Latent structure of intermittent explosive disorder in an epidemiological sample

Intermittent explosive disorder (IED) is characterized by distinct periods of impulsive aggression marked by assaultive acts or destruction of property. However, impulsive aggression is also a feature of other disorders, all of which are viewed in diagnostic nomenclature as qualitatively distinct from IED. This state of affairs is problematic for categorical models unless it is demonstrated empirically that IED-related impulsive aggression is qualitatively distinct from impulsive aggression observable in other axis I and II disorders. The current study addresses this question using taxometric methods to examine the latent structure of IED. Participants were respondents on the Collaborative Psychiatric Epidemiological Surveys, which obtained data on a range of disorders including intermittent explosive disorder (N = 20,013) and a range of psychological variables. Indicator variables used were drawn from the survey items and submitted to select taxometric methods (MAMBAC and MAXEIG) to determine the relative fits of a taxonic versus dimensional model. The results of taxometric analyses provided support for a taxonic, rather than dimensional, structure for IED symptoms in the epidemiological sample. Taxon group membership was associated with treatment seeking, family history of anger attacks, lower age of onset of anger attacks, and male biological sex, providing strong support for the validity of the IED taxon.     

Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US military veteran sample

This study examined the prevalence of intermittent explosive disorder (IED) and its associations with trauma exposure, posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a sample of trauma-exposed veterans (n = 232) with a high prevalence of PTSD. Structural associations between IED and latent dimensions of internalizing and externalizing psychopathology were also modeled to examine the location of IED within this influential structure. Twenty-four percent of the sample met criteria for a lifetime IED diagnosis and those with the diagnosis were more likely to meet criteria for lifetime PTSD than those without (30.3% vs. 14.3% respectively). Furthermore, regression analyses revealed lifetime PTSD severity to be a significant predictor of IED severity after controlling for combat, trauma exposure, and age. Finally, confirmatory factor analysis revealed significant cross-loadings of IED on both the externalizing and distress dimensions of psychopathology, suggesting that the association between IED and other psychiatric disorders may reflect underlying tendencies toward impulsivity and aggression and generalized distress and negative emotionality, respectively.     

Amygdala hyperactivation to angry faces in intermittent explosive disorder

BackgroundIndividuals with intermittent explosive disorder (IED) were previously found to exhibit amygdala hyperactivation and relatively reduced orbital medial prefrontal cortex (OMPFC) activation to angry faces while performing an implicit emotion information processing task during functional magnetic resonance imaging (fMRI). This study examines the neural substrates associated with explicit encoding of facial emotions among individuals with IED.MethodTwenty unmedicated IED subjects and twenty healthy, matched comparison subjects (HC) underwent fMRI while viewing blocks of angry, happy, and neutral faces and identifying the emotional valence of each face (positive, negative or neutral). We compared amygdala and OMPFC reactivity to faces between IED and HC subjects. We also examined the relationship between amygdala/OMPFC activation and aggression severity.ResultsCompared to controls, the IED group exhibited greater amygdala response to angry (vs. neutral) facial expressions. In contrast, IED and control groups did not differ in OMPFC activation to angry faces. Across subjects amygdala activation to angry faces was correlated with number of prior aggressive acts.ConclusionsThese findings extend previous evidence of amygdala dysfunction in response to the identification of an ecologically-valid social threat signal (processing angry faces) among individuals with IED, further substantiating a link between amygdala hyperactivity to social signals of direct threat and aggression.     

Suicide risk and suicide method in patients with personality disorders

ObjectiveThe influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method.MethodWe examined 25,217 individuals aged 15–64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987–2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk.ResultsOverall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3–39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3–33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity.ConclusionThe increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.     

