The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication

Abstract

Intermittent explosive disorder (IED), as operationalized in DSM-IV, is characterized by recurrent episodes of serious assaultive acts that are out of proportion to psychosocial stressors and that are not better accounted for either by another mental disorder or by the physiological effects of a substance with psychotropic properties. Despite the fact that IED, or some version of this diagnosis, has always been included in the DSM, changes in criteria in the various editions over the years have resulted in relatively little being known about the incidence or prevalence of IED either in clinical samples or in the general population. In DSM-III, for example, IED could not be diagnosed in patients with generalized aggression or impulsivity. Given that most individuals with serious aggressive outbursts also have generalized aggression or impulsivity, this restriction resulted in a significant underestimation of the IED syndrome in DSM-III.¹ While this problem was remedied in the DSM-IV, other uncertainties remain, such as the nature and threshold frequency of aggressive acts needed to meet criteria for a diagnosis of IED.