Intermittent explosive disorder-revised: Development, reliability, and validity of research criteria

doi:10.1016/S0010-440X(98)90050-5

Comprehensive Psychiatry

Volume 39, Issue 6, November–December 1998, Pages 368-376

https://doi.org/10.1016/S0010-440X(98)90050-5 Get rights and content

Abstract

The study of human aggression has been hindered by the lack of reliable and valid diagnostic categories that specifically identify individuals with clinically significant displays of impulsive aggressive behavior. DSM intermittent explosive disorder (IED) ostensibly identifies one such group of individuals. In its current form, IED suffers from significant theoretical and psychometric shortcomings that limit its use in clinical or research settings. This study was designed to develop a revised criteria set for IED and present initial evidence supporting its reliability and validity in a well characterized group of personality disordered subjects. Accordingly, research criteria for IED-Revised (IED-R) were developed. Clinical, phenomenologic, and diagnostic data from 188 personality disordered individuals were reviewed. IED-R diagnoses were assigned using a best-estimate process. The reliability and construct validity of IED-R were examined. IED-R diagnoses had high interrater reliability (kappa = .92). Subjects meeting IED-R criteria had higher scores on dimensional measures of aggression and impulsivity, and had lower global functioning scores than non-IED-R subjects, even when related variables were controlled. IED-R criteria were more sensitive than DSM-IV IED criteria in identifying subjects with significant impulsive-aggressive behavior by a factor of four. We conclude that in personality disordered subjects, IED-R criteria can be reliably applied and appear to have sufficient validity to warrant further evaluation in field trials and in phenomenologic, epidemiologic, biologic, and treatment-outcome research.

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Impulse-control disorders are characterized by an individual's inability to control impulses that may be harmful to oneself or to others. The lack or loss of control is often distinguished by increased feelings of tension or anxiety prior to engaging in a behavior and feelings of relief or gratification afterward. While many psychological disorders may coexist with feelings of lack of control, such as substance abuse or obsessive-compulsive disorder, impulse-control disorders are defined mainly by this lack of control. In other words, an individual with another psychological disorder may demonstrate a marked inability to control impulses, but this inability is part of a larger pattern of maladaptive behavior within some other diagnosis.In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), disruptive Behavior, Impulse-Control and Conduct Disorders is classified as an Axis I disorder which includes oppositional defiant disorder (ODD), intermittent explosive disorder (IED), conduct disorder, pyromania, and kleptomania. Previously, pathological gambling and trichotillomania were categorized as impulse-control disorders in the DSM-IV (American Psychiatric Association [APA], 1994), however, in the DSM-5, gambling disorder is now classified as a non-substance-related disorder within the substance-related and addictive disorders and trichotillomania now fall in the obsessive-compulsive and related disorders (APA, 2013). Disruptive behavior, impulse-control and conduct disorders are characterized by an individual's lack of control over their emotions and behaviors which becomes problematic when their behaviors violate the rights of others and conflict with societal norms (APA, 2013, p. 461). Prior to engaging in these behaviors, a person may feel tense or anxious and experience feelings of relief or gratification after engaging in the behavior. Initially, this wide range of disorders may appear too diverse for a cohesive functional analysis, but upon critical investigation of behavioral functions, many psychologists will see similarities across these disorders.
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Citation Excerpt :
Before inclusion in the study, FPOs were screened for exclusion criteria: current major depression, current severe addiction, or lifetime bipolar disorder or psychosis, as assessed using the MINI International Neuropsychiatric Interview (Sheehan et al., 1998; Van Vliet and De Beurs, 2007). The FPOs included in the study were screened by trained clinicians to verify an axis II disorder with the Structured Clinical Interview for DSM-IV axis II personality disorders (SCID-II; Weertman et al., 2000) and the Research Criteria set for Intermittent Explosive Disorder (Coccaro et al., 1998). Inclusion in the study required FPOs to comply with one or more of the following criteria: 1) an antisocial, borderline, and/or narcissistic personality disorder, and/or the intermittent explosive disorder (IED), and 2) a total score of five points or higher on the Social Dysfunction and Aggression Scale (SDAS; Wistedt et al., 1990).
Previous research showed that the disposition to react with disproportionate aggression in adults is influenced by an interaction between a variant in the X-chromosomal monoamine oxidase A gene (MAOA) and early traumatic events. Such studies have often focused on a single type of trauma, whereas we know that experiencing multiple trauma types is associated with more detrimental consequences. The differential susceptibility hypothesis suggests that individuals who are most susceptible to adversity, are also most likely to benefit from supportive experiences in childhood. Differences in susceptibility are thought to be partly genetically driven. In the present study we explored whether a genotype of MAOA linked to lower expression of the gene (MAOA-L) modified the effect of multiple types of trauma on aggression and/or altered responsiveness to treatment among adults with severe aggression. Forensic psychiatric outpatients (FPOs) (N=150) receiving treatment for aggression regulation problems were recruited. Traumatic events and aggression were measured using self-report. FPOs with multiple trauma types and those with the MAOA-L allele reported more severe levels of aggression. No interaction effects between MAOA genotype and trauma emerged. There were no differences in response to the intervention between FPOs with and without the MAOA-L variant, whereas FPOs with a single type of trauma showed the slowest reduction of aggression. FPOs with multiple types of trauma reported the highest levels of aggression over the course of treatment. Future research is needed to elucidate this association in further detail. The current study emphasized the importance of early recognition of early traumatic events.
Psychiatric comorbidity in Intermittent Explosive Disorder
2019, Journal of Psychiatric Research
This study examined aspects of psychiatry comorbidity in Intermittent Explosive Disorder (IED) in order to explore the validity of IED in the context of other psychiatric disorders. Data from the National Comorbidity Study – Revised (NCS-R: n = 9,282 adults) and its Adolescent Supplement (NCS-AS: n = 10,148 adolescents) and a large clinical research data set (n = 1640) were analyzed in this study. Mean number of comorbid disorders among current IED participants was similar to that among other Non-IED disorders and comorbidity of IED with Non-IED disorders was similar to comorbidity among Non-IED disorders. When examined together, current IED was significantly comorbid with current bipolar, depressive, anxiety, substance use, and post-traumatic stress disorder, and age of onset of IED generally preceded that of the comorbid disorders. Finally, mean aggression scores were generally highest among those with IED and the comorbid disorder while scores among those with the comorbid disorder alone were generally less than that with IED or with IED and the comorbid disorder. Comorbidity in IED is similar to that in other, more established, Non-IED disorders. The observation that the development of IED precedes the onset of most comorbid disorders and that aggression scores in those with IED and a comorbid disorder are often higher than those with IED alone supports the rationale that a diagnosis of both IED and the comorbid disorder should be made when both are present.

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^☆: Supported in part by NIMH Grants No. ROIMH46948, RO1MH47495 and K02MH00951 to E.F.C.

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Intermittent explosive disorder-revised: Development, reliability, and validity of research criteria☆

Abstract

J Psychiatr Res

Psychiatry Res

Biol Psychiatry

Life Sci

Psychiatry Res

Biol Psychiatry