Differential Diagnosis
A diagnosis of intermittent ex plosive disorder shou ld not be made when Criteria A1 and/
or A2 are only met during an  episode of another mental disorder (e.g., major depressive
disorder, bipolar disorder, psychotic disorder ), or when impulsive aggressive outbursts
are attributable to another me dical condition or to the physio logical effects of a substance
or medication. This diagnosis also should not be made, particularly in children and ado-
lescents ages 6–18 years, when the impulsive aggressive outbursts occur in the context of
an adjustment disorder. Other examples in which recurrent, proble matic, impulsive ag-
gressive outbursts may, or may not, be diag nosed as intermittent explosive disorder in-
clude the following. 
Disruptive mood dysregulation disorder. In contrast to intermittent explosive disorder,
disruptive mood dysregulation disorder is charac terized by a persistently  negative mood state
(i.e., irritability, anger) most of the day, nearly every day, between impulsive aggressive out-
bursts. A diagnosis of disruptive mood dysregul ation disorder can only be given when the on-
set of recurrent, problematic, impulsive aggressive outbursts is before age 10 years. Finally, a
diagnosis of disruptive mood dysregulation di sorder should not be made for the first time
after age 18 years. Otherwise, these diagnoses are mutually exclusive. 
Antisocial personality disorder or  borderline personality disorder. Individuals with an-
tisocial personality disorder or borderline personality disorder often display recurrent,
problematic impulsive aggressive outbursts. However, the level of impulsive aggression
in individuals with antisocial personality di sorder or borderline personality disorder is
lower than that in individuals with  intermittent explosive disorder.