伴人格障碍自杀未遂者临床特点研究

目的：探讨伴人格障碍自杀未遂者的临床特点。方法：对108名自杀未遂急诊入院的患者按CCMD-2-R进行人格障碍的诊断，分为伴人格障碍组和不伴人格障碍组，对两组的社会人口学资料和临床资料进行统计，并进行自杀意图量表及自杀企图冲动性和致死性的测定，将有关项目作对比分析。结果：有40（37.04％）名自杀未遂者伴发人格障碍，伴人格障碍自杀未遂者与不伴人格障碍自杀未遂者，有较多的既往自杀未遂史和精神科治疗史，自杀意图和自杀企图致死性较低，冲动性较高。结论：对伴人格障碍自杀未遂者应给予特别对待和积极治疗。     

Functions,lifetime frequency,and variety of methods of non-suicidal self-injury among college students

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.     

The role of parental psychopathology and personality in adolescent non-suicidal self-injury

Adolescent non-suicidal self-injury (NSSI), a significant risk factor for suicidal behavior, is strongly associated with adolescent psychopathology and personality traits, particularly those characterized by poor self-regulation. Some parental psychopathology and personality traits have also been identified as risk factors for adolescent NSSI, but specific parental characteristics and mechanisms involved in this association have not been systematically examined. The current study comprehensively investigated the contribution of parental psychopathology and personality to adolescent NSSI using data from the baseline wave of the Adolescent Development of Emotion and Personality Traits (ADEPT) study of 550 adolescent girls (mean age = 14.39 years, SD = 0.63) and their biological parents. We first investigated whether parental lifetime psychiatric diagnoses, and personality and clinical (rumination, self-criticism, emotional reliance) traits were associated with adolescent NSSI. We also tested whether adolescent history of psychiatric illness, personality, and clinical traits mediated the associations between parental characteristics and adolescent NSSI. Parental substance use disorder, adult-ADHD symptoms, self-criticism, and lower agreeableness and conscientiousness were associated with offspring's NSSI. These associations were mediated through adolescent characteristics. In contrast, parental mood and anxiety disorders and neuroticism were unrelated to adolescent NSSI. The results suggest that parental traits and disorders characterized by self-regulatory difficulties and lack of support constitute risk factors for self-injury in adolescent girls, acting via adolescent traits. This demonstrates that parental influences play a significant role in the etiology of adolescent NSSI.     

心智化家庭治疗对青少年抑郁障碍患者抑郁症状及非自杀性自伤行为的影响

背景青少年抑郁障碍患病率高,且患者多伴有非自杀性自伤（NSSI）行为。改善青少年抑郁障碍患者病情已成为临床关注的重点。目的 探讨心智化家庭治疗（MBFT）对青少年抑郁障碍患者抑郁症状及NSSI行为的影响,为促进青少年抑郁障碍患者康复提供参考。方法 于2022年1月—12月选取武汉市精神卫生中心收治的符合《国际疾病分类（第10版）》（ICD-10）抑郁障碍诊断标准的90例青少年抑郁障碍患者为研究对象,采用随机数字表法分为研究组（n=44）和对照组（n=46）。两组均接受常规干预,研究组在此基础上接受为期8周、每周1次、每次60 min的MBFT干预。分别于干预前和干预第1、2、4、8周末,对两组患者进行汉密尔顿抑郁量表24项版（HAMD-24）、自我效能感量表（GSES）、匹兹堡睡眠质量指数量表（PSQI）以及渥太华自我伤害调查表（OSI）评定。结果 重复测量方差分析结果显示,干预前和干预第1、2、4、8周末,两组HAMD-24评分（F=69.621、15.428、29.623,P均?0.05）、OSI总评分（F=176.642、37.682、21.873,P均?0.05）、GSES评分...     

