Emil F Coccaro

University of Chicago | UC · Department of Psychiatry and Behavioral Neuroscience

Intermittent Explosive Disorder (IED) is a common, chronic, and impairing psychological condition characterized by recurrent, affective aggressive behavior. IED is associated with a host of cognitive and affective symptoms not included in the diagnostic criteria which may be a valuable indicator of heterogeneity in IED-such information can be usefu...

Introduction Consumption of fast food has been linked to psychiatric distress, violent behaviors, and impulsivity in adolescents. The relationship between eating fast food, anger, and impulsivity has not been widely investigated. The National Consortium on Alcohol and Neurodevelopment in Adolescence community-based cohort consists of 831 youth, hal...

Black Americans are arrested at disproportionate levels compared with White Americans. We sought to understand whether the association between psychopathology and arrest record is equally strong for Black Americans and White Americans, hypothesizing that the association would be stronger for Black Americans. In a sample of adults (age: M = 34.81 ye...

Introduction: The modified Taylor Aggression Paradigm (TAP) has been used to study impulsive aggression in experimental designs and has been relatively successful in addressing critiques of aggression paradigms; however, little has been done to examine the potential of using the TAP as a direct measure of aggression. This study aimed to explore the...

Background: Intermittent Explosive Disorder (IED) is a disorder primarily of aggression, defined by recurrent behavioral outbursts out of proportion to provocations or stressors. IED first appears in childhood and adolescence. This study examines the underlying childhood environment of those with IED, particularly familial and school-related facto...

A growing body of work suggests that individuals with aggressive behavior and/or aggressive tendencies have evidence of chronic, low level, inflammation as manifested by elevated circulating levels of acute phase reactant proteins and pro-inflammatory cytokines. While animal studies report that direct application of pro-inflammatory proteins in bra...

Background: The role of the hypothalamic-pituitary-adrenal (HPA) axis in human aggressive behavior is poorly characterized, though some studies report that, unlike depression, circulating or salivary levels of cortisol are low compared with controls. Methods: In this study, we collected three salivary cortisol levels (two in the morning and one...

A Lifetime History of Experienced Aggression and a Lifetime History of Witnessed Aggression assessment was developed and its psychometric properties examined in a modest sample of individuals with and without history of psychopathology. Following this, the two assessments were administered to 400 subjects with or without histories of major psychiat...

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20-55 years completed...

Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well‐being of affected individuals. While aggression and impulsivity have been examined in relation to mTBI, little work has been done to evaluate the relationship between history of mTBI and personality disorder (PD). The authors examined the associations...

How we perceive and interpret signals from others’ behavior, known as social-emotional information processing (SEIP), is key when responding to social threat. Impulsively aggressive individuals, behaviorally, demonstrate impaired SEIP for encoding relevant social stimuli, attribution of intent of the other person in the interaction, and responding...

Aim One potential barrier for people with diabetes to reach glycemic goals is diabetes distress. Accumulating evidence suggests diabetes distress may be linked to individuals’ emotion regulation capacities. Thus, we conducted two studies to elucidate a model for how emotion regulation impacts diabetes distress and A1c levels and determine prelimina...

Evidence of chronic, systemic, low levels of inflammation is present in several stress-related psychiatric conditions including schizophrenia, depression, and intermittent explosive disorder (IED). We analyzed leukocyte gene expression (mRNA) to quantify the activity of pro and anti-inflammatory signaling pathways. Work performed in non-aggressive...

Background Caffeine, alcohol, and nicotine are the three most commonly used psychoactive substances in the world. Given the known propensity of these substances to influence behavior, the relationship between these substances and aggressive and impulsive behaviors, in particular is of interest. Methods 1062 adult individuals participated in this s...

Background : Individuals with intermittent explosive disorder (IED) are reported to exhibit amygdala (AMYG) hyper-activation to anger faces during functional magnetic resonance imaging (fMRI). However, it remains unknown if emotional experience is different in study participants with IED compared with healthy controls (HC). Thus, we examined the co...

