ANXIOUS AND AGGRESSIVE: THE CO-OCCURRENCE OF IED WITH ANXIETY DISORDERS
Corresponding Author
Katherine M. Keyes Ph.D.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Correspondence to: Katherine M. Keyes, Department of Epidemiology, Mailman School of Public Health, Columbia University 722 West 168th Street, Suite 503, New York, NY 10032.
E-mail: [email protected]
Search for more papers by this authorKatie A. McLaughlin Ph.D.
Department of Psychology, University of Washington, Seattle, Washington
Search for more papers by this authorThomas Vo M.P.H.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Search for more papers by this authorTodd Galbraith Ph.D.
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Search for more papers by this authorRichard G. Heimberg Ph.D.
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Search for more papers by this authorCorresponding Author
Katherine M. Keyes Ph.D.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Correspondence to: Katherine M. Keyes, Department of Epidemiology, Mailman School of Public Health, Columbia University 722 West 168th Street, Suite 503, New York, NY 10032.
E-mail: [email protected]
Search for more papers by this authorKatie A. McLaughlin Ph.D.
Department of Psychology, University of Washington, Seattle, Washington
Search for more papers by this authorThomas Vo M.P.H.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Search for more papers by this authorTodd Galbraith Ph.D.
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Search for more papers by this authorRichard G. Heimberg Ph.D.
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Search for more papers by this authorContract grant sponsor: National Institutes of Health; Contract grant number: AA021511; Contract grant number: MH092526.
Abstract
Background
Evidence suggests that impulsive aggression and explosive anger are common among individuals with anxiety disorders; yet, the influence of intermittent explosive disorder (IED) on the onset, course, consequences, and patterns of comorbidity among those with anxiety disorders is unknown.
Methods
Data were drawn from the National Comorbidity Survey Replication (N = 9,282) and Adolescent Supplement (N = 9,632), nationally representative surveys conducted between 2001 and 2004. Diagnoses were based on structured lay-administered interviews. Lifetime diagnoses were assessed with structured instruments. Outcomes included comorbidity, functional and role impairment, and treatment utilization.
Results
Adolescents with a lifetime anxiety disorder had a higher prevalence of a lifetime anger attacks (68.5%) and IED (22.9%) than adolescents without a lifetime anxiety disorder (48.6 and 7.8%, respectively), especially social phobia and panic disorders. Similar elevation was found for adults. Age of onset and course of anxiety disorders did not differ by IED. Severe functional impairment associated with anxiety was higher among adolescents (39.3%) and adults (45.7%) with IED than those without IED (29.2 and 28.2%, respectively). Comorbidity for all other disorders was elevated. However, individuals with anxiety disorders and IED were no more likely to use treatment services than those with anxiety disorders without IED.
Conclusions
Individuals with IED concomitant to anxiety disorder, especially social phobia and panic, are at marked risk for worse functional impairment and a higher burden of comorbidity, but onset and course of anxiety disorder do not differ, and those with anxiety and IED are no more likely to utilize treatment services. Assessment, identification, and specialized treatment of anger in the context of anxiety disorders are critical to reducing burden.
Supporting Information
Disclaimer: Supplementary materials have been peer-reviewed but not copyedited.
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REFERENCES
- 1McLaughlin KA, Green JG, Hwang I, et al. Intermittent explosive disorder in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2012; 69: 1131–1139.
- 2Coccaro EF. Intermittent explosive disorder. Curr Psychiatry Rep 2000; 2: 67–71.
- 3McCloskey MS, Kleabir K, Berman ME, et al. Unhealthy aggression: intermittent explosive disorder and adverse physical health outcomes. Health Psychol 2010; 29: 324–332.
- 4Kessler RC, Coccaro EF, Fava M, et al. The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006; 63: 669–678.
- 5Coccaro EF, Posternak MA, Zimmerman M. Prevalence and features of intermittent explosive disorder in a clinical setting. J Clin Psychiatry 2005; 66: 1221–1227.