The prevalence and correlates of intermittent explosive disorder in Iraq

Al‐Hamzawi A, Al‐Diwan JK, Al‐Hasnawi SM, Taib NI, Chatterji S, Hwang I, Kessler RC, McLaughlin KA. The prevalence and correlates of intermittent explosive disorder (IED) in Iraq. Objective: Intermittent explosive disorder is common, begins early in life, and is associated with considerable impairment in the United States. The epidemiology of IED outside the United States is unknown. We examined the prevalence and correlates of IED in Iraq, where exposure to violence has been widespread during the last three decades. Method: Data were drawn from a national survey of the Iraq population, the Iraq Mental Health Survey (IMHS), conducted in 2006–2007. The WHO Composite International Diagnostic interview was used to assess DSM‐IV disorders, including IED. The response rate was 95.2%. Results: Lifetime and 12‐month prevalence estimates of IED were 1.7% and 1.5%. Mean age of onset was 18.5. The mean number of lifetime attacks was 141.6 attacks, and IED‐related injuries occurred 61 times per 100 lifetime cases. IED was significantly comorbid with mood and anxiety, but not substance, disorders. Conclusion: Although the prevalence of IED is lower in Iraq than in the United States, the disorder has an early age of onset, is highly persistent, and is associated with substantial comorbidity and functional impairment. Iraq lacks national policies or systematic programmes to reduce aggression, highlighting the importance of implementing violence prevention programmes to reduce the societal burden of violence in Iraq.     

瑞典大学人格量表在强迫症患者中的应用

目的采用瑞典大学人格量表（SSP）探讨强迫症患者的人格特质及其与不同临床特征的关系。方法收集33例符合DSM-IV诊断标准的强迫症患者及31例健康对照,采用瑞典大学人格量表（SSP）评估两组样本的人格特质,采用Yale-Brown强迫量表（Y-BOCS）、汉密尔顿焦虑量表（HA-MA）和汉密尔顿抑郁量表（HAMD）评估强迫症患者临床特征。结果强迫症组躯体性焦虑、精神性焦虑、应激敏感性、怨恨、兴奋性和不信任分量表分别为57.70±11.64、63.19±10.41、66.77±10.31、61.14±7.56、54.09±9.13、57.15±11.57,健康对照组分别为46.18±8.30、52.08±8.42、55.79±7.69、56.37±7.92、48.03±7.69、51.59±9.97,强迫症组高于对照组,差异有统计学意义。其余分量表的差异无统计学意义。强迫症患者SSP社交愿望分与Y-BOCS总分呈正相关（r=0.349,P〈0.05）;躯体性焦虑、精神性焦虑和应激敏感性分与HAMA、HAMD总分呈正相关;社交愿望分与HAMA呈正相关;怨恨分与HAMD呈正相关。结论强迫症患者具有神经质和攻击性人格特质;强迫症患者的人格特质与强迫、焦虑和抑郁症状之间可能存在一定的相关性。     

Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide

This study examined clinical characteristics and laboratory-measured impulsive behavior of adolescents engaging in either non-suicidal self-injury with (NSSI + SA; n = 25) or without (NSSI-Only; n = 31) suicide attempts. We hypothesized that adolescent with NSSI + SI would exhibit more severe clinical symptoms and higher levels of behavioral impulsivity compared to adolescents with NSSI-Only. Adolescents were recruited from an inpatient psychiatric hospital unit and the two groups were compared on demographic characteristics, psychopathology, self-reported clinical ratings, methods of non-suicidal self-injury, and two laboratory impulsivity measures. Primary evaluations were conducted during psychiatric hospitalization, and a subset of those tested during hospitalization was retested 4–6 weeks after discharge. During hospitalization, NSSI + SA patients reported worse depression, hopelessness, and impulsivity on standard clinical measures, and demonstrated elevated impulsivity on a reward-directed laboratory measure compared to NSSI-Only patients. In the follow-up analyses, depression, hopelessness, suicidal ideation, and laboratory impulsivity were improved for both groups, but the NSSI + SA group still exhibited significantly more depressive symptoms, hopelessness, and impulsivity than the NSSI-Only group. Risk assessments for adolescents with NSSI + SA should include consideration not only of the severity of clinical symptoms but of the current level impulsivity as well.     

