INABILITY TO CONTROL RECURRING AGGRESSIVE IMPULSES: PSYCHOLOGICAL MANAGEMENT. A CASE REPORT

Abstract

Background: Intermittent explosive disorder is recurrent behavioral outburst with failure to control aggressive impulses. A case of intermittent explosive disorder with differential diagnosis of Adjustment disorder and Borderline Personality traits. Mental Status Examination reflected guilt, regret and distress due to inability to control anger followed by aggressive action. Millon Clinical Multiaxial Inventory III (MCMI-III) and Rorschach Ink Blot Test were used for psychological evaluation. Assessments results indicates traits of lower stress tolerance, feels uncomfortable about her ability to deal adequately with negative feelings and often have problems modulating her own affective displays and impulsive. Methodology: A re-educative approach of treatment was planned with short term goals to increase awareness of anger, avoidance and escape, managing physical arousal, relaxation skill development. The long term goals were focused on cognitive restructuring, assertive training, self-instructional and self-regulation training. Treatment Outcome: After psychological management, patient reported more satisfied and better aware of physiological arousal when angry, use distraction technique when required and regulate anger. There was improvement in daily functioning, coping and problem solving and in relationship with his parents and peer. Future plan is focused on providing Neurofeedback training to enhance her self-regulation. Implication and Recommendation: In cases like Intermitted explosive disorder and other conditions of Impulse control disorder, along with psychotherapy or pharmacotherapy, effect of neurofeedback training could be explored.