Conduct Disorder 469
Delirium, major neurocognitive disorder, an d personality change due to another med-
ical condition, aggressive type. A diagnosis of intermittent ex plosive disorder should not
be made when aggressive outbur sts are judged to result from the physiological effects of an-
other diagnosable medical condition (e.g., brain in jury associated with a change in personality
characterized by aggressive outbursts; comple x partial epilepsy). Nonspecific abnormalities
on neurological examination (e.g., “soft signs”) and nonspecific electroencephalographic
changes are compatible with a diagnosis of interm ittent explosive disorder  unless there is a di-
agnosable medical condition that better expl ains the impulsive aggressive outbursts. 
Substance intoxication or substance withdrawal. A diagnosis of inte rmittent explosive
disorder should not be made when impulsive aggressive outbursts are nearly always as-
sociated with intoxicati on with or withdrawal from substa nces (e.g., alcohol, phencyclidine,
cocaine and other stimulants, barbiturates, inhalants). However, when  a sufficient number
of impulsive aggressive outbur sts also occur  in the absence of substance intoxication or
withdrawal, and these warrant in dependent clinical attention,  a diagnosis of intermittent
explosive disorder may be given. 
Attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disor-
der, or autism spectrum disorder. Individuals with any of these childhood-onset dis-
orders may exhibit impulsive aggressive outbursts. Individu als with ADHD are typically
impulsive and, as a result, may also exhibit impulsive aggressive outbursts. While indi-
viduals with conduct disorder can exhibit impulsive aggressive outbur sts, the form of ag-