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Emil F. Coccaro - One of the best experts on this subject based on the ideXlab platform.

  • gene expression in peripheral blood mononuclear cells in impulsive aggression Intermittent Explosive Disorder compared with non aggressive healthy and psychiatric controls
    Psychoneuroendocrinology, 2021
    Co-Authors: Emil F. Coccaro, Michael R Irwin, Jesusa M G Arevalo, Thomas Dizon, Steven W Cole
    Abstract:

    Abstract Evidence of chronic, systemic, low levels of inflammation is present in several stress-related psychiatric conditions including schizophrenia, depression, and Intermittent Explosive Disorder (IED). We analyzed leukocyte gene expression (mRNA) to quantify the activity of pro and anti-inflammatory signaling pathways. Work performed in non-aggressive populations has uncovered a Conserved Transcriptional Response to Adversity (CTRA) characterized by an upregulation of pro-inflammatory gene transcription in chronically stressed individuals. We used pathway-based bioinformatic analyses of genome-wide transcriptional profiles of peripheral blood leukocyte samples from IED study participants (N = 45) and controls [healthy (n = 45) and psychiatric (n = 34)], with analyses focusing on the pro-inflammatory transcription control pathway mediated by the NF-kB family of transcription factors (typically upregulated in CTRA) and the antiviral transcription control pathway mediated by anti-viral response (IRF) family transcription factors (typically downregulated in CTRA). Compared with both healthy and psychiatric controls, individuals with IED had upregulated transcriptional activity of the antiviral response (IRF), but no evidence of pro-inflammatory NF-kB activation. Analyses implicated CD4+ T cells, CD8+ T cells, and B lymphocytes in IED-related transcriptional alterations, but showed no significant indication of monocyte involvement. This suggests that the inflammatory profile of IED differs substantially from that observed previously in other stress-related Disorders, and may involve a pathogen-driven adaptive immune etiology.

  • neural responses to induced emotion and response to social threat in Intermittent Explosive Disorder
    Psychiatry Research-neuroimaging, 2021
    Co-Authors: Nicole Ogbuagu, Luan K Phan, Sarah K Keedy, Emil F. Coccaro
    Abstract:

    Abstract Background : Individuals with Intermittent Explosive Disorder (IED) are reported to exhibit amygdala (AMYG) hyper-activation to anger faces during functional magnetic resonance imaging (fMRI). However, it remains unknown if emotional experience is different in study participants with IED compared with healthy controls (HC). Thus, we examined the comparative effect of pleasant and unpleasant IAPS pictures in IED and HC individuals. Method : Eighty study participants (40 IED and 40 HC) underwent fMRI scanning while viewing blocks of angry and happy faces and while viewing blocks of pleasant and unpleasant pictures from the International Affective Picture System (IAPS). Results : Compared with HC participants, IED participants exhibited greater AMYG responses to angry, but not happy, faces; IED and HC participants, however, did not differ in AMYG responses to pleasant or unpleasant IAPS pictures. There were no group differences in Orbital-Frontal Cortical (OFC) responses to emotional faces or IAPS pictures other than a significantly higher OFC response pleasant, compared with unpleasant, IAPS pictures. Conclusion : These findings suggest that, compared with healthy individuals, those with IED have a hypersensitive amygdala to social-emotional threat but that this characteristic does not extend to neural responses related to the experience of emotion in the context of the paradigms tested.

  • emotion attribution in Intermittent Explosive Disorder
    Comprehensive Psychiatry, 2021
    Co-Authors: Michaela S Patoilo, Mitchell E Berman, Emil F. Coccaro
    Abstract:

    Abstract Background Accurate recognition of the emotions of others is an important part of healthy neurological development and promotes positive psychosocial adaptation. Differences in emotional recognition may be associated with the presence of emotional biases and can alter one's perception, thus influencing their overall social cognition abilities. The present study aims to extend our collective understanding of emotion attribution abnormalities in individuals with Intermittent Explosive Disorder (IED). Methods Two-hundred and forty-two adults participated, separated into groups of those diagnosed with IED according to DSM 5 criteria, Psychiatric Controls (PC), and Healthy Controls (HC). Participants completed a modified version of the Emotional Attribution Task wherein they attributed an emotion to the main character of a short vignette. Results Participants with IED correctly identified anger stories and misattributed anger to non-anger stories significantly more often than PC and HC participants. They were also significantly less likely than HC participants to correctly identify “sad stories.” Limitations We utilized self-report assessments in a community-recruited sample. Replication in a clinical is suggested. Conclusions Findings from this study support the validity of IED as a diagnostic entity and provide important information about how individuals with psychiatric Disorders perceive and experience emotional cues.

