اختلال انفجاری متناوب: توسعه استاندارد تحقیقات یکپارچه برای راهنمای تشخیصی و آماری اختلالات روانی، ویرایش پنجم

This study was designed to develop a revised diagnostic criteria set for intermittent explosive disorder (IED) for consideration for inclusion in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This revised criteria set was developed by integrating previous research criteria with elements from the current DSM-IV set of diagnostic criteria. Evidence supporting the reliability and validity of IED-IR (“IED Integrated Criteria”) in a new and well-characterized group of subjects with personality disorder is presented. Clinical, phenomenologic, and diagnostic data from 201 individuals with personality disorder were reviewed. All IED diagnoses were assigned using a best-estimate process (eg, kappa for IED-IR >0.85). In addition, subjects meeting IED-IR criteria had higher scores on dimensional measures of aggression and had lower global functioning scores than non–IED-IR subjects, even when related variables were controlled. The IED-IR criteria were more sensitive than the DSM-IV criteria only in identifying subjects with significant impulsive-aggressive behavior by a factor of 16. We conclude that the IED-IR criteria can be reliably applied and have sufficient validity to warrant consideration as DSM-V criteria for IED.

Intermittent explosive disorder (IED) is a disorder of impulse control characterized by intermittent aggressive outbursts [1]. Despite its presence in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) over the past 3 decades, little empirical research has been performed on IED. This is largely because, for its first 14 years, DSM-III and DSM-III-R criteria allowed few individuals with intermittent aggressive outbursts to meet the DSM criteria for this disorder. This was largely due to specific exclusion criteria, which did not allow individuals with generalized aggression and/or impulsivity to receive a DSM diagnosis of IED [2]. Because other issues with DSM-III/R criteria were also noted as problematic, some investigators proposed research criteria to address these issues [3]. Research criteria for IED (IED-R; 3), written in response to deficiencies in the DSM-III/R diagnostic criteria set, specified the nature (ie, impulsive rather than premeditated aggression), severity (ie, allowed nonphysical/destructive aggression provided that it was associated with personal distress and/or functional impairment), and frequency (ie, 2 aggressive outbursts per week on average for at least 1 month) of aggression. In addition, it required personal distress and/or functional impairment due to the aggressive outbursts, and it removed the presence of borderline or antisocial personality disorder (BPD/AsPD) as an exclusion to the diagnosis. Initial study of individuals with and without recurrent, problematic, impulsive-aggressive behavior found preliminary evidence for the validity and reliability of these research criteria [3] and suggested that these criteria could serve as a template upon which to revise DSM IED criteria in the future. However, because research criteria were developed around the time DSM-IV was finalizing its work for its current edition, few of these changes could have been incorporated into the current DSM-IV criteria set for IED. Despite this, DSM-IV criteria were significantly improved by the removal of the criterion excluding intermittently aggressive individuals from the IED diagnosis if there was evidence of generalized aggression and/or impulsivity. Otherwise, DSM-IV criteria for IED continued to be problematic in ways already addressed by research criteria, specifically with regard to the nature, severity, and frequency of aggression; to the requirement for personal distress and/or functional impairment as a result of intermittent aggressive behavior; and to the allowance of individuals with BPD/AsPD. This article examines data from on ongoing study of intermittent aggressive behavior to examine the original research criteria for IED in the context of the DSM-IV criteria for IED criteria and to attempt an integration of the 2 diagnostic criteria sets (IED-R and DSM-IV) in preparation for work on the diagnostic criteria for IED in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This work provides initial evidence that most individuals with problematic, intermittent aggressive behaviors can be identified through the use of this new integrated research diagnostic criteria set for IED (IED-IR).