Background While prior research has linked clinical sleep issues and aggression, little is known about how clinical sleep issues among individuals with Intermittent Explosive Disorder (IED), which is characterized by a pervasive pattern of impulsive aggression and associated with consequences across multiple life-domains. The present study aims to...

Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of int...

Evidence is mixed regarding differences in prevalence of aggressive behavior, with many (though not all) studies suggesting that men are more aggressive than women. Furthermore, while aggression often occurs in response to provocation-induced anger, this relationship may be stronger for men; women may be more likely to engage in non-aggressive (e.g...

Background Accurate recognition of the emotions of others is an important part of healthy neurological development and promotes positive psychosocial adaptation. Differences in emotional recognition may be associated with the presence of emotional biases and can alter one's perception, thus influencing their overall social cognition abilities. The...

Social-emotional information processing (SEIP) is critical for appropriate human interaction. It is composed of processes that underlie how we behave towards others, especially in response to adverse social threat. We conducted a study in 26 healthy participants who completed a validated Video-SEIP (V-SEIP) task in the fMRI scanning environment. Th...

Human aggression is typically distinguished in two forms. These are instrumental or proactive and impulsive or reactive. When sufficiently frequent and severe, individuals with impulsive aggression may meet the Diagnostic and Statistical Manual of Mental Disorders‐5th Edition diagnosis of Intermittent Explosive Disorder, a disorder with a lifetime...

Objective: To explore the correlates of diabetes-related distress (DD) with psychometrically valid assessments of emotional regulation in individuals with type 1 and type 2 diabetes. Research design and methods: Adults with diabetes (n = 298) were assessed for psychological issues possibly associated with diabetes and were further evaluated with...

Experiencing behavioral control over stress can have long-lasting and generalizing effects. Animal research has shown that vmPFC-subcortical interactions are critical for behavioral control; however, research in humans is sparse. Therefore a paradigm was developed in which participants (n = 18) were first assigned to a controllable or uncontrollabl...

Background: Aggressive behavior in children and adolescents may be accounted for by several disruptive behavioral disorders (DBD) including attention-deficit/hyperactive (ADHD), conduct (CD), and oppositional defiant (ODD), disorders and intermittent explosive disorder (IED). The comorbidity among the DBDs is well known, but not its comorbidity wi...

Objective: To determine the prevalence and correlates of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States. Methods: Community survey data (collected between 2001-2004) from the National Comorbidity Survey-Replication (NCS-R) and Adolescent Supplement (NCS-AS) involving 10,148 adolescents and 9,282 adult...

The authors hypothesized that personality disorders characterized by interpersonal hypersensitivity would be associated with an elevated concentration of 8-hydroxy-2'-deoxyguanosine (8-OH-DG), the oxidized form of guanine, and a biomarker of oxidative stress burden. One hundred ninety-five male and female adults underwent semistructured diagnostic...

Intermittent Explosive Disorder (IED), the only psychiatric diagnosis for which affective aggression is the cardinal symptom, is uniquely associated with both a history of childhood abuse and a diagnosis of an alcohol use disorder (AUD). Moreover, both childhood abuse and AUD are associated with increased general aggression and aggression while int...

Rationale: Impulsive aggressive behavior is associated with reduced central function of serotonin (5-HT). Although selective serotonin reuptake inhibitors can reduce such behaviors, many with history of impulsive aggression do not respond adequately to selective serotonin reuptake inhibitors and may require treatment with a direct 5-HT agonist. O...

Background: Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) intermittent explosive disorder (IED) belongs...

Background: Kynurenine pathway metabolites and endocannabinoids both exert potent regulatory effects on the immune system, but the relationship between these molecules is unknown. The role of these immunobiological mediators in emotionality and personality traits is not previously characterized. Methods: Interleukin-6 (IL-6), 2-arachidonoylglyce...

A relationship between HbA1c levels and emotional regulation in T1/T2 diabetes has been reported. Accordingly, we developed a 10-session Emotion-Focused Cognitive Behavioral Treatment (EF-CBT) program to address this issue. Twenty patients with T2D were equally randomized to EF-CBT and Treatment As Usual (TAU). While both displayed HbA1c reductions...