- 6Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011; 68: 90–100.
- 7Kashdan TB, Collins RL. Social anxiety and the experience of positive emotion and anger in everyday life: an ecological momentary assessment approach. Anxiety Stress Coping 2010; 23: 259-72.
- 8Moscovitch DA, McCabe RE, Antony MM, et al. Anger experience and expression across the anxiety disorders. Depress Anxiety 2008; 25: 107–113.
- 9Kashdan TB, McKnight PE. The darker side of social anxiety: when aggressive impulsivity prevails over shy inhibition. Curr Dir Psychol Sci 2010; 19: 47–50.
- 10Breen WE, Kashdan TB. Anger suppression after imagined rejection among individuals with social anxiety. J Anxiety Disord 2011; 25: 879–887.
- 11Schaeffer CM, Petras H, Ialongo N, et al. Modeling growth in boys’ aggressive behavior across elementary school: links to later criminal involvement, conduct disorder, and antisocial personality disorder. Dev Psychol 2003; 39: 1020–1035.
- 12Gross JJ. Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J Pers Soc Psychol 1998; 74: 224–237.
- 13Galbraith T, Heimberg RG, Wang S, et al. Comorbidity of social anxiety disorder and antisocial personality disorder in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). J Anxiety Disord 2014; 28: 57–66.
- 14Fettich KC, McCloskey MS, Look AE, Coccaro EF. Emotion regulation deficits in intermittent explosive disorder. Aggress Behav 2014. doi: 10.1002/AB.21566. [Epub ahead of print]
- 15Blanchard-Fields F, Coats AH. The experience of anger and sadness in everyday problems impacts age differences in emotion regulation. Dev Psychol 2008; 44: 1547–1556.
- 16Kashdan TB, Hofmann SG. The high-novelty-seeking, impulsive subtype of generalized social anxiety disorder. Depress Anxiety 2008; 25: 535–541.
- 17Kessler RC, Merikangas KR. The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res 2004; 13: 60–68.
- 18Kessler RC, Avenevoli S, Costello EJ, et al. National comorbidity survey replication adolescent supplement (NCS-A): II. Overview and design. J Am Acad Child Adolesc Psychiatry 2009; 48: 380–385.
- 19Kessler RC, Avenevoli S, Costello EJ, et al. Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Int J Methods Psychiatr Res 2009; 18: 69–83.
- 20Kessler RC, Ustun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93–121.
- 21Kessler RC, Avenevoli S, Green J, et al. National comorbidity survey replication adolescent supplement (NCS-A): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments. J Am Acad Child Adolesc Psychiatry 2009; 48: 386–399.
- 22Kessler RC, Abelson J, Demler O, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 122–139.
- 23Ahmed AO, Green BA, McCloskey MS, Berman ME. Latent structure of intermittent explosive disorder in an epidemiological sample. J Psychiatr Res 2010; 44: 663–672.
- 24McCloskey MS, Lee R, Berman ME, et al. The relationship between impulsive verbal aggression and intermittent explosive disorder. Aggress Behav 2008; 34: 51–60.
- 25 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
- 26Perlis RH, Smoller JW, Fava M, et al. The prevalence and clinical correlates of anger attacks during depressive episodes in bipolar disorder. J Affect Disord 2004; 79: 291–295.
- 27First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.
- 28Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36: 980–988.
- 29Bird HR, Gould MS, Staghezza B. Aggregating data from multiple informants in child psychiatry epidemiological research. J Am Acad Child Adolesc Psychiatry 1992; 31: 78–85.
- 30Braaten EB, Biederman J, DiMauro A, et al. Methodological complexities in the diagnosis of major depression in youth: an analysis of mother and youth self-reports. J Child Adolesc Psychopharmacol 2001; 11: 395–407.
- 31Leon AC, Olfson M, Portera L, et al. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 1997; 27: 93–105.
