Abstract

Aims

Intermittent explosive disorder (IED) is characterized by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioral subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.

Methods

IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioral subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.

Results

The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterized by high rates of externalizing comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterized by higher rates of internalizing than externalizing comorbid disorders. Suicidal behavior did not vary across the five behavioral subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.

Conclusions

The most common IED behavioral subtypes in these general population samples are associated with high rates of externalizing disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalizing disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterizes the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.
Epidemiology and Psychiatric Sciences, 29, E138. doi:10.1017/S2045796020000517

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