Objective: Despite increased use of behavioral analogues to identify casual mechanisms of self-injurious behavior (e.g. suicide attempts; non-suicidal self-injury), little is known about the impact on participants. The current study examined the impact of a specific behavior analogue, Self-Aggressive Paradigm (SAP), on participant affect. Methods...

Research in aggression has distinguished two major subtypes of aggressive behavior: hostile and instrumental. Previous research has examined these subtypes in healthy individuals and forensic samples but not in intermittent explosive disorder (IED), a disorder characterized by recurrent and severe aggressive behavior. We examined aggression subtype...

Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We us...

There is ambiguity in how recurrent anger and aggression are accounted for by psychiatric nosology. One area of uncertainty is the extent to which Intermittent Explosive Disorder (IED) overlaps with and is distinct from Personality Disorder (PD). Accordingly, we conducted a study of individuals with IED and PD in order to understand the nature of c...

Individuals with DSM-5 Intermittent Explosive Disorder (IED) are often suspected of minimizing the nature of their recurrent, problematic, impulsive aggressive behavior due to the social undesirability of these behaviors. Our first study involved 400 study participants categorized as Healthy Controls (HC), Psychiatric Controls (PC) and as having IE...

The endocannabinoid (EC) system influences a wide variety of neurobiological processes including affect and emotionality as well as other neuropsychiatric functions. In this study we examined the relationship of circulating endocannabinoids [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)] with affect and emotionality in 175 individuals with (n...

Physically healthy, adult, same-sexed twins (n = 287) from a population-based twin cohort underwent high-resolution magnetic resonance imaging (MRI) to identify fronto-limbic brain regions significantly associated with lifetime history of aggression. MRI scans used a 3D magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) sequence, for...

This chapter provides an overview of treatment considerations for intermittent explosive disorder (IED), and then for impulse-control disorders (kleptomania; pyromania). Aggressive outbursts in IED have a rapid onset and are short-lived (<30 minutes). these outbursts are frequent and of low intensity (i.e., verbal outbursts and/or non-destructive/n...

Purpose of review: Aggressive behavior has adaptive value in many natural environments; however, it places substantial burden and costs on human society. For this reason, there has long been interest in understanding the neurobiological basis of aggression. This interest, and the flourishing of neuroimaging research in general, has spurred the dev...

Experiencing behavioral control over stress can have long lasting and generalizing effects. The controllability of a physical threat, for example, affects the processing of subsequent social stress. Animal research has shown that the vmPFC plays a critical role in behavioral control and orchestrating subcortical responses. However, translational re...

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Objective: A relationship between aggression and substance use has been debated for many years. While substance use increases the risk of aggressive behavior, no studies have reported on the relationship between impulsive aggression and substance use/disorder, specifically. Methods: We analyzed data from the community-based National Comorbidity...

Objective: This study was designed to develop and test a screening approach to identify individuals with DSM-5 Intermittent Explosive Disorder (IED), a disorder of recurrent, problematic, impulsive aggression. Methods: A screening approach to diagnose DSM-5 IED (IED-SQ) was developed by combining items related to life history of aggression and i...

A computerized version of an assessment of Social-Emotional Information Processing (SEIP) using audio-video film stimuli instead of written narrative vignettes was developed for use in adult subjects. This task allows for an assessment of encoding or relevant/irrelevant social-emotional information, attribution bias, and endorsement of appropriate,...

A diminished capacity to reason about one's own or others’ mood states (part of emotional intelligence, EI) may impair one's ability to respond to threat or frustration, leading to aggression and/or impulsivity. In this study, 1544 adult subjects completed the Trait-Meta-Mood Scale (TMMS), an assessment of perceived EI, in order to examine how atte...

Background Individuals with intermittent explosive disorder (IED) were previously found to exhibit amygdala (AMYG) hyperactivation to anger faces during functional magnetic resonance imaging (fMRI). However, acute alcohol consumption, and/or life history of alcoholism, may blunt amygdala responses to negative emotional stimuli. Thus, we examined th...

Social-emotional information processing (SEIP) was assessed in individuals with current DSM-5 Intermittent Explosive Disorder (IED: n = 100) and in healthy (n = 100) and psychiatric (n = 100) controls using a recently developed and validated self-rated questionnaire. SEIP vignettes depicted both direct aggressive and relationally aggressive scenari...

