Question

A 35-year-old woman presents to your office with her husband. He tells you that she has experienced discrete episodes of physical and verbal aggression directed toward other people and property for the past year. Her husband states that the aggressiveness is not precipitated by any particular trigger and is completely unpredictable and intermittent. In between these bouts of aggression, the patient is otherwise fine and leads a normal life as a wife and mother. The most plausible diagnosis is:

A. Borderline personality disorder
B. Intermittent explosive disorder
C. Antisocial personality disorder
D. Psychotic disorder due to temporal lobe seizures
E. Bipolar I disorder, with manic and psychotic episodes

Answer 1

The most plausible diagnosis for a woman with unpredictable and intermittent aggression, living a normal life in between episodes, is likely Intermittent Explosive Disorder (IED), not the other listed disorders.

Step-by-step explanation:

A 35-year-old woman experiencing discrete episodes of aggression without specific triggers, and leading an otherwise normal life, may be most appropriately diagnosed with Intermittent Explosive Disorder (IED). This condition is characterized by sudden episodes of unwarranted anger and aggression, which are not explained by other mental disorders. In contrast, Borderline Personality Disorder (BPD) is typified by an instability of identity, mood, and behavior and has been argued to be overdiagnosed in women, carrying a stigmatizing connotation. Antisocial Personality Disorder generally involves a broader pattern of disregard for and violation of the rights of others, without the intermittent nature described. Psychotic disorder due to temporal lobe seizures would involve additional symptoms such as altered consciousness or motor symptoms, and Bipolar I disorder typically includes periods of mania that are more sustained than the episodes described in this case.