The experience of aggressive outbursts in Intermittent Explosive Disorder

Abstract

Conceptualizations of Intermittent Explosive Disorder (IED) have suffered from a scarcity of research investigating the subjective experience and phenomenology of the aggressive outbursts among those with IED relative to those who partake in more normative forms of aggression. Furthermore, though some studies have shown that individuals with IED are more impaired and have a poorer quality of life, few studies looked at negative outcomes specific to an individual with IED’s aggressive behavior. The purpose of this study was to examine the subjective experience and social, occupational, and legal consequences of aggressive outbursts in IED. We assessed individuals with IED (n = 410), psychiatric controls (n = 133), and healthy controls (n = 154) in the experiential correlates present before, during, and after an aggressive outburst as well as the consequences of aggressive outbursts. Results indicated that before and during aggressive outbursts, individuals with IED experienced more intense anger, physiological reactivity, and feelings of dyscontrol as well as more remorse after an aggressive outburst. Furthermore, individuals with IED report more negative consequences of their aggressive outbursts. These results provide an account of how the subjective experience and consequences of aggressive outbursts in IED differ from those with more normative forms of aggression.

Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality

“…reported greater functional impairment than the 'other mental disorder' comparison group (Kulper et al, 2015;Rynar and Coccaro, 2018), whereas our finding of 39.8% of those with IED reporting severe impairment is lower than the corresponding proportion reported for other mental disorders (Scott et al, 2018). In these and in other clinical studies from the same group (Fahlgren et al, 2019;Fanning et al, 2019), IED-associated comorbidity was dominated by internalising disorders, in contrast to our finding that comorbidity was at least equally if not more likely to be with externalising disorders.…”

“…As previously reported (Scott et al, 2016), a small proportion of the IED sample admitted to purposely torturing or injuring an animal, or arson, within the prior 12 months, so it is possible that these individuals may be more appropriately classified as personality disordered (or CD) than IED. Some researchers have chosen to deal with the difficulty of differentiating between IED and bipolar disorder by excluding people with a lifetime history of bipolar disorder from the IED sample (Kulper et al, 2015;Rynar and Coccaro, 2018;Fahlgren et al, 2019). It is unclear why the same theoretical concern does not apply to some of the other comorbid disorders, and if we were to remove all those with lifetime comorbidities associated with impulsive aggression from the group classified with IED we would end up with a much smaller group.…”

Emotion regulation deficits in intermittent explosive disorder

“…Given the distressing nature of negative affect, individuals with IED, who experience more intense and frequent anger, likely also experience a correspondingly greater urge to engage in behavior potentiated by the negative affect such as aggression. Individuals with IED are more likely than other psychiatric groups to often refer to their anger and aggression as "out of control" (Kulper et al, 2014).…”

The co‐occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder

“…Aggression of this nature, which falls outside the range of normative developmental behavior, may warrant a diagnosis of intermittent explosive disorder (IED). IED is a common and serious mental health concern among adolescents, often resulting in serious, long-term impairment in social, occupational, legal, and/or health domains (Kulper, Kleiman, McCloskey, Berman, & Coccaro, 2015; McLaughlin et al, 2012). …”