological obsessions. People with intermittent explosive disorder have a problem with controlling their temper.
In addition, their violent behavior is out of proportion to the incident or event that triggered the outburst. Impulsive acts of aggression, however, are not unique to intermittent explosive disorder. Impulsive aggression can be present in many psychological and nonpsychological disorders.
The diagnosis of intermittent explosive disorder IED is essentially a diagnosis of exclusion, which means that it is given only after other disorders have been ruled out as causes of impulsive aggression.
Patients diagnosed with IED usually feel a sense of arousal or tension before an outburst, and relief of tension after the aggressive act.
Patients with IED believe that their aggressive behaviors are justified; however, they feel genuinely upset, regretful, remorseful, bewildered or embarrassed by their impulsive and aggressive behavior.
Causes and symptoms Causes Recent findings suggest that IED may result from abnormalities in the areas of the brain that regulate behavioral arousal and inhibition. Research indicates that impulsive aggression is related to abnormal brain mechanisms in a system that inhibits motor muscular movement activity, called the serotoninergic system.
This system is directed by a neurotransmitter called serotonin, which regulates behavioral inhibition control of behavior. Some studies have correlated IED with abnormalities on both sides of the front portion of the brain.
These localized areas in the front of the brain appear to be involved in information processing and controlling movement, both of which are unbalanced in persons diagnosed with IED.
Studies using positron emission tomography PET scanning have found lower levels of brain glucose sugar metabolism in patients who act in impulsively aggressive ways. The researchers concluded that a significant subgroup of people with IED may be predisposed to explosive behavior by an inborn characteristic of their central nervous system.
In sum, there is a substantial amount of convincing evidence that IED has biological causes, at least in some people diagnosed with the disorder. Other clinicians attribute IED to cognitive distortions.
According to cognitive therapists, persons with IED have a set of strongly negative beliefs about other people, often resulting from harsh punishments inflicted by the parents. The child grows up believing that others "have it in for him" and that violence is the best way to restore damaged self-esteem.
He or she may also have observed one or both parents, older siblings, or other relatives acting out in explosively violent ways. In short, people who develop IED have learned, usually in their family of origin, to believe that certain acts or attitudes on the part of other people "justify" aggressive attacks on them.While the witch trials only really began in the 15th century, with the start of the early modern period, many of their causes  had been developing during the previous centuries, with the prosecution of heresy by the Medieval Inquisition during the late twelfth and the thirteenth centuries, and during the Late Medieval period, during which the idea of witchcraft or sorcery.
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