Lifetime and 1-month prevalence rates of intermittent explosive disorder in a community sample

Objective: To determine the lifetime and 1-month prevalence of intermittent explosive disorder (IED) by both DSM-IV and research criteria in a community sample. Method: The final 253 (34.1%) of individuals who were entered into the Hopkins Epidemiology Study of Personality Disorder and sampled in the context of a follow-up study of participants from the Baltimore Epidemiologic Catchment Area (ECA) study completed a supplemental interview that allowed for the determination of IED by DSM-IV and/or research criteria. Results: The mean ± SE percentage of subjects who met inclusion criteria was 11.07% ± 1.97%, and 6.32% ± 1.53% met full criteria, for lifetime IED by either diagnostic criteria set; 2.37% ± 0.96% met full criteria for IED within the previous 1 month. Adjusting the prevalence rates to account for differential sampling from the original ECA study did not substantially affect these results. Onset of problematic aggressive behavior in IED subjects (described as life-long in most subjects) began as early as childhood, peaked in the third decade, and declined steadily after the fifth decade. While distress and/or impairment due to aggressive behavior was documented in 87.5% of IED subjects, only 12.5% of IED subjects reported seeking help for this problem. Conclusions: Intermittent problematic aggressive behavior in the community, as defined by IED, may be far more common than previously thought. Conservatively estimated, the number of individuals in the United States with IED, based on these data, may be no lower than 1.4 million for current IED or nearly 10 million for lifetime IED.