  • evidence for the taxonic latent structure for dsm 5 Intermittent Explosive Disorder in adults
    Psychological Medicine, 2021
    Co-Authors: Jennifer R Fanning, David K Marcus, Jonathan Preszler, Emil F. Coccaro
    Abstract:

    BACKGROUND Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) Intermittent Explosive Disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum. METHODS This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 Disorders (n = 293), and adults without any DSM-5 Disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies. RESULTS Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results. CONCLUSION These findings support the proposition that DSM-5 IED represents a distinct behavioral Disorder rather than the severe end of an aggressive behavior continuum.

  • comorbidity of disruptive behavior Disorders and Intermittent Explosive Disorder
    Child and Adolescent Psychiatry and Mental Health, 2020
    Co-Authors: Karam Radwan, Emil F. Coccaro
    Abstract:

    Aggressive behavior in children and adolescents may be accounted for by several disruptive behavioral Disorders (DBD) including attention-deficit/hyperactive (ADHD), conduct (CD), and oppositional defiant (ODD), Disorders and Intermittent Explosive Disorder (IED). The comorbidity among the DBDs is well known, but not its comorbidity with IED. We reanalyzed data from the National Comorbidity Studies (adolescents and adults), and from a large clinical research adult sample, to estimate the comorbidity of IED with each of the DBDs and to explore correlates of these comorbidities. The rate of current comorbidity between IED and the DBDs ranged from 10 to 19%, in adolescents (5–14% in adults) with odds ratios of about five. The onset of ADHD typically appeared before onset of IED while onset ODD and CD more typically appeared before that of IED in adolescents and about equally before or after IED in adults but IED persisted outside the duration window in many (ADHD) or most (ODD, CD) cases. Measures of impulsive aggression severity were highest in those with IED+DBD but relatively low in those with DBD alone while measures of DBD severity were highest in those with DBD alone and in those with IED+DBD. Despite the comorbidity of IED with the DBDs, IED can be separated from the DBDs over time and in terms of severity measures of IED and of DBD. Overall, impulsive aggression varies with IED while DBD behaviors vary with DBD. Based on this, clinicians should consider IED in their differential in the workup of impulsively aggressive children and adolescents.

Royce Lee - One of the best experts on this subject based on the ideXlab platform.

  • subtypes of aggression in Intermittent Explosive Disorder
    Journal of Psychiatric Research, 2019
    Co-Authors: Jennifer R Fanning, Royce Lee, Morgan Coleman, Emil F. Coccaro
    Abstract:

    Research in aggression has distinguished two major subtypes of aggressive behavior: hostile and instrumental. Previous research has examined these subtypes in healthy individuals and forensic samples but not in Intermittent Explosive Disorder (IED), a Disorder characterized by recurrent and severe aggressive behavior. We examined aggression subtypes in individuals with IED, healthy subjects, and psychiatric control subjects. We also considered the relationship between aggression subtypes and measures of trait anger and impulsivity to evaluate whether the hostile/instrumental dichotomy adequately captures the heterogeneity of aggressive behavior in this sample. Finally, we consider the implications of these results for research on aggression, including neuroscience research on aggression.

  • Pharmacologic Treatment of Intermittent Explosive Disorder
    Intermittent Explosive Disorder, 2019
    Co-Authors: Royce Lee, Jennifer Wang, Emil F. Coccaro
    Abstract:

    Abstract This chapter will cover the pharmacological treatment of Intermittent Explosive Disorder (IED) and impulsive aggression. It will primarily focus on the treatment of impulsive aggression in adults. The first section will review the theoretical and clinical framework of pharmacological treatment. The second section will review data from randomized, placebo-controlled trials of pharmacological approaches. The third and final section will review ethical, regulatory, and safety issues.

