Verbal versus physical aggression in Intermittent Explosive Disorder.

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 aggression. It remains unclear how individuals with verbal aggression differ from those with physical aggression with respect to cognitive-affective deficits and psychosocial functioning. The current study compared individuals who met IED criteria with either frequent verbal aggression without physical aggression (IED-V), physical aggression without frequent verbal aggression (IED-P), or both frequent verbal aggression and physical aggression (IED-B) as well as a non-aggressive personality-disordered (PD) comparison group using behavioral and self-report measures of aggression, anger, impulsivity, and affective lability, and psychosocial impairment. Results indicate all IED groups showed increased anger/aggression, psychosocial impairment, and affective lability relative to the PD group. The IED-B group showed greater trait anger, anger dyscontrol, and aggression compared to the IED-V and IED-P groups. Overall, the IED-V and IED-P groups reported comparable deficits and impairment. These results support the inclusion of verbal aggression within the IED criteria and suggest a more severe profile for individuals who engage in both frequent verbal arguments and repeated physical aggression.

Look AE ，McCloskey MS ，Coccaro EF 《-》

Prevalence and clinical correlates of intermittent explosive disorder in Turkish psychiatric outpatients.

Intermittent explosive disorder (IED) is defined as the failure to resist aggressive impulses resulting in repeated acts of verbal and/or physical aggression. Although it is frequently encountered in clinical psychiatric practice, there is a paucity of data concerning IED in the scientific literature both internationally and in Turkey. The aim of this study was to evaluate the prevalence of IED and associated sociodemographic and clinical features in a clinical setting. A total of 406 patients who were referred to our psychiatry outpatient clinic for the first time in a six-month period were included in the study. The diagnosis of IED was made using both Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and DSM-5 criteria. Axis I disorder and personality disorder diagnoses were made according to DSM-5 criteria. Diagnoses were based on information from the Structured Clinical Interview for DSM-IV (SCID I) and the Structured Clinical Interview for DSM-IV personality disorders (SCID II), Symptom Checklist-90 (SCL-90), Wender Utah Rating Scale, Adult Attention Deficit Hyperactivity Disorder (ADHD) DSM-IV Based Diagnostic Screening and Rating Scale, a clinical interview conducted by the researcher, and a sociodemographic data form. In addition, participants were administered the Buss-Perry Aggression Scale and Barratt Impulsiveness Scale Version 11 (BIS-11) to assess aggression and impulsivity. Lifetime and 12-month prevalence of IED according to DSM-5 were 16.7% and 11.3%, respectively. Mean age at onset was 16.4 years. The prevalence of lifetime IED was 3.8 times higher in males than females (95% CI = 1.9-7.5); twice as high in individuals living in rural areas compared to those living in urban centers (95% CI = 1.1-3.7); 2.7 times higher among those with lifetime suicide attempt versus those without (95% CI = 1.3-5.6); 4.5 times higher in those with lifetime self-injurious behavior compared to those without (95% CI = 2.3-8.7); and 3 times higher in individuals reporting aggression/anger problems in the family compared to those without (95% CI = 1.5-5.9). The prevalences of childhood ADHD, conduct disorder, and oppositional defiant disorder were significantly higher in the IED group. The result of the current study has revealed that approximately one-sixth of respondents experienced lifetime IED according to DSM-5 diagnostic criteria. Statistically significant sociodemographic correlates of IED include gender, urbanicity, history of suicide attempt, history of self-injurious behavior, and family history of aggression/anger problems.

Gelegen V ，Tamam L 《-》

The relationship between impulsive verbal aggression and intermittent explosive disorder.

Intermittent explosive disorder (IED) is the sole psychiatric diagnostic category for which aggression is a cardinal symptom. IED focuses on physical aggression, but researchers have argued for the inclusion of verbal aggression (VA) (e.g., arguing, threatening) as a part of the IED criteria set. The utility of VA in identifying clinically relevant aggression, however, is unknown. IED participants were compared to individuals without a marked history of physical aggression, but who report frequent (two or more times a week) VA, and non-aggressive personality-disorder individuals on behavioral and self-report measures of aggression, self-report measures of related constructs (e.g., anger, affective lability), and a clinician assessment of psychosocial impairment. Both the IED and VA groups were more aggressive, angry, and clinically impaired than personality-disorder individuals, while the IED and VA groups did not differ from each other on these measures. These results support the clinical importance of frequent VA for future iterations of the IED criteria set.

McCloskey MS ，Lee R ，Berman ME ，Noblett KL ，Coccaro EF ... -  《-》

Comorbid intermittent explosive disorder and posttraumatic stress disorder: Clinical correlates and relationship to suicidal behavior.

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 the relationship between anger and PTSD, there is likely to be an increased prevalence of IED among individuals with PTSD; however, little is known about the overlap in these two disorders, including how individuals with comorbid IED and PTSD may differ from those with either disorder alone. The purpose of this study is to examine the clinical correlates of comorbid IED and PTSD and the contribution of these two disorders (among others) to lifetime suicide attempt and characteristics of suicidal behavior. In a large sample of community research volunteers (N=1460), we compared individuals with PTSD, IED, and comorbid PTSD and IED on measures of current mood, trait aggression, and trait impulsivity. We also examined the contributions of PTSD, IED, and other syndromal and personality disorders to the prediction of lifetime aggression and lifetime suicide attempt, and their relationship to characteristics of suicide attempts, including level of intent, use of violent versus non-violent means, and the medical seriousness of the attempt. Comorbid PTSD and IED was associated with significantly elevated levels of depression, anxiety, anger, aggression, and impulsivity, as well as with high rates of comorbidity with other psychiatric disorders. IED (β=.56, p<.001), but not PTSD, significantly and uniquely predicted lifetime aggressive behavior. Both IED and PTSD were associated with lifetime suicide attempt in multivariate analysis (ORs: 1.6 and 1.6, ps<.05). The results show that IED, when comorbid with PTSD, identifies a subgroup of individuals with particularly high levels of aggressive behavior and a high rate of suicide attempt (41.4% in this sample). These findings add support to the notion that the diagnosis of IED may aid in identifying individuals at risk for aggressive and suicidal behavior.

Fanning JR ，Lee R ，Coccaro EF 《-》

Comorbidity of personality disorder with intermittent explosive disorder.

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 comorbidity relationships seen across these two areas of psychopathology. One-thousand-five-hundred-twenty-one adults were studied (441 Healthy Controls (HC), 430 Psychiatric Controls (PC), and 650 IED subjects) and assessed for DSM-5 psychiatric disorders, life history of aggressive behavior, trait aggression, state and trait anger reactivity, and impulsivity. While nearly half of IED study participants had a comorbid PD diagnosis, nearly half with a Cluster B PD, almost as many had other personality disorders. IED predicted anger symptoms and history of aggressive behavior above and beyond a PD diagnosis. Comorbidity between IED and either Antisocial (AsPD) or Borderline (BPD) PD was associated with the highest levels of aggressive behavior. However, having IED comorbid with either AsPD and/or BPD PD was not associated with higher levels of impulsivity. Underlying personality traits related to anger, affect, and social behavior, but not identity disturbance, contribute to the shared symptom profile of IED and PD. IED is usually comorbid with PD, but does not have a unique relationship with any single PD. When comorbid with PD, a diagnosis of IED predicts more severe anger and aggression, but not necessarily increased impulsivity. These results suggest that IED and PD diagnoses retain clinical utility when made in cases meeting criteria for both.

Coccaro EF ，Shima CK ，Lee RJ 《-》