Intermittent explosive disorder: Development of integrated research criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL 60637, USA.
Comprehensive psychiatry (Impact Factor: 2.25). 03/2011; 52(2):119-25. DOI: 10.1016/j.comppsych.2010.05.006
Source: PubMed


This study was designed to develop a revised diagnostic criteria set for intermittent explosive disorder (IED) for consideration for inclusion in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This revised criteria set was developed by integrating previous research criteria with elements from the current DSM-IV set of diagnostic criteria. Evidence supporting the reliability and validity of IED-IR ("IED Integrated Criteria") in a new and well-characterized group of subjects with personality disorder is presented. Clinical, phenomenologic, and diagnostic data from 201 individuals with personality disorder were reviewed. All IED diagnoses were assigned using a best-estimate process (eg, kappa for IED-IR >0.85). In addition, subjects meeting IED-IR criteria had higher scores on dimensional measures of aggression and had lower global functioning scores than non-IED-IR subjects, even when related variables were controlled. The IED-IR criteria were more sensitive than the DSM-IV criteria only in identifying subjects with significant impulsive-aggressive behavior by a factor of 16. We conclude that the IED-IR criteria can be reliably applied and have sufficient validity to warrant consideration as DSM-V criteria for IED.

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    • "Axis I and Axis II personality disorder diagnoses were made according to DSM-IV criteria (APA, 1994). The diagnosis of alcoholism was made by modified research criteria (see Coccaro et al. 1989) and intermittent explosive disorder (IED) was made by integrated research criteria (Coccaro, 2011). All diagnoses were made using information from : (a) semi-structured interviews conducted by trained masters or doctoral level clinicians using the Structured Clinical Interview for DSM Diagnoses (First et al. 1997) for Axis I disorders and the Structured Interview for the Diagnosis of DSM-IV Personality Disorder (Pfohl et al. 1997) for Axis II disorders ; (b) clinical interview by a research psychiatrist ; (c) review of all other available clinical data. "
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    • "I and Axis II Personality Disorder diagnoses were made according to DSM-IV criteria (American Psychiatric Association, 1994). The diagnosis of Intermittent Explosive Disorder was made by Research Criteria as previously described (Coccaro, 2011). Diagnoses were made using information from: (a) the Structured Clinical Interview for DSM Diagnoses (SCID-I; First et al., 1996) for Axis I disorders and the Structured Interview for the Diagnosis of DSM Personality Disorder [SIDP-IV; Pfohl et al., 1997) for Axis II disorders; (b) clinical interview by a research psychiatrist; and, (c) review of all other available clinical data. "
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