Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Intermittent Explosive Disorder


Related Terms

  • Aggressive Personality Disorder
  • Anger Attacks
  • Episodic Dyscontrol
  • Impulse Control Disorder
  • Rage Attacks

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Neurologist
  • Psychiatrist

Comorbid Conditions

  • Attention-deficit/hyperactivity disorder
  • Depression
  • Impulse control disorders (e.g., pathological gambling, kleptomania, pyromania, trichotillomania)
  • Substance abuse (alcohol or drugs)

Factors Influencing Duration

Presence of underlying conditions (such as another mental disorder), type and quality of treatment, compliance with recommended treatment, and extent of condition may influence the length of disability.

Medical Codes

ICD-9-CM:
312.34 - Disorders of Impulse Control, Not Elsewhere Classified; Intermittent Explosive Disorder

Overview

Intermittent explosive disorder was first recognized as a mental disorder by the American Psychiatric Association in 1980. The condition is categorized as an impulse-control disorder by the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The disorder's primary feature is recurrent failure to resist an impulse, drive, or temptation to perform acts that are harmful to the individual or others. The aggressive response is grossly out of proportion to any provocation or precipitating psychosocial stressors, and it cannot be accounted for by other medical, psychiatric, or substance-related disorders.

Aggressive episodes frequently result in physical or verbal assaults or property destruction (for example, road rage). The individual may report feeling tension prior to the episode, immediately followed by relief, and then feelings of remorse, regret, or embarrassment. This disorder may lead to occupational and relationship difficulties, accidents, hospitalizations, financial problems, or legal problems.

Intermittent explosive disorder may begin abruptly with usual age of onset from childhood to the early 20s. When aggressive episodes appear suddenly in older individuals, they are often accounted for by neurological disorders. A very high percentage of individuals with intermittent explosive disorder also have a mental disorder. Substance abuse including alcohol is often associated with this disorder, and can significantly hamper treatment.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Intermittent explosive disorder is more common in men than women, and may be more common among first-degree relatives of individuals with this disorder. Some women with the disorder have reported an increase in intermittent explosive symptoms before their menstrual cycle.

Source: Medical Disability Advisor



Diagnosis

History: The individual may give a childhood history of severe temper tantrums, impaired attention, hyperactivity, and other behavioral difficulties such as stealing or fire-setting. They often report repeated episodes of rage and destruction, despite being severely punished for earlier episodes. The individual may report irritability, increased energy, or racing thoughts during the aggressive impulses and acts, and rapid onset of fatigue and depression afterward. After the episode concludes, the individual may report feeling remorse, shame, or embarrassment.

The aggressive episodes may be preceded with tingling, tremor, the feeling of a very fast heart rate (palpitations), chest tightness, head pressure, or hearing an echo. Individuals may also report having aggressive impulses that they resisted or acted out in a less assaultive way such as hitting a wall.

Physical exam: History is more important than physical examination in diagnosing intermittent explosive disorder. The physical examination may reveal signs of tension or anxiety such as pacing or clenched jaws or fists. Bruises or abrasions may occur if the individual has recently had a fight as a result of aggressive impulses. Otherwise, physical examination is used to eliminate other possible causes of the rage episodes.

Tests: There are no specific diagnostic tests but nonspecific changes may be noted in brain wave patterns (electroencephalogram, EEG), neurological measurements of the visual system (visual evoked potentials), or altered serotonin metabolism. A brain magnetic resonance imaging (MRI) or computed tomography (CT) scan may help eliminate neurologic disorders as a cause of aggression.

Psychological evaluation tools such as the Minnesota Impulsive Disorders Interview, the Minnesota Multiphasic Personality Inventory, and facial-emotion recognition tasks may reveal difficulty with impulse control.

Source: Medical Disability Advisor



Treatment

The treatment goal is to decrease or end the destructive episodes. Group and individual psychotherapy and pharmacotherapy are treatments of choice in various combinations. Self-help and anger-management groups may also be useful. Pharmacotherapy utilizes anti-anxiety agents and antidepressants to reduce symptoms of anxiety and depression. Tricyclic antidepressants, serotonin reuptake inhibitors, and mood stabilizers are often effective in controlling the explosive episodes.

Behavioral interventions play an important role in treatment. Group therapy may be effective, especially when individuals in the group have experienced similar disorders. Group therapy may help the individual identify, understand, and deal with underlying problems that result in aggressive behavior. Group situations can also help the individual learn how to improve interpersonal relationships and find more appropriate ways of expressing feelings.

Source: Medical Disability Advisor



Prognosis

There is little data on the course of this disorder. Some individuals have a chronic course and others a more episodic course. Many individuals experience some decrease in symptoms or a change in fixed patterns of thoughts, feelings, or behaviors that are causing difficulty over a period of time or after receiving treatment. Studies suggest that serotonin reuptake inhibitors and mood stabilizers help reduce aggressive impulses and explosive acts. Prognosis is often complicated by the presence of comorbid mental disorders. Some individuals respond to treatment and are able to learn to control their aggressive impulses. Individuals who are able to develop supportive relationships and make use of self-help groups are more likely to experience continued improvement in social and occupational functioning.

Source: Medical Disability Advisor



Complications

This disorder often results in repeated loss of employment, damage to personal relationships, divorce, social isolation, accidental injury, legal entanglements, or prison confinement. Assaultive behavior poses an increased risk of premature death from suicide, accident, or homicide.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Tolerance for explosive rage is minimal in the workplace, particularly in light of concern for the safety of coworkers. Frequency of episodes has a direct bearing on employability. Job accommodations, when possible, should include a quiet, predictable low stress environment. Work should be completed independent of reliance on coworkers. Provisions may be needed for flexible breaks to control stress and anger levels. Flexibility may also be needed in work schedule for individual to contact support system and attend treatment programs and meetings with the employer, supervisor, and job coach to explore sources of tension on the job, and to discuss any solutions or other accommodations.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual's condition fit the criteria for intermittent explosive disorder?
  • Has diagnosis been confirmed? Are symptoms better accounted for by a different diagnosis?
  • Have psychological and medical disorders with similar symptoms been ruled out?

Regarding treatment:

  • If individual is not responding effectively to current medication, what other drug options are available?
  • Is individual currently involved in appropriate individual or group therapy?
  • Does therapy help individual identify, understand, and deal with underlying problems that result in aggressive behavior?
  • Is individual learning how to improve interpersonal relationships and find more appropriate ways of expressing feelings?
  • Would individual benefit from enrollment in a self-help or anger-management group?
  • Are comorbid conditions being treated?

Regarding prognosis:

  • Does individual have an underlying condition, such as substance abuse, that may impact recovery?
  • Have underlying psychiatric conditions that tend to worsen prognosis been identified and treated appropriately?
  • Has individual been involved in the current form of treatment for more than 6 weeks without a noticeable effect?
  • Should treatment plan be reassessed?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Source: Medical Disability Advisor






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