  • neurotransmitters and Intermittent Explosive Disorder
    2019
    Co-Authors: Royce Lee, Emil F. Coccaro
    Abstract:

    Abstract According to the SEIP/predictive coding framework, neurotransmitters and neuromodulators have a role as signaling molecules in circuits that enable social interaction. Depending on the balance of stress demands on the system and its biological vulnerabilities, variability can be seen in the balance of facilitation versus restraining of aggression. Neurobiological research has pointed to disturbed serotonin signaling in impulsive aggression. Impulsive aggression is indeed caused by serotonin dysregulation but in distinct, receptor-specific pathways. Recent research has not provided evidence to the contrary, but has rather expanded the network of connections to serotonin to distributed brain circuits and even out into the body in immune and intracellular signaling cascades. In total, the resulting neurobiological portrait of IED is of a person with a lifelong history of angry outbursts, with evidence of disturbed, stress-related 5-HT signaling. This 5-HT dysfunction worsens the very system that can regulate stress reactivity, centered on hubs in the prefrontal cortex. Contributing to this positive feedback loop may be an overtaxed immune system, tasked with cleaning up the metabolically costly synaptic downsides of stress. Despite progress in understanding the basic biological mechanism of IED, many unanswered questions remain regarding the role of neurotransmitters and neuromodulators. The task is daunting, because the brain is an enormously complicated system; its functions are not captured simply. System-based approaches have increasingly been called on in the treatment of other complex medical Disorders and will likely be required to understand and treat IED. Neurotransmitter and neuromodulator signaling systems have a key role in how brain circuits learn about social interaction over time. This work can be considered as part of the larger effort to understand IED as a brain-based Disorder of interpersonal reactivity.

  • social desirability deceptive reporting and awareness of problematic aggression in Intermittent Explosive Disorder compared with non aggressive healthy and psychiatric controls
    Psychiatry Research-neuroimaging, 2018
    Co-Authors: Diana M Steakleyfreeman, Royce Lee, Michael Mccloskey, Emil F. Coccaro
    Abstract:

    Individuals with DSM-5 Intermittent Explosive Disorder (IED) are often suspected of minimizing the nature of their recurrent, problematic, impulsive aggressive behavior due to the social undesirability of these behaviors. Our first study involved 400 study participants categorized as Healthy Controls (HC), Psychiatric Controls (PC) and as having IED and included the Crowne-Marlowe Social Desirability Scale (SDS), the Lie Scale from the Eysenck Personality Questionnaire-Revised (EPQ-R Lie), and the Readiness to Change (Anger) Questionnaire (RTC). IED study participants had lower SDS and lower EPQ-R Lie scores, while having higher RTC scores, compared with both HC and PC study participants. Thus, when studied in a clinical research setting, IED study participants do not provide socially desirable answers to questions and do not engaging in deceptive reporting; likely because they have recognized their need/interest in reducing their own impulsive aggressive behavior. The second study, part of a family study of 70 probands and their first-degree relatives revealed a very high positive (96.3%), but substantially lower negative (55.8%), predictive power for IED based on informant report. This suggests that, while interview of close informants can confirm the diagnosis of IED, informant interviews cannot rule out IED when such informants provide a negative report.

  • comorbidity of personality Disorder with Intermittent Explosive Disorder
    Journal of Psychiatric Research, 2018
    Co-Authors: Emil F. Coccaro, Carolyn Shima, Royce Lee
    Abstract:

    There is ambiguity in how recurrent anger and aggression are accounted for by psychiatric nosology. One area of uncertainty is the extent to which Intermittent Explosive Disorder (IED) overlaps with and is distinct from Personality Disorder (PD). Accordingly, we conducted a study of individuals with IED and PD in order to understand the nature of comorbidity relationships seen across these two areas of psychopathology. One-thousand-five-hundred-twenty-one adults were studied (441 Healthy Controls (HC), 430 Psychiatric Controls (PC), and 650 IED subjects) and assessed for DSM-5 psychiatric Disorders, life history of aggressive behavior, trait aggression, state and trait anger reactivity, and impulsivity. While nearly half of IED study participants had a comorbid PD diagnosis, nearly half with a Cluster B PD, almost as many had other personality Disorders. IED predicted anger symptoms and history of aggressive behavior above and beyond a PD diagnosis. Comorbidity between IED and either Antisocial (AsPD) or Borderline (BPD) PD was associated with the highest levels of aggressive behavior. However, having IED comorbid with either AsPD and/or BPD PD was not associated with higher levels of impulsivity. Underlying personality traits related to anger, affect, and social behavior, but not identity disturbance, contribute to the shared symptom profile of IED and PD. IED is usually comorbid with PD, but does not have a unique relationship with any single PD. When comorbid with PD, a diagnosis of IED predicts more severe anger and aggression, but not necessarily increased impulsivity. These results suggest that IED and PD diagnoses retain clinical utility when made in cases meeting criteria for both.

