16 million Americans may fit the criteria for IED. Diagnosis DSM-5 diagnosis The current DSM-5 criteria for Intermittent Explosive Disorder 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 IED 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 Intermittent Explosive Disorder which was defined,