Borderline personality disorder (BPD) is a highly comorbid disorder, and these comorbidities increase the impairment associated with BPD. For example, depression, which occurs in the majority of individuals with BPD, increases the likelihood of an individual with BPD to engage in nonsuicidal self-injury (NSSI). Little research, however, has investi...

Objective: Posttraumatic stress disorder (PTSD) is associated with both aggressive and suicidal behavior. Recent research suggests that the diagnosis of intermittent explosive disorder (IED), an impulse-control disorder characterized by repeated impulsive aggressive behavior, may help to identify individuals at risk for attempting suicide. Given t...

Background: A relationship between substance use and aggression has been noted for decades. While substance use appears to be associated with an increased risk of aggressive behavior, no study has yet reported on the pattern of comorbidity and temporal relationship between impulsive aggression (i.e., intermittent explosive disorder) and substance...

An expanded self-report, vignette-based, questionnaire was developed to assess five components in a social emotional information processing model (SEIP: attribution, emotional response, response valuation, outcome expectancy, response efficacy, and response enactment), first in a population-based sample (n = 250) and, second in healthy control part...

Aims: Understanding the role of emotion in glycemic control may be critical for the long-term treatment of patients with type 2 diabetes (T2D). In this study we investigated the relationship between measures of emotional regulation and emotional intelligence and HbA1c levels in adult patients with T2 diabetes. Methods: 100 adult patients with T2...

Intermittent Explosive Disorder (IED), as described in DSM-5, is the categorical expression of pathological impulsive aggression. Previous work has identified neurobiological correlates of the disorder in patterns of frontal-limbic brain activity and dysregulation of serotonergic neurotransmission. Given the importance of short and long range white...

Inflammatory proteins are thought to be causally involved in the generation of aggression, possibly due to direct effects of cytokines in the central nervous system and/or by generation of inflammatory metabolites along the tryptophan-kynurenine (TRP/KYN) pathway, including KYN and its active metabolites kynurenic acid (KA), quinolinic acid (QA), a...

Background: Individuals with intermittent explosive disorder (IED) were previously found to exhibit amygdala hyperactivation and relatively reduced orbital medial prefrontal cortex (OMPFC) activation to angry faces while performing an implicit emotion information processing task during functional magnetic resonance imaging (fMRI). This study exami...

Toxoplasma gondii (T. gondii), a protozoan parasite that persists in host tissues, including brain, has been associated with several psychiatric disorders and with suicidal behavior. We sought to test the hypothesis that latent T. gondii infection, as manifest by circulating immunoglobulin G (IgG) antibodies to T. gondii, is associated with both ca...

The overreliance on immature and/or neurotic defense mechanisms, as opposed to more mature defensive functioning has been linked to several psychiatric disorders. However, to date, the role of defense styles among individuals with Intermittent Explosive Disorder (IED) has not been examined. Given that individuals with IED display difficulties contr...

Background: Childhood trauma is a risk factor for personality disorder. We have previously shown that childhood trauma is associated with increased central corticotrophin-releasing hormone concentration in adults with personality disorder. In the brain, the release of corticotrophin-releasing hormone can be stimulated by noradrenergic neuronal act...

Background: Impulsive aggressive behavior is thought to be facilitated by activation of the limbic brain, particularly the amygdala and hippocampus., Functional imaging studies suggest abnormalities in limbic brain activity during emotional information processing in impulsively aggressive subjects with Intermittent Explosive Disorder (IED). It is...

Intermittent Explosive Disorder (IED) is a disorder of impulsive aggression affecting 4-7% of the U.S. population during some period of life. In addition to other biological correlates, elevations of plasma inflammatory markers have been reported in IED, compared with control, subjects. In this study we sought to explore if treatment exposure to an...

The neurobiological underpinnings of Intermittent Explosive Disorder (IED) are traditionally linked to deficiencies in the serotonergic system. In this study, we investigated the effects of escitalopram, a Selective Serotonin Reuptake Inhibitor (SSRI), on brain activation during face processing. We expected that escitalopram would reduce amygdala a...

