DSM-5 diagnosis The current DSM-5 criteria for<unk>  include: * Recurrent outbursts that demonstrate an inability to control impulses, including either of the following: * Verbal aggression (tantrums, verbal arguments, or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to the destruction of property or physical injury (Criterion A1) * Three outbursts that involve injury or destruction within a year-long period (Criterion A2) * Aggressive behavior is grossly disproportionate to the magnitude of the psychosocial stressors (Criterion B) * The outbursts are not premeditated and serve no premeditated purpose (Criterion C) * The outbursts cause distress or impairment of functioning or lead to financial or legal consequences (Criterion D) * The individual must be at least six years old (Criterion E) * The recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use (Criterion F) It is important to note that DSM-5 now includes two separate criteria for types of aggressive outbursts (A1 and A2) which have empirical support: * Criterion A1: Episodes of verbal and/or non-damaging, nondestructive, or non-injurious physical assault that occur, on average, twice weekly for three months. These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage. This criterion includes high frequency/low-intensity outbursts. * Criterion A2: More severe destructive/assaultive episodes which are more infrequent and occur, on average, three times within a twelve-month period. These could be destroying an object without regard to value, assaulting an animal or individual. This criterion includes high-intensity/low-frequency outbursts. DSM-IV diagnosis The past DSM-IV criteria for<unk>  were similar to the current criteria, however, verbal aggression was not considered as part of the diagnostic criteria. The DSM-IV diagnosis was characterized by the occurrence of discrete episodes of failure to resist aggressive impulses that result in violent assault or destruction of property. Additionally, the degree of aggressiveness expressed during an episode should be grossly disproportionate to provocation or precipitating psychosocial stressor, and, as previously stated, diagnosis is made when certain other mental disorders have been ruled out, e.g., a head injury, Alzheimer's disease, etc., or due to substance use or medication. Diagnosis is made using a psychiatric interview to affective and behavioral symptoms to the criteria listed in the DSM-IV. The DSM-IV-TR was very specific in its definition of<unk>  which was defined, essentially, by the exclusion of other conditions. The diagnosis required: # several episodes of impulsive behavior that result in serious damage to either persons or property, wherein # the degree of the aggressiveness is grossly disproportionate to the circumstances or provocation, and # the episodic violence cannot be better accounted for by another mental or physical medical condition. Differential diagnosis Many psychiatric disorders and some substance use disorders are associated with increased aggression and are frequently comorbid with<unk> , often making differential diagnosis difficult. Individuals with<unk>  are, on average, four times more likely to develop depression or anxiety disorders, and three times more likely to develop substance use disorders. Bipolar disorder has been linked to increased agitation and aggressive behavior in some individuals, but for these individuals, aggressiveness is limited to manic and/or depressive episodes, whereas individuals with<unk>  experience aggressive behavior even during periods with a neutral or positive mood. In one clinical study, the two disorders co-occurred 60% of the time. Patients report manic-like symptoms occurring just before outbursts and continuing throughout. According to a study, the average onset age of<unk>  was around five years earlier than the onset age of bipolar disorder, indicating a possible correlation between the two. Similarly, alcohol and other substance use disorders may exhibit increased aggressiveness, but unless this aggression is experienced outside of periods of acute intoxication and withdrawal, no diagnosis of<unk>  is given. For chronic disorders, such as PTSD, it is important to assess whether the level of aggression met<unk>  criteria before the development of another disorder. In antisocial personality disorder, interpersonal aggression is usually instrumental in nature (i.e., motivated by tangible rewards), whereas<unk>  is more of an impulsive, unpremeditated reaction to situational stress.
Intermittent explosive disorder
Transference neurosis
Psychopathy
Externalizing disorder
Internalizing disorder
Dissociative disorder
Gemütlose psychopathy
Other specified dissociative disorder