اعتبار معیارهای جدید A1 و A2 برای اختلال انفجاری متناوب DSM-5

A disorder of impulsive aggression has been in the Diagnostic and Statistical Manual for Mental Disorders (DSM) since the first edition. In DSM-III, this disorder was codified as Intermittent Explosive Disorder (IED) and was thought to be rare. However, DSM criteria for IED were poorly operationalized and empiric research in IED was limited until the past decade when research criteria were developed. Subsequently, renewed interest in disorders of impulsive aggression led to a recent series of community based studies that have now documented IED to be as common as many other psychiatric disorders. Recent research indicates that the core of IED (A criteria) can be captured with new criteria that identify high frequency/low intensity aggressive outbursts (A1) and low frequency/hi intensity outbursts (A2). This paper presents new data regarding the phenomenology, comorbidity/life course of IED as a function of A1 and A2 criteria. Together with reanalysis of previously published data regarding family history, biomarkers, and treatment response in individuals with recurrent, problematic, impulsive aggression, these data provide empirical support for both A1 and A2 criteria for DSM-5 IED.

The construct for Intermittent Explosive Disorder (IED) has been in the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1956 [1]. In DSM-I and DSM-II, excessive reactivity to threat/environmental pressures was at the core of this disorder construct. In DSM I, this disorder was called “Passive–Aggressive Personality (Aggressive Type)” and was characterized as “persistent reaction to frustration with irritability, temper tantrums and destructive behavior". In DSM-II, this disorder became "Explosive Personality" in DSM-II (1968) and such individuals were characterized as “aggressive individuals” who displayed “intermittently violent behavior” and who were "generally excitable, aggressive, and over-responsive to environmental pressures" with "gross outbursts of rage or of verbal or physical aggressiveness different from their usual behavior." Despite these vivid descriptions, little empiric data existed on either “Passive–Aggressive Personality (Aggressive Type)” or on “Explosive Personality". This was also the case when DSM-III and DSM-IV Work Groups drew up, and then revised, operational criteria for IED, later, in the 1970s and 1990s, respectively.