*DSM-5 Diagnosis * 312.34 (F63.81) Intermittent Explosive Disorder with underlying
Anti-social Personality Disorder Features, *Rule out possible Exhibitionism paraphilia* and *Psychopathy (Sociopathy)*

Purpose of Evaluation

Mr. Hulk is undergoing psychological evaluation for the purposes of placement and treatment planning within the Bureau of Prisons (BOP) after he was found sleeping semi-nude in public (again).

Psychological Diagnosis and Justification

A review of Mr. Hulk’s file reveals that he exhibits classic symptoms of Intermittent Explosive Disorder with underlying Anti Social Personality Traits. Request investigation to rule out possible Exhibitionistic Sexual Paraphilia Disorder.

The American Psychiatric Association (2013) defines Intermittent Explosive Disorder as “recurrent behavioral outbursts representing a failure to control aggressive impulses.” These outbursts appear as a verbal tirade and/or physical aggression. The outbursts are impulsive in nature and not premeditated. They are unpredictable and are disproportionate to the trigger or stressor. In order to qualify for a diagnosis, these outbursts must occur about twice a week for at least three months. Mr. Hulk clearly meets these criteria.

According to the American Psychiatric Association (2013) Antisocial personality disorder is an enduring pattern of personal experience and behavior deviating markedly from cultural expectations, is pervasive, enduring, and leads to personal distress or impairment. It is characterized by a pattern of disregard for and violation of the rights of others. Symptoms of antisocial personality disorder vary in severity and range from verbally abusive behavior to severe violence. Care should be taken to distinguish the anti-social behavior that Mr. Hulk exhibits from the psychopathic behavior exhibited by his colleague Magneto. Whereas Hulk’s violence is “affective” expressive, and emotionally driven, Magnetos violence is “instrumental,” calculated and goal driven. The difference can be understood by imagining a cat’s behavior in two different situations.

First, imagine the cat that has been cornered by the neighborhood dog. It’s hair is standing on end, it is caterwauling and hissing loudly and basically completely freaking out. If you go and try to pick up this cat when it is in this state, it will tear you apart- this is the anti-social Hulk’s effective violence. Now imagine the cat as it is hunting a wounded bird. It’s ears are back, its body low, moving controlled with stealth towards its prey with deadly purpose and focused intent. When it strikes, it it is lethal and the bird rarely sees it coming. This is the psychopathic Magneto’s violence. As far as ruling out a diagnosis of Exhibitionistic Disorder for Mr. Hulk, that is a tough one.

Paraphilias are behaviorally and cognitively defined. For instance, Exhibitionistic Disorder involves the behavioral exposure to a stranger or unsuspecting individual, accompanied by intense sexual arousal. Mr. Hulk certainly does exhibit the core *behavioral* criteria of Exhibitionistic Disorder in that he has repeatedly exposed his genitals in public to strangers and unsuspecting individuals.

What is less clear is whether or not Mr. Hulk is motivated to do so by an uncontrollable sexual urge that is deliberately intended for the unsuspecting and unconsenting individuals. Mr. Hulk maintains, that his semi-nude presentation is purely the result of him losing his temper, which he claims causes him to grow so large that he completely destroys his pants.

It should be noted that no witness has ever reported that Mr. Hulk displayed any sort of arousal during any of these reported incidents. Nevertheless, the frequency with which Mr. Hulk  has been cited for borderline public indecency is hard to ignore and should raise questions about the possibility of future sexual motives. A full assessment is recommended in order to determine the extent of Mr. Hulk’s level of Exhibitionistic Disorder.

Evaluation and diagnosis conducted by John Snyder, Psy.D. Psychotherapy in San Francisco. For more information, please contact Mr. Snyder at http://drjohnsnyder.net/