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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    ABSTRACT: Centrally acting monoamines have long been thought to be associated with component traits of behavior and emotion and are potential biological mediators of psychopathology. In this study we tested the hypothesis that centrally acting monoamines would be associated with measures of affective instability (i.e. affective intensity and affective lability) in healthy and personality disordered human subjects. In total, 57 adult subjects including 19 psychiatrically healthy volunteers and 38 personality disordered individuals were assessed for affective instability with the affective intensity measure (AIM) and the Affective Lability Scale (ALS). Samples of cerebrospinal fluid (CSF) were collected for assay of 5-hydroxyindoleacitic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy-phenylglycol (MHPG). CSF 5-HIAA concentration correlated directly with overall AIM score and, specifically, with the AIM Negative Intensity score, in all subjects and in personality disordered subjects. This result was not affected but the addition of aggression scores or life history of mood disorder to the model. Neither CSF HVA nor MHPG were found to uniquely correlate with either AIM or ALS measure. Higher Affective Intensity scores, Negative Intensity scores, specifically, are directly correlated with higher basal levels of CSF 5-HIAA. This relationship was independent of aggression, life history of mood disorder and general personality traits.
    Full-text · Article · Apr 2012 · The International Journal of Neuropsychopharmacology
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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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    ABSTRACT: The vast majority of studies that have examined the latent structure of attention deficit/hyperactivity disorder (ADHD) in children and adolescents have concluded that ADHD has a dimensional latent structure. In other words, ADHD symptomatology exists along a continuum and there is no natural boundary or qualitative distinction (i.e., taxon) separating youth with ADHD from those with subclinical inattention or hyperactivity/impulsivity problems. Although adult ADHD appears to be less prevalent than ADHD in youth (which could suggest a more severe adult ADHD taxon), researchers have yet to examine the latent structure of ADHD in adults. The present study used a sample (N = 600) of adults who completed a self-report measure of ADHD symptoms. The taxometric analyses revealed a dimensional latent structure for inattention, hyperactivity/impulsivity, and ADHD. These findings are consistent with previous taxometric studies that examined ADHD in children and adolescents, and with contemporary polygenic and multifactorial models of ADHD.
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    ABSTRACT: Although selective serotonin reuptake inhibitors (SSRI) are generally effective in reducing impulsive aggression in individuals with intermittent explosive disorder, a large proportion of intermittent explosive disorder patients fail to achieve full remission despite adequate dosage and duration of treatment. Temperament, specifically those associated with negative emotionality (neuroticism, harm avoidance) may predict response to SSRI treatment. The objective of this study was to determine whether baseline neuroticism and harm avoidance scores would be associated with reduced aggression (as measured by the Overt Aggression Scale-Modified [OAS-M] aggression scores) after SSRI treatment. Participants participating in a randomized, placebo-controlled clinical trial of fluoxetine completed the Eysenck Personality Questionnaire (n=57) and the Tridimensional Personality Questionnaire (n=38) before entering the treatment trial. Multiple regression analyses (accounting for baseline OAS-M aggression scores) revealed that pretreatment eysenck personality questionnaire neuroticism and tridimensional personality questionnaire harm avoidance independently and uniquely predicted OAS-M aggression scores at endpoint in the fluoxetine, but not placebo, treated group. These preliminary findings are the first from a placebo-controlled clinical trial to suggest that temperamental factors such as neuroticism and harm avoidance can partly explain the observed variability in treatment response in SSRI treated individuals with impulsive aggression and prompt future prospective studies examining personality dimensions as predictors of outcomes in clinical trials.
    No preview · Article · Sep 2011 · International clinical psychopharmacology
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