首次住院的青少年抑郁障碍患者非自杀性自伤行为与冲动性的关系

目的 探讨伴有非自杀性自伤（NSSI）行为的青少年抑郁障碍患者在冲动性方面的特征,分析NSSI行为与冲动性的关系,以便早期识别有NSSI行为风险的患者并及时干预。方法 采取顺序入组的方式,选取在深圳市康宁医院首次住院的青少年抑郁障碍患者共53例,根据《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准评估患者有无NSSI行为,将患者分为伴NSSI行为组（n=30）和不伴NSSI行为组（n=23）。采用汉密尔顿抑郁量表17项版（HAMD-17）、青少年自我伤害问卷和Barratt冲动性量表（BIS-11）评定患者抑郁情绪、自伤严重程度和冲动性。结果 伴NSSI行为组HAMD-17评分[（25.50±4.10）分vs.(21.43±4.64)分,t=3.379,P<0.01]、BIS-11运动冲动性[（51.67±15.95）分vs.(38.70±14.90)分,t=3.018,P<0.01]、认知冲动性[（52.75±13.22）分vs.(43.37±18.40)分,t=2.161,P<0.05]、无计划冲动性[（68.00±15.32）分vs.(50.76±21...     

Prevalence of suicidal and self-injurious behavior among subjects with intermittent explosive disorder

The prevalence of suicidal attempts and self-injurious behavior among 376 subjects diagnosed with Intermittent Explosive Disorder (IED) was assessed via structured interviews. Results showed 16% of IED subjects reported self-aggression, with 12.5% reporting suicide attempts and 7.4% reporting non-lethal self-injurious behaviors. Additional risk factors were identified.     

Temperament,character and personality disorders

ObjectiveTo study, whether temperament and character remain stable over time and whether they differ between patients with and without personality disorder (PD) and between patients with specific PDs.MethodsPatients with (n = 225) or without (n = 285) PD from Jorvi Bipolar Study, Vantaa Depression Study (VDS) and Vantaa Primary Care Depression Study were interviewed at baseline and at 18 months, and in the VDS also at 5 years. A general population comparison group (n = 264) was surveyed by mail.ResultsCompared with non-PD patients, PD patients scored lower on self-directedness and cooperativeness. Cluster B and C PDs associated with high Novelty Seeking and Harm Avoidance, respectively. In logistic regression models, sensitivity and specificity of Temperament and Character Inventory (TCI) dimensions for presence of any PD were 53% and 75%, and for specific PDs from 11% to 41% and from 92% to 100%, respectively. The 18-month test-retest correlations of TCI-R dimensions ranged from 0.58 to 0.82.ConclusionsMedium-term temporal stability of TCI in a clinical population appears good. Character scores differ markedly between PD and non-PD patients, whereas temperament scores differ only somewhat between the specific PDs. However, the TCI dimensions capture only a portion of the differences between PD and non-PD patients.     

Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis

BACKGROUNDDifferential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD), but clinical assessments often omit screening for personality disorders (PD), which are especially common in individuals with high-functioning ASD where there is less need for support.AIMTo summarize the research findings on PD in adults with ASD and without intellectual disability, focusing on comorbidity and differential diagnosis. METHODSPubMed searches were performed using the key words “Asperger’s Syndrome”, “Autism”, “Personality”, “Personality disorder” and “comorbidity” in order to identify relevant articles published in English. Grey literature was identified through searching Google Scholar. The literature reviews and reference sections of selected papers were also examined for additional potential studies. The search was restricted to studies published up to April 2020. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTSThe search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria: 16 evaluated personality profiles or PD in ASD (comorbidity), five compared ASD and PD (differential diagnosis) and one performed both tasks. There were significant differences in the methodological approaches, including the ASD diagnostic instruments and personality measures. Cluster A and cluster C PD are the most frequent co-occurring PD, but overlapping features should be considered. Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSIONASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Further studies are needed to explore the complex relationship between ASD and PD.     