Aggression is a behavior with evolutionary origins, but is often both destructive and maladaptive in today's society. Research over the past several decades has confirmed the involvement of neurotransmitter function in aggressive behavior. This research has centered around the "serotonin hypothesis." As this literature continues to grow, guided by...

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 c...

Intermittent Explosive Disorder (IED) is the only adult psychiatric diagnosis for which pathological aggression is primary. DSM-IV criteria focused on physical aggression, but Diagnostic and Statistical Manual of Mental Disorders (DSM-5) allows for an IED diagnosis in the presence of frequent verbal aggression with or without concurrent physical ag...

Parental bonding has been shown to have lasting impacts on the psychological development of children. Despite a growing body of research examining trauma as it relates to Intermittent Explosive Disorder (IED), no prior research has examined the relationship between parental bonding and IED. 658 subjects were studied and categorized into one of thre...

Emotional Intelligence (EI) relates to one’s ability to recognize and understand emotional information and then, to use it for planning and self-management. Given evidence of abnormalities of emotional processing in impulsively aggressive individuals, we hypothesized that EI would be reduced in subjects with Intermittent Explosive Disorder (IED: n...

Conceptualizations of Intermittent Explosive Disorder (IED) have suffered from a scarcity of research investigating the subjective experience and phenomenology of the aggressive outbursts among those with IED relative to those who partake in more normative forms of aggression. Furthermore, though some studies have shown that individuals with IED ar...

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 frequent...

Intermittent explosive disorder (IED) is a psychiatric disorder characterized by repeated acts of affective aggression. Despite the diagnostic emphasis on the failure to control aggressive impulses, there is little research on affective processes and emotion regulation in IED; however, this research suggests possible dysfunctions in experiences of...

Self-harm behaviors are a major public health concern across the lifespan, particularly among individuals with psychiatric disorders. Little research, however, has examined these behaviors among individuals with a diagnosis characterized by recurrent acts of impulsive aggression, Intermittent Explosive Disorder (IED). Furthermore, extant research h...

Intermittent Explosive Disorder (IED) is a relatively common disorder of impulsive aggression that typically emerges by adulthood. Maltreatment in childhood (CM) may contribute to the development of IED, but little is known about the association between CM and IED, including about how subtypes of CM may specifically relate to IED. This study aimed...

C-reactive protein (CRP), in the plasma, serves as a marker of systemic inflammation and has been shown to correlate with history of actual aggressive behavior, and as a personality trait of aggressive tendency, in human subjects. This pilot study was conducted to determine if plasma CRP levels are correlated with cerebrospinal fluid levels (CSF CR...

Background: Animal and clinical studies suggest a link between inflammation and oxidative stress. Because oxidative stress is an inherent part of inflammation, and inflammation is associated with behavioral aggression in lower mammals and humans, we hypothesized that markers of oxidative stress would be related to aggression in human subjects. In...

Background: We hypothesized that SRX246, a vasopressin V1a receptor antagonist, blocks the effect of intranasally administered vasopressin on brain processing of angry Ekman faces. An interaction of intranasal and oral drug was predicted in the amygdala. Methods: Twenty-nine healthy male subjects received a baseline fMRI scan while they viewed angr...

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 t...

An understanding of the latent structure of oppositional defiant disorder (ODD) is essential for better developing causal models, improving diagnostic and assessment procedures, and enhancing treatments for the disorder. Although much research has focused on ODD-including recent studies informing the diagnostic criteria for DSM-5-research examining...

Background: Generalized social phobia (gSP), also known as generalized social anxiety disorder, is characterized by excessive fear of scrutiny by others and pervasive avoidance of social interactions. Pathophysiologic models of gSP implicate exaggerated reactivity of the amygdala and insula in response to social evaluative threat, making them plau...

Focuses on the evidence suggesting that there are biological predispositions to aggression. The authors review a case in which this issue arose in a forensic evaluation and discuss the implications of these finding in criminal settings. Aggression can be verbal, directed at inanimate objects, directed at other living beings, and it can be defensive...