The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication

Abstract

Context: Little is known about the epidemiology of intermittent explosive disorder (IED).

Objective: To present nationally representative data on the prevalence and correlates of DSM-IV IED.

Design: The World Health Organization Composite International Diagnostic Interview was used to assess DSM-IV anxiety disorders, mood disorders, substance use disorders, and impulse control disorders.

Setting: The National Comorbidity Survey Replication, a face-to-face household survey carried out in 2001-2003.

Participants: A nationally representative sample of 9282 people 18 years and older.

Main outcome measure: Diagnoses of DSM-IV IED.

Results: Lifetime and 12-month prevalence estimates of DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks resulting in 1359 dollars in property damage. Intermittent explosive disorder-related injuries occurred 180 times per 100 lifetime cases. Mean age at onset was 14 years. Sociodemographic correlates were uniformly weak. Intermittent explosive disorder was significantly comorbid with most DSM-IV mood, anxiety, and substance disorders. Although the majority of people with IED (60.3%) obtained professional treatment for emotional or substance problems at some time in their life, only 28.8% ever received treatment for their anger, while only 11.7% of 12-month cases received treatment for their anger in the 12 months before interview.

Conclusions: Intermittent explosive disorder is a much more common condition than previously recognized. The early age at onset, significant associations with comorbid mental disorders that have later ages at onset, and low proportion of cases in treatment all make IED a promising target for early detection, outreach, and treatment.

Figure 1

Age of onset distributions of narrow and broad-only lifetime DSM-IV intermittent explosive disorder (n = 9282)