青少年抑郁障碍患者非自杀性自伤行为诊断性预测模型的建立及验证

目的 建立青少年抑郁障碍患者非自杀性自伤（NSSI）行为诊断性预测模型,以期对青少年抑郁障碍患者NSSI行为的早期识别提供参考。方法 回顾性分析2021年1月1日-12月31日在深圳市康宁医院儿少科住院的抑郁障碍患者（n=366）临床资料。根据《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准,将患者分为伴NSSI行为组（n=289）和不伴NSSI行为组（n=77）。将366例患者按7∶3随机分为训练集（n=258）和验证集（n=108）。使用Logistic回归分析筛选青少年抑郁障碍患者NSSI行为的独立危险因素,建立预测模型。使用受试者工作特征（ROC）曲线下面积（AUC）评估训练集和验证集模型的区分度,使用校准曲线评估训练集和验证集模型的校准度,使用Homser-Lemeshow(HL)检验评估模型的拟合优度,使用临床决策分析（DCA）曲线评价模型的临床获益情况。结果 性别（β=1.734,OR=5.561,95%CI:2.678～11.964）、受教育程度（β=0.864,OR=2.737,95%CI:1.174～4.795）、自杀未遂史（β=0.932,OR=2.53...     

Intermittent explosive disorder-integrated research diagnostic criteria: convergent and discriminant validity

Research on intermittent explosive disorder (IED) has been hindered by vague and restrictive DSM-IV diagnostic criteria. Integrated research criteria have been developed for IED (IED-IR) that address the DSM-IV criteria's shortcomings. The purpose of this study was to examine the convergent and discriminant validity of the IED-IR criteria set by comparing adults meeting these criteria (n=56) to healthy controls (n=56) and to individuals with an Axis I major mental disorder (n=33) or an Axis II personality disorder (n=22) diagnoses on measures of aggression (self-report and behavioral) and global functioning. IED-IR individuals demonstrated higher levels of aggression compared to the other three groups, and were rated as more impaired than the healthy control and Axis I individuals. Subgroup analyses showed that IED-IR subjects who did not meet DSM IED criteria did not differ from DSM IED subjects on self-report measures of aggressiveness or global functioning. Furthermore, the IED-IR subjects evidenced more behavioral aggression than their DSM-IED counterparts.     

精神分裂症暴力行为与人格问题关系的神经影像学研究

精神分裂症患者暴力行为的发生有一定的异质性,阳性精神病症状并不能完全解释其暴力起源。近年的研究开始关注人格障碍在精神分裂症暴力行为中的作用,影像学技术的应用促进了该类研究有了新的进展。现就精神分裂症暴力与人格关系的影像学研究进展进行综述。     

Substance use disorders: Relationship with intermittent explosive disorder and with aggression,anger, and impulsivity

BackgroundA relationship between substance use and aggression has been noted for decades. While substance use appears to be associated with an increased risk of aggressive behavior, no study has yet reported on the pattern of comorbidity and temporal relationship between impulsive aggression (i.e., intermittent explosive disorder) and substance use disorders (SUD), specifically.MethodsTo specify these relationships, we examined DSM-5 diagnosis data from diagnostic interviews of 1355 adults who met one of five non-overlapping diagnostic subgroups: those with intermittent explosive disorder (IED; n = 339), those with SUD (n = 136), IED+SUD (n = 280), adults with psychiatric disorders but no SUD or IED (n = 320), and healthy Controls: HC, n = 282).ResultsOccurrence of lifetime SUD was elevated in IED vs. all Non-IED subjects (Odds Ratio: 3.61 [95% CI: 2.82–4.63]) and onset of IED preceded SUD in 80% of comorbid IED+SUD cases. Examination of the severity of impulsive aggression and SUD revealed that IED increased SUD severity but the presence of SUD did not increase severity of IED core features, including aggression, anger, or impulsivity.ConclusionsSubjects with IED are at increased risk of developing substance use disorder, compared to those without IED. This suggests that history of recurrent, problematic, impulsive aggression is a risk factor for the later development of SUD rather than the reverse. Thus, effective treatment of impulsive aggression, before the onset of substance misuse, may prevent or delay the development of SUD in young individuals.