Intermittent Explosive Disorder or Functional Behavior?

Intermittent Explosive DisorderMy home state of Colorado is no stranger to road rage. Right now, a Parker man is charged with two counts of first degree murder, our own Broncos quarterback has been accused of causing injury and destruction of property, and last March a man was shot in the neck during an alleged road-rage incident. If some in the psychology industry have their way, road-ragers may have the perfect alibi in court. And it’s the perfect threat to individual responsibility.

This month, the AP reported findings from the University of Chicago and Harvard medical schools suggesting that nearly one in twenty of us suffer from “repeated, uncontrollable anger attacks.” The cause of hissy-fits, tantrums, and violent outbursts? A group of symptoms labeled intermittent explosive disorder, or IED. It’s a condition that conveniently allows the victim to abuse others without the threat of guilt or shame.

These new findings received much media attention, mostly within the context of road rage. But IED is not some arbitrary BS diagnosis that psychologists recently dreamed up to explain violence in automobiles. This is an existing BS diagnosis offered by the American Psychiatric Association (APA) to explain “failure to resist aggressive impulses.”

According to the APA, individuals suffering from IED can experience sudden attacks of anger, and they display “aggression that is grossly out of proportion to any precipitating psychological stressors.” Having spent a good deal of time treating convicted felons, I’m familiar with the diagnosis. Its legitimacy is subject to debate among those who deal with such patients. But let’s come back to this.

There is another tragic condition that I would like to bring to your attention called intermittent disbursement disorder, or IDD. In this tragic syndrome, the afflicted find themselves randomly and intermittently handing thousand-dollar bills to complete strangers.

Imagine the plight of these poor souls. Picture yourself walking down the street when suddenly your vision becomes blurred, sounds become muffled. You see your hand, as if controlled by an unseen entity, reaching into your pocket, pulling out a cool grand, and handing it to the first passer-by. He disappears around a corner with your hard-earned cash and a smile.

IDD is no laughing matter, my friend. This horrific ailment afflicts nearly…

OK, I made it up. It doesn’t afflict anybody. It doesn’t exist.

The reason IDD doesn’t exist is that doling out cash is not a simple reflex that can go haywire; it is functional behavior, initiated by the individual and shaped by the environment. We do it when we want or need to accomplish something, like buy a big-screen TV or fund the latest study on immature behavior – which brings us back to intermittent explosive disorder. Aggression, too, is functional behavior. Like all animals with a collection of neurons, we use it to accomplish things. Some of us use it very effectively.

Proponents of IED argue that there is a biological basis for aggression. Of course there is; there’s a biological basis for all behavior. They will also tell you that medicine can eliminate the behavior. Of course it can. Medicine can eliminate any behavior, even breathing.

There are times when biological problems truly do contribute to aggression. People recovering from brain injuries or tumors, for example, often find that they have difficulty managing their emotions and impulses. A violent or neglectful upbringing can lead to similar effects. But even in cases of physical brain damage or the most chaotic upbringing, people have learned to manage their tempers. The trick is to focus on the strengths of the individual rather than the hypothetical weaknesses of an unseen group.

IED illustrates two of psychology’s most common sins. First, it promotes the illusion that labeling a thing is the same as understanding it. But much worse than that, this sort of diagnosis is patronizing in the extreme. It is an accusation of impotence against our own whims. If any shrink ever impugned my character in such a manner, I might think about punching him in the nose. But instead, I would walk away with my humanity intact – despite the best efforts of those who would make me a victim of my own mind.


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Gardner, R. M., Bird, F. L., Maguire, H., Carreiro, R., & Abeniam, N. (2003). Intensive positive behavior supports for adolescents with acquired brain injury. Journal of Head Trauma Rehabilitation, 18(1), 52-74.

Tanner, L. (2006). Study says millions have “rage” disorder. Retrieved June 8, 2006, from

Watson, C., Rutterford, D. S., Williamson, N., & Alderman, N. (2001). Reduction of chronic aggressive behaviour 10 years after brain injury. Brain Injury, 15(11), 1003-1015.