Other big difference, which is highlighted in other card, is childhood vs. adult. Feel like this could go in extra but relatively indifferent
I don’t know if you’re saying that IED is an “adult” diagnosis? Both IED and DMDD can be diagnosed in childhood, although DMDD is only diagnosed in childhood
Which I think makes it all the more important to add this defining characteristic (remorse) to the question stem.
If I told you I was thinking of a disorder that is charcterized by “recurrent behavioral outbursts that are unplanned and out of proportion to the provocation,” and asked you to tell me if it was DMDD or IED, I don’t know if you’d be able to just from that information, espcially in light of the DSM-5’s definitions of the two disorders below:
DMDD: “Severe outbursts of anger (verbal or behavioral) lasting for ≥ 12 months (without interruption for ≥ 3 consecutive months) on average ≥ 3 times/week that are grossly disproportionate in intensity or duration to the situation and the child’s developmental level”… age criteria, etc.
IED: “Sudden aggressive outbursts (verbal or physical) grossly disproportionate to the triggering stressor”… ≥ 2 times/week, etc., significant distress, remorse, etc.
@AnKing-Maintainers no love for this change?
Maybe its just me but I just feel like the right way to decipher them is their “baseline mood” As stated in the extra of nid:1484686725827
What if it was more like:
{{c1::Intermittent explosive disorder }} is characterized by recurrent behavioral outbursts that are unplanned and out of proportion to the provocation, in addition to significant distress / impairing psychosocial functioning outside of outbursts
Or
significant distress / remorse
It would seem there is never remorse or any level of concern in DMDD (b/c they’re always baseline irritated)
I think since it is getting a bit long, we turn it into a question style card
Which psychiatric disorder is characterized by recurrent behavioral outbursts that are unplanned and out of proportion to the provocation, usually resulting in feelings of remorse and regret?
{{c1::Intermittent explosive disorder}}
I think if we change this one’s format we should change the DMDD card too (which I’d support)
I was also under the impression that baseline mood is a major difference between DMDD and IED.
DSM-5TR says this about DMDD under the Differential Diagnosis for IED: “In contrast to intermittent explosive disorder, disruptive mood dysregulation disorder is characterized by a persistently negative mood state (i.e., irritability, anger) most of the day, nearly every day, between impulsive aggressive outbursts. A diagnosis of disruptive mood dysregulation disorder can only be given when the onset of recurrent, problematic, impulsive aggressive outbursts is before age 10 years. Finally, a diagnosis of disruptive mood dysregulation disorder should not be made for the first time after age 18 years. Otherwise, these diagnoses are mutually exclusive.”
Also age at onset > 18 y/o rules out DMDD.
All true. Thanks for that deep dive! I think the issue is that, as the card currently is, there’s not enough to differentiate it between DMDD and IED (there’s no mention of patient age, age of onset, or baseline characteristics during the day/between outbursts). Are you suggestion we add something regarding those characteristics instead of including something about remorse following outbursts?
I think so:
I don’t like “significant distress / impairing psychosocial functioning outside of outbursts” because it sounds very similar to the “trouble functioning due to irritability in various situations” described in DMDD.
I like the addition of “…, typically resulting in feelings of remorse” because it implies a return to baseline mood (remorseful, AKA no longer irritable) and is distinct from DMDD, where the individual remains in a state of anger/irritability between outbursts, lacking remorse.
However, since this doesn’t seem to have support, we could implement @DillingerMed’s suggestion to highlight the fact that “baseline mood is a major difference between DMDD and IED” and say something like:
{{c1::Intermittent explosive disorder}} is characterized by recurrent behavioral outbursts that are unplanned and out of proportion to the provocation, with return to normal mood between outbursts
or to @herstein.jacob’s point about age:
{{c1::Intermittent explosive disorder}} is characterized by recurrent behavioral outbursts that are unplanned and out of proportion to the provocation, and may be diagnosed in both childhood and adulthood
?
Would focus on:
- Possibility of physical outbursts (DMDD is classically temper/behavior, but IED will often include stuff like punching walls or breaking things)
- Return to normal mood
I like this the best, but your other suggestions also work.
I think saying “…return to normal mood (typically including remorse) between outbursts” is one option. Another option is adding a bullet in Extra saying “- Typically includes remorse for actions afterwards”. Not sure how to include physical outbursts of IED vs DMDD in a concise way without adding another bullet.
@AnKing-Maintainers - Just came across this card and had the same problem, agree that it needs a major determiner to be able to differentiate it from DMDD - think we should focus on baseline mood as that is the main thing that differentiates them (not onset of diagnosis), possibly changing it to
“{{c1::Intermittent explosive disorder}} is characterized by recurrent behavioral outbursts that are unplanned and out of proportion to the provocation, with feelings of remorse and regret after outbursts occur”
Also think we should add DMDD in extra - e.g., “compared to DMDD which presents with persistently irritable and angry moods in between outbursts”
It definitely needs some sort of change. As you can see it was hard to find a consensus 
. Might be worth scrapping this one and starting with a fresh suggestion