The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 07/2006; 63(6):669-78. DOI: 10.1001/archpsyc.63.6.669
Source: PubMed


Little is known about the epidemiology of intermittent explosive disorder (IED).
To present nationally representative data on the prevalence and correlates of DSM-IV IED.
The World Health Organization Composite International Diagnostic Interview was used to assess DSM-IV anxiety disorders, mood disorders, substance use disorders, and impulse control disorders.
The National Comorbidity Survey Replication, a face-to-face household survey carried out in 2001-2003.
A nationally representative sample of 9282 people 18 years and older.
Diagnoses of DSM-IV IED.
Lifetime and 12-month prevalence estimates of DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks resulting in 1359 dollars in property damage. Intermittent explosive disorder-related injuries occurred 180 times per 100 lifetime cases. Mean age at onset was 14 years. Sociodemographic correlates were uniformly weak. Intermittent explosive disorder was significantly comorbid with most DSM-IV mood, anxiety, and substance disorders. Although the majority of people with IED (60.3%) obtained professional treatment for emotional or substance problems at some time in their life, only 28.8% ever received treatment for their anger, while only 11.7% of 12-month cases received treatment for their anger in the 12 months before interview.
Intermittent explosive disorder is a much more common condition than previously recognized. The early age at onset, significant associations with comorbid mental disorders that have later ages at onset, and low proportion of cases in treatment all make IED a promising target for early detection, outreach, and treatment.

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    • "However, only, experimental studies examining aggressive responding in the laboratory, with and without pretreatment with antiinflammatory agents, can shed light on whether IL-1β or other inflammatory cytokines are related to aggressive behavior in any meaningful causal fashion. Given that a disorder of aggression, intermittent explosive disorder displays, a 2% to 3% 1-year prevalence rate in the US (Kessler et al., 2006), and that currently available psychotropic treatments bring <50% of those treated into remission (Coccaro et a., 2009), additional strategies for the examination and intervention of aggression in human subjects is needed. "
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    ABSTRACT: Background. Neurochemical studies have pointed to a modulatory role in human aggression for a variety of central neurotransmitters and neuromodulators such as cytokines. While animal studies of cytokines suggest an aggression facilitating role for central cytokines, especially for IL-1β and other cytokines, no cerebrospinal fluid (CSF) studies of cytokines have yet been reported in regard to human aggression. Methods. Basal lumbar CSF samples were obtained from 38 physically healthy subjects with DSM-5 Personality Disorder (PD) and assayed for CSF Interleukin-6 (log IL-6) and CSF soluble IL-1 Receptor II (sIL-1RII) protein in the context of their relationship with measures of aggression. Results. CSF sIL-1RII (r = .35, r(2) = .12, p = .03), but not log IL-6 (r = -.05, r(2) = .00, p = .76), levels were positively correlated with a composite measure of aggression. Adding relevant covariates, including CSF levels of serotonin and dopamine metabolites, to the statistical model doubled the strength of this relationship (partial r = .54, r(2) = .29, p = .002). No relationship was seen with history of suicidal behavior or with any measure of impulsivity, negative affectivity, or of general dimensions of personality. Conclusion. These data suggest a positive relationship between at least one inflammatory cytokine in the central nervous system and aggression in human subjects. This finding adds to the complex picture of the central neurochemistry of impulsive aggression in human subjects. © The Author 2014. Published by Oxford University Press on behalf of CINP.
    The International Journal of Neuropsychopharmacology 02/2015; 18(7). DOI:10.1093/ijnp/pyv001 · 4.01 Impact Factor
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    • "Assaultive behavior and destruction of property among adolescents have been found to be associated with substance use [2] [3] [4], poor academic performance, smoking, earlier age at first sexual intercourse, and risky sexual behavior [5]. Previous research on aggression and specifically intermittent explosive disorder (IED), has noted the both types of physical aggression are common, suggesting that it is suitable to collapse general discussions of physical aggression across the two [6] [7] [8]. "
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    ABSTRACT: Objective Assaultive behaviors are common among young people and have been associated with a range of other unhealthy, impulsive behaviors such as substance use and problem gambling. This study sought to determine the predictive ability of single assaultive incidents for impulse control disorders, an association that has yet to be examined, especially in young adults Methods The authors conducted a university-wide email survey in the spring of 2011 on 6000 University students. The survey examined assaultive behavior and associated mental health variables (using a clinically validated screening instrument, the Minnesota Impulsive Disorders Interview), stress and mood states, and psychosocial functioning. Results The rate of response was 35.1% (n = 2108). 109 (5.9%) participants reported that they had assaulted another person or destroyed property at some time in their lives. Compared with respondents without lifetime assaultive behavior, those with a history of assaultive or destructive behavior reported more depressive symptoms, more stress, and higher rates of a range of impulse control disorders (intermittent explosive disorder, compulsive sexual behavior, compulsive buying, and skin picking disorder). Conclusions Assaultive behavior appears fairly common among college students and is associated with symptoms of depression and impulse control disorders. Significant distress and diminished behavioral control suggest that assaultive behaviors may often be associated with significant morbidity. Additional research is needed to develop specific prevention and treatment strategies for young adults attending college who report problems with assaultive behaviors.
    Comprehensive Psychiatry 11/2014; 55(8). DOI:10.1016/j.comppsych.2014.07.012 · 2.25 Impact Factor
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    • "Respondents who report at least two of these symptoms at least some of the time in the past six months then receive an additional eight questions shown in a number of previous studies to detect adult ADHD with good accuracy (Kessler et al., 2007; Kessler et al., 2010a; Kessler et al., 2009). The CIDI-SC intermittent explosive disorder (IED) scale includes one entry question about lifetime attacks of anger when the respondent all of a sudden … lost control and either broke or smashed something worth more than a few dollars, hit or tried to hurt someone, or threatened someone (Kessler et al., 2006b). A positive response is followed by six additional questions that assess the remaining DSM-IV inclusion criteria of IED. "
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    ABSTRACT: A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) and post-traumatic stress disorder (PTSD) checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; six-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n = 460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (area under curve [AUC] = 0.69-0.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = 0.80-0.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Methods in Psychiatric Research 12/2013; 22(4):303-21. DOI:10.1002/mpr.1398 · 3.76 Impact Factor
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