رابطه بین مواجهه با دوران کودکی با تروما و اختلال انفجاری متناوب

There has been a paucity of research linking intermittent explosive disorder (IED) to trauma and posttraumatic stress responses, despite evidence that trauma is strongly associated with anger reactions. The present study investigated the relationship between IED and a number of trauma-related factors, including trauma dosage, timing of first trauma, and posttraumatic stress disorder (PTSD). Participants were 4844 trauma-exposed and 731 non trauma-exposed adults who took part in the National Comorbidity Survey-Replication (NCS-R). Findings indicated that IED was associated with greater trauma exposure, PTSD and generalized anxiety disorder (GAD) diagnosis, and first exposure to traumatic events in childhood. Exploratory analyses investigating the link between IED and age at first trauma exposure across trauma types suggested that IED is related to childhood exposure to interpersonal traumatic events. These findings are discussed in the context of developmental trauma and cycles of violence models.

Intermittent explosive disorder (IED) has attracted little research attention since its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, American Psychiatric Association (APA), 1987). While anger responses play a role in several psychological disorders including depression, posttraumatic stress disorder (PTSD), borderline personality disorder, and antisocial personality disorder (APA, 1994), IED is the only psychological disorder in the DSM-IV to explicitly focus on aggressive impulses. To meet criteria for IED, one must engage in recurrent assaultive or destructive acts that are out of proportion to triggering stressors (APA, 1994). Epidemiological research conducted in the United States, Japan and South Africa has suggested that lifetime prevalence rates of IED range from 1.2 to 9.0% (Kessler et al., 2006, Fincham et al., 2009 and Yoshimasu and Kawakami, 2010). Recent research on IED focusing on the correlates of this disorder suggest that IED occurs relatively early in life, often during adolescence or the teenage years, that it is more common in men, among those with low education, and that it is often co-morbid with other psychological disorders (Coccaro et al., 2005, Kessler et al., 2006, Fincham et al., 2009 and Yoshimasu and Kawakami, 2010). Previous investigation of IED in the National Comorbidity Survey-Replication also suggests that it is associated with impairment in functioning (Kessler et al., 2006). There has been a paucity of research investigating factors that may contribute to IED. One factor that has been implicated in the development of this disorder is exposure to traumatic experiences. A study undertaken with a nationally representative sample in South Africa suggested that IED was related to exposure to multiple traumatic events (Fincham et al., 2009). A second study conducted in Timor-Leste (East Timor) suggested that high levels of trauma exposure was the strongest predictor of explosive anger attacks amongst survivors of human rights violations (Silove et al., 2009). Findings from these studies are consistent with the growing body of research suggesting that anger is prevalent amongst trauma survivors. Studies undertaken with combat veterans (Lasko et al., 1994, Novaco and Chemtob, 2002 and Jakupcak et al., 2007), victims of crime (Riggs et al., 1992 and Orth et al., 2008), refugees and post-conflict populations (Hinton et al., 2003, Hinton et al., 2009 and Silove et al., 2009), police and emergency service workers (Jayasinghe et al., 2008 and Meffert et al., 2008), and other trauma survivors (Orth and Wieland, 2006) have documented a strong relationship between trauma, PTSD and anger reactions. Further research is needed to determine the extent to which the link between the dosage of exposure to traumatic events, symptoms of posttraumatic stress and anger reactions extends to the explosive anger attacks defined in the clinical criteria of IED. Considering the typically early onset of IED (Kessler et al., 2006, Coccaro, 2010 and Yoshimasu and Kawakami, 2010), it is possible that traumatic events occurring early in life may have a particularly strong impact on the development of this disorder. Childhood trauma may interfere with normal biological and psychological developmental processes, and thus impair the ability of the survivor to successfully navigate the social environment as an adult. This may then manifest in emotion regulation and interpersonal difficulties in adulthood (Bremner and Vermetten, 2001, De Bellis, 2001, De Bellis et al., 2002, van der Kolk, 2003, Kinniburgh et al., 2005, Santa Ana et al., 2006, Cloitre et al., 2009 and Walter et al., 2010). Many studies have documented the association between childhood trauma and negative mental health outcomes, including depression and anxiety (Hovens et al., 2010), drug and alcohol use (Tucci et al., 2010 and Wu et al., 2010), suicidality (Sarchiapone et al., 2009), and borderline personality disorder (Herman et al., 1989 and McLean and Gallop, 2003). The timing of trauma, and particularly trauma occurring during childhood, may thus impact the development of IED. Further, research has highlighted the heterogeneous impact of various types of traumatic events on PTSD reactions. Studies have suggested that military traumas, as well as interpersonal traumatic events, such as sexual and physical assault, have stronger relations with PTSD than other types of traumatic events, such as motor vehicle accidents and crime (Amir et al., 1996, Frans et al., 2005, Hapke et al., 2006, Naifeh et al., 2008 and Kelley et al., 2009). Therefore, it is possible that the impact of age of first exposure to a traumatic event on IED may differ according to trauma type. The aim of the present study is to examine the impact of trauma exposure, PTSD and timing of trauma on IED in traumatized adults who had taken part in the National Comorbidity Survey-Replication (NCS-R). This study builds on past research to determine the extent to which trauma dosage, PTSD and timing of first exposure to trauma is related to IED in a nationally representative sample. We hypothesized that a) greater trauma exposure (i.e., dosage) would be related to increased likelihood of developing IED; and b) individuals who had first been exposed to trauma in childhood would be more likely to have a diagnosis of IED compared to those who had first experienced trauma in adulthood (controlling for trauma dosage effects and PTSD). We also explored the relationship between various types of traumatic events and IED.