A family history study of intermittent explosive disorder

Clinical Neuroscience and Psychopharmacology Research Unit, Department of Psychiatry and Behavioral Neuroscience, The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA. .
Journal of Psychiatric Research (Impact Factor: 4.09). 11/2010; 44(15):1101-5. DOI: 10.1016/j.jpsychires.2010.04.006
Source: PubMed

ABSTRACT Intermittent Explosive Disorder (IED) is newly appreciated as a commonly occurring disorder of impulsive aggression. Since aggression and impulsivity are under genetic influence, IED may be familial.
Blinded and controlled family history study of IED and co-morbid conditions in an outpatient clinical research center for impulsive aggression. The subjects were first-degree relatives of individuals who did and did not meet criteria for IED by DSM-IV and Research Criteria.
Elevated Morbid Risk of IED was observed in relatives of IED Probands compared with relatives of Non-IED Probands. This familial signal of IED was not affected by comorbidity in the IED Probands of comorbidity in the relatives of the IED Probands.
IED, as defined by research criteria, appears to be familial and may not be an artifact of other co-morbid conditions.

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    ABSTRACT: Intermittent explosive disorder (IED) in DSM-5 represents a disorder of recurrent, problematic, reactive (i.e., affective or impulsive), aggressive behavior that, over the lifetime, affects about 5–6% of individuals in the United States. While aggression is also observed in those with psychopathic personality, aggression in this context is frequently proactive rather than reactive, and neurobiological study suggests important differences between those with proactive aggression/psychopathy and those with reactive aggression. In this paper, we conducted two sets of analyses. First, a phenomenologic study to explore the frequency of psychopathic personality defined by the Psychopathology Checklist-Screening Version (PCL-SV) among IED and comparator participants and to explore differences in measures of aggression, anger, and impulsivity as a function of IED and psychopathic personality. Second, we re-analyzed data from five published studies to determine if psychopathic personality accounted for differences between IED and comparator participants. The first study found that only a modest proportion of IED participants display clinically substantial features of psychopathy and that measures of trait aggression and anger, rather than those of psychopathy, are the strongest correlates of IED. The second study found little evidence for any impact of psychopathy on reported findings in IED compared with various control participants. Aggr. Behav. 9999:XX–XX, 2014. © 2014 Wiley Periodicals, Inc.
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    ABSTRACT: CONTEXT Epidemiologic studies of adults show that DSM-IV intermittent explosive disorder (IED) is a highly prevalent and seriously impairing disorder. Although retrospective reports in these studies suggest that IED typically begins in childhood, no previous epidemiologic research has directly examined the prevalence or correlates of IED among youth. OBJECTIVE To present epidemiologic data on the prevalence and correlates of IED among US adolescents in the National Comorbidity Survey Replication Adolescent Supplement. DESIGN United States survey of adolescent (age, 13-17 years) DSM-IV anxiety, mood, behavior, and substance disorders. SETTING Dual-frame household-school samples. PARTICIPANTS A total of 6483 adolescents (interviews) and parents (questionnaires). MAIN OUTCOME MEASURES The DSM-IV disorders were assessed with the World Health Organization Composite International Diagnostic Interview (CIDI). RESULTS Nearly two-thirds of adolescents (63.3%) reported lifetime anger attacks that involved destroying property, threatening violence, or engaging in violence. Of these, 7.8% met DSM-IV/CIDI criteria for lifetime IED. Intermittent explosive disorder had an early age at onset (mean age, 12.0 years) and was highly persistent, as indicated by 80.1% of lifetime cases (6.2% of all respondents) meeting 12-month criteria for IED. Injuries related to IED requiring medical attention reportedly occurred 52.5 times per 100 lifetime cases. In addition, IED was significantly comorbid with a wide range of DSM-IV/CIDI mood, anxiety, and substance disorders, with 63.9% of lifetime cases meeting criteria for another such disorder. Although more than one-third (37.8%) of adolescents with 12-month IED received treatment for emotional problems in the year before the interview, only 6.5% of respondents with 12-month IED were treated specifically for anger. CONCLUSIONS Intermittent explosive disorder is a highly prevalent, persistent, and seriously impairing adolescent mental disorder that is both understudied and undertreated. Research is needed to uncover risk and protective factors for the disorder, develop strategies for screening and early detection, and identify effective treatments.
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    ABSTRACT: A disorder of impulsive aggression has been in the Diagnostic and Statistical Manual for Mental Disorders (DSM) since the first edition. In DSM-III, this disorder was codified as Intermittent Explosive Disorder (IED) and was thought to be rare. However, DSM criteria for IED were poorly operationalized and empiric research in IED was limited until the past decade when research criteria were developed. Subsequently, renewed interest in disorders of impulsive aggression led to a recent series of community based studies that have now documented IED to be as common as many other psychiatric disorders. Recent research indicates that the core of IED (A criteria) can be captured with new criteria that identify high frequency/low intensity aggressive outbursts (A1) and low frequency/hi intensity outbursts (A2). This paper presents new data regarding the phenomenology, comorbidity/life course of IED as a function of A1 and A2 criteria. Together with reanalysis of previously published data regarding family history, biomarkers, and treatment response in individuals with recurrent, problematic, impulsive aggression, these data provide empirical support for both A1 and A2 criteria for DSM-5 IED.
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