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

ArticleinComprehensive psychiatry 52(2):119-25 · March 2011with30 Reads
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.
    • "disorder interview-revised for DSM-5 (IEDI-5) The IEDI (Coccaro, unpublished instrument) is a reliable and validated (k ¼ .84; McCloskey and Coccaro, 2003 ) structured diagnostic interview that provides the necessary diagnostic information in order to diagnose both DSM-IV IED (APA, 2000) and IED- Integrated Research criteria (Coccaro, 2011 ). This includes qualitative and quantitative information about an individual's verbal and physical aggression and any resulting distress/impairment due to their aggression. "
    [Show abstract] [Hide abstract] ABSTRACT: Methods: The present study compared individuals diagnosed with IED (n=81) with psychiatric controls (PCs; n=52) and healthy volunteers (HVs; n=58) on the impulsivity domains of negative and positive urgency, perseverance, sensation seeking, and premeditation, as well as on reward and punishment sensitivity. We hypothesized that individuals with IED would show greater negative and positive urgency, reward sensitivity, punishment sensitivity, with negative urgency independently predicting IED status. We also hypothesized that negative urgency would predict levels of anger, aggression, and aggression control among those with IED. Results: The IED participants reported greater negative urgency than both comparison groups, and greater levels of positive urgency, reward sensitivity, and punishment sensitivity compared to HVs. Further, heightened negative urgency was the sole predictor an IED diagnosis. Within the IED group negative urgency uniquely predicted decreased aggression control and increased trait anger. Limitations: Limitations included reliance on self-report measures to assess RS/PS, impulsivity, and aggression. Conclusions: These findings suggest that negative urgency is a key factor associated with IED and is associated with dampened control of aggression within those with IED.
    Full-text · Article · Apr 2016
    • "Assaultive behavior and destruction of property among adolescents have been found to be associated with substance use234, 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 two678. The health and social problems associated with assaultive behavior, however, are not limited to high school aged students. "
    [Show abstract] [Hide abstract] 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.
    Article · Nov 2014
    • "p ¼ .69; Coccaro et al., 1998Coccaro et al., , 2011Coccaro et al., , 2012aCoccaro et al., , 2012b Lee et al., 2009). In comparison, the correlation between adjusted CSF Glutamate and CSF Substance P levels was larger in magnitude, though not statistically significant (r ¼ .27, "
    [Show abstract] [Hide abstract] ABSTRACT: Neurochemical studies have pointed to a modulatory role in human aggression for various central neurotransmitters. Some (e.g., serotonin) appear to play an inhibitory role, while others appear to play a facilitator role. While recent animal studies of glutaminergic activity suggest a facilitator role for central glutamate in the modulation of aggression, no human studies of central glutaminergic indices have yet been reported regarding aggression. Basal lumbar cerebrospinal fluid (CSF) was obtained from 38 physically healthy subjects with DSM-IV Personality Disorder (PD: n = 28) and from Healthy Volunteers (HV: n = 10) and assayed for glutamate, and other neurotransmitters, in CSF and correlated with measures of aggression and impulsivity. CSF Glutamate levels did not differ between the PD and HC subjects but did directly correlate with composite measures of both aggression and impulsivity and a composite measure of impulsive aggression in both groups. These data suggest a positive relationship between CSF Glutamate levels and measures of impulsive aggression in human subjects. Thus, glutamate function may contribute to the complex central neuromodulation of impulsive aggression in human subjects.
    Full-text · Article · Jun 2013
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