- 32Kashdan TB, McKnight PE, Richey JA, Hofmann SG. When social anxiety disorder co-exists with risk-prone, approach behavior: investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication. Behav Res Ther 2009; 47: 559–568.
- 33Linehan MM, Bohus M, Lynch TR. Dialectical behavior therapy for pervasive emotion dysregulation. In: JJ Gross, editor. Handbook of Emotion Regulation. New York: Guilford Press; 2007: 581–605.
- 34Denson T. The multiple systems model of angry rumination. Pers Soc Psychol Rev 2013; 17: 103–123.
- 35Coccaro EF, McCloskey MS, Fitzgerald DA, Phan KL. Amygdala and orbitofrontal reactivity to social threat in individuals with impulsive aggression. Biol Psychiatry 2007; 62: 168–178.
- 36Coccaro EF. A family history study of intermittent explosive disorder. J Psychiatr Res 2010; 44: 1101–1105.
- 37Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry 2001; 158: 1568–1578.
- 38Boylan JM, Ryff CD. Varieties of anger and the inverse link between education and inflammation: toward an integrative framework. Psychosom Med 2013; 75: 566–574.
- 39Dougherty DD, Rauch SL, Deckersbach T, et al. Ventromedial prefrontal cortex and amygdala dysfunction during an anger induction positron emission tomography study in patients with major depressive disorder with anger attacks. Arch Gen Psychiatry 2004; 61: 795–804.
- 40Monk CS, Telzer EH, Mogg K, et al. Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Arch Gen Psychiatry 2008; 65: 568–576.
- 41Kimbrell TA, George MS, Parekh PI, et al. Regional brain activity during transient self-induced anxiety and anger in healthy adults. Biol Psychiatry 1999; 46: 454–465.
- 42Marks I, Nesse RM. Fear and fitness: an evolutionary analysis of anxiety disordersq. Ethnol Sociobiol 1994; 15(5-6): 247–261.
- 43Cloitre M, Stovall-McClough KC, Nooner K, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry 2010; 167: 915–924.
- 44Lejoyeux M, Feuche N, Loi S, et al. Study of impulse-control disorders among alcohol-dependent patients. J Clin Psychiatry 1999; 60: 302–305.
- 45Bolton J, Cox B, Clara I, Sareen J. Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. J Nerv Ment Dis 2006; 194: 818–825.
- 46Odgers CL, Caspi A, Nagin DS, et al. Is it important to prevent early exposure to drugs and alcohol among adolescents? Psychol Sci 2008; 19: 1037–1044.
- 47Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 593–602.
- 48Kessler RC, Avenevoli S, McLaughlin KA, et al. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med 2012; 42: 1997–2010.
- 49Zimmerman M, Mattia JI. Principal and additional DSM-IV disorders for which outpatients seek treatment. Psychiatr Serv 2000; 51: 1299–1304.
- 50Coccaro EF, Lee RJ, Kavoussi RJ. A double-blind, randomized, placebo-controlled trial of fluoxetine in patients with intermittent explosive disorder. J Clin Psychiatry 2009; 70: 653–662.
- 51Keyes KM, Liu C. Age, birth cohort, and period effects in psychiatric disorders in the USA. In: K Koenen, S Rudenstine, E Susser, S Galea, editors. A Life Course Approach to Mental Disorders. New York: Oxford University Press; 2014: 46–60.
- 52McCloskey MS, Berman ME, Noblett KL, Coccaro EF. Intermittent explosive disorder-integrated research diagnostic criteria: convergent and discriminant validity. J Psychiatr Res 2006; 40: 231–242.
- 53Gould RA, Ball S, Kaspi SP, et al. Prevalence and correlates of anger attacks: a two site study. J Affect Disord 1996; 39: 31–38.
- 54Coccaro EF, Kavoussi RJ, Berman ME, Lish JD. Intermittent explosive disorder-revised: development, reliability, and validity of research criteria. Compr Psychiatry 1998; 39: 368–376.
