|Intermittent Explosive Disorder Affects up to 16 Million Americans
A little-known mental disorder marked by episodes of unwarranted anger is more
common than previously thought, a study funded by the National Institutes of
Health’s (NIH) National Institute of Mental Health (NIMH) has found. Depending
upon how broadly it’s defined, intermittent explosive disorder (IED) affects
as many as 7.3 percent of adults — 11.5-16 million Americans — in
their lifetimes. The study is based on data from the National Comorbidity Survey
Replication, a nationally representative, face-to-face household survey of 9,282
U.S. adults, conducted in 2001-2003.
People with IED may attack others and their possessions, causing bodily injury
and property damage. Typically beginning in the early teens, the disorder often
precedes — and may predispose for — later depression, anxiety and
substance abuse disorders. Nearly 82 percent of those with IED also had one of
these other disorders, yet only 28.8 percent ever received treatment for their
anger, report Ronald Kessler, Ph.D., Harvard Medical School, and colleagues.
In the June, 2006 Archives of General Psychiatry, they suggest that
treating anger early might prevent some of these co-occurring disorders from
To be diagnosed with IED, an individual must have had three episodes of impulsive
aggressiveness “grossly out of proportion to any precipitating psychosocial stressor,” at
any time in their life, according to the standard psychiatric diagnostic manual.
The person must have “all of a sudden lost control and broke or smashed something
worth more than a few dollars…hit or tried to hurt someone…or threatened to hit
or hurt someone.”
People who had three such episodes within the space of one year — a more
narrowly defined subgroup — were found to have a much more persistent and
severe disorder, particularly if they attacked both people and property. The
latter group caused 3.5 times more property damage than other violent IED sub-groups.
Affecting nearly 4 percent of adults within any given year — 5.9-8.5 million
Americans — the disorder leads to a mean of 43 attacks over the course
of a lifetime and is associated with substantial functional impairment.
Evidence suggests that IED might predispose toward depression, anxiety, alcohol
and drug abuse disorders by increasing stressful life experiences, such as financial
difficulties and divorce.
Given its earlier age-of-onset, identifying IED early — perhaps in school-based
violence prevention programs — and providing early treatment might prevent
some of the associated psychopathology, propose the researchers. Although most
study respondents with IED had seen a professional for emotional problems at
some time in their lives, only 11.7 percent had been treated for their anger
in the 12 months prior to the study interview.
Although the new prevalence estimates for IED are somewhat higher than previous
studies have found, the researchers consider them conservative. For example,
anger outbursts in people with bipolar disorder, which often overlaps with IED,
were excluded. Previous studies have found little overlap between IED and other
mental illnesses associated with impulsive violence, such as antisocial and borderline
Also participating in the study were Dr. Emil Coccaro, University of Chicago,
Dr. Maurizio Fava, Massachusetts General Hospital, and Dr. Savina Jaeger, Robert
Jin, and Ellen Walters, Harvard University.
In addition to primary funding from the NIMH, the National Comorbidity Survey
Replication received supplemental funding from a number of sources, including
National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health
Services Administration (SAMHSA).
The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind, brain,
and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov.
The National Institute on Drug Abuse is a component of the National Institutes
of Health, U.S. Department of Health and Human Services. NIDA supports more
than 85 percent of the world’s research on the health aspects of drug abuse
and addiction. The Institute carries out a large variety of programs to ensure
the rapid dissemination of research information and its implementation in policy
and practice. Fact sheets on the health effects of drugs of abuse and information
on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U.S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit www.nih.gov.