تجربه طغیان پرخاشگرانه در اختلال انفجاری متناوب

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 (HC) (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.

Aggression, defined as behavior directed toward an individual with the intent to harm (Geen and Donnerstein, 1998) is a common occurrence, with over 80% of individuals engaging in some form of aggression in their lifetime (Newton et al., 2001). Homicide, aggression׳s most extreme point, is the second leading cause of death among individuals aged 15–24 (Xu et al., 2010) and lesser acts of violence are even more ubiquitous (Barratt et al., 1999). Thus, aggression is both ever-present and dangerous. Moreover, billions of dollars in productivity are lost yearly due to aggression and its consequences, so much so that the World Health Organization (2002) has identified aggression as a major public health concern. Despite this, the phenomenology and consequences of aggression are not well understood. Aggression can vary in both form and function. With respect to form, aggression can be verbal (e.g., yelling, heated arguments) or physical (e.g., assaults against people or property), with the verbal more common and the physical typically more severe in its consequences (Baron and Neuman, 1996). The function of aggression can also vary as aggressive acts can be predominately instrumental, in which aggression is a tool to achieve a goal not directly connected to anger (e.g., knocking someone down to rob them) or affective (i.e., reactive) where aggression is used express anger and/or retaliate (Anderson and Bushman, 2002). Though some have argued that a strict dichotomy based on these functions is not valid as most acts of aggression have both instrumental and affective aspects (Feshbach, 1964), research suggests the large majority of aggressive acts or predominately affective (Anderson et al., 1995 and Bushman and Anderson, 2001). As such, aggression is linked to the activation of the sympathetic nervous system, often producing the subjective experiences indicative of a “fight or flight” response such as racing heart, trembling, fear and/or rage, and feeling out of control (Böddeker and Stemmler, 2000). These emotional and physiological responses may be enhanced among more aggressive individuals, such as those with an aggressive disorder. Though several psychiatric disorders include aggression as a criterion, Intermittent Explosive Disorder (IED) is the sole psychological disorder defined by recurrent acts of affective aggression (DSM-5; American Psychiatric Association, 2013). Research on IED demonstrates that the frequency of the aggressive outbursts among individuals with IED is much higher than the general population with these individuals engaging in, on average, approximately 65–70 acts of assault and/or property destruction, causing over $1000 in damage and leading to multiple hospitalizations in their lifetime ( Coccaro, 2003, Kessler et al., 2006 and Kessler et al., 2011). Although the frequency of aggressive acts clearly differentiates individuals with and without IED, no study has assessed the extent to which the physiological and emotional experiences associated with an aggressive outburst differ among those with IED relative to other less aggressive clinical and non-clinical populations. Aggression can be harmful to the aggressor as well as the victim. Highly aggressive individuals tend to experience interpersonal difficulties such as damaged friendships (Deffenbacher et al., 1996), workplace difficulties (Bedi et al., 2013) and negative health consequences such as high blood pressure, heart disease, and stroke (McCloskey et al., 2010). Individuals with IED are more likely to engage in aggression in romantic relationships (O׳Leary et al., 2014), develop ulcers (Scott et al., 2013) and other more serious health problems (McCloskey et al., 2010), and show greater overall functional impairment relative to other psychiatric and non-psychiatric comparison groups (McCloskey et al., 2006). However individual with IED also tend to have global problems with emotion regulation (McCloskey et al., 2008a) and no published studies to date have examined the extent to which impaired psychosocial functioning (e.g., family problems, relationship problems, legal problems) in IED is specifically related to their aggressive behavior. To address these gaps in the literature, the current study investigated the phenomenology of aggressive outbursts in individuals with IED, as compared to individuals with other psychiatric disorders and healthy volunteers. Specifically, we looked at (1) subjective emotional and physical reactions before, during, and after an aggressive outburst and (2) the reported interpersonal and occupational consequences of aggressive outbursts. We hypothesized that individuals with IED will report higher levels of negative emotions, physical symptoms, and feelings of dyscontrol before and during the aggressive outburst, as well as more negative emotionality following the aggressive outburst than participants in the control groups. We also predicted that aggressive outbursts in IED will be associated with more negative interpersonal, occupational, and legal consequences than in the comparison groups.