Michael Mccloskey - One of the best experts on this subject based on the ideXlab platform.

  • History of childhood abuse and alcohol use Disorder: Relationship with Intermittent Explosive Disorder and intoxicated aggression frequency.
    Journal of psychiatric research, 2020
    Co-Authors: Alexander A Puhalla, Mitchell E Berman, Emil F. Coccaro, Martha K. Fahlgren, Michael Mccloskey
    Abstract:

    Intermittent Explosive Disorder (IED), the only psychiatric diagnosis for which affective aggression is the cardinal symptom, is uniquely associated with both a history of childhood abuse and a diagnosis of an alcohol use Disorder (AUD). Moreover, both childhood abuse and AUD are associated with increased general aggression and aggression while intoxicated. Yet, no study to date has examined the relative contributions of childhood abuse and AUD to IED, nor their effects on overall and intoxicated aggression among those with and without IED. The following study aimed to fill these gaps. Participants were 493 individuals (68% female; Age M = 26.65) either with (n = 265) or without (psychiatric control group; n = 228) IED. All participants completed a clinical interview to (a) diagnose AUD, IED, and other comorbid psychiatric Disorders; (b) assess childhood abuse history; and (c) determine lifetime frequency of overall and intoxicated aggression. Results indicated that a history of childhood abuse, but not AUD status, was uniquely predictive of IED status. With regard to aggression frequency, IED, AUD and childhood abuse were all independently associated with overall aggression, although only those with IED showed increased intoxicated aggression as a function of AUD severity. Overall, these results suggest that a history of childhood abuse may increase the chances of engaging in overall aggression and developing IED, which in turn may increase the association between AUD severity and intoxicated aggression.

  • emotion processing in Intermittent Explosive Disorder
    Psychiatry Research-neuroimaging, 2019
    Co-Authors: Martha K. Fahlgren, Alexander A Puhalla, Kristen M Sorgi, Michael Mccloskey
    Abstract:

    Abstract Intermittent Explosive Disorder (IED), a Disorder characterized by outbursts of affective aggression, is associated with deficits in regulating emotions. However, less is known about specific deficits in understanding and processing emotions in IED. This study sought to fill that gap by examining components of emotion processing (rumination, alexithymia, and empathy) in those with IED. Participants completed diagnostic interviews and self-report measures, and were categorized into three diagnostic groups: IED (n = 177), Psychiatric Control (PC; n = 171), and Healthy Volunteer (HV; n = 144). Those with IED reported more anger rumination and greater difficulty identifying their feelings than PC or HV participants. Interestingly, those with IED reported higher affective empathy scores than those in the HV group, with no other group differences on measures of empathy. Amongst those with IED, increased anger rumination and decreased sadness rumination predicted greater lifetime aggression, while increased sadness rumination predicted poorer quality of life. These findings suggest that although those with IED have a harder time recognizing their emotions, once they identify feeling angry, they spend more time focused this emotion than those with other Disorders. These findings also suggest that cognitive intervention techniques may be beneficial for those with IED.

  • psychosocial interventions for treatment of Intermittent Explosive Disorder
    2019
    Co-Authors: Michael Mccloskey
    Abstract:

    Abstract Research on psychosocial interventions for Intermittent Explosive Disorder (IED) is still in its infancy. Cognitive-behavioral interventions have been shown to be effective in treating anger and aggression; however, little research has been conducted assessing the efficacy of cognitive-behavioral therapy (CBT) (or any psychosocial intervention) in treating the severe anger dysregulation and aggression characteristic of IED. The few published studies that have examined CBT for IED, though all somewhat methodologically limited, have been consistent in showing that CBT can reduce anger and aggressive tendencies and increase anger control. This improvement appears to be in excess of wait-list/self-monitoring controls and early data suggests the improvement from CBT exceeds that of more nondirective, client-centered therapy. However, more well-controlled studies are needed including studies using more rigorous comparison conditions (e.g., treatment as usual) as well as investigations of other treatment modalities both separate from, and in combination with, CBT.

  • social desirability deceptive reporting and awareness of problematic aggression in Intermittent Explosive Disorder compared with non aggressive healthy and psychiatric controls
    Psychiatry Research-neuroimaging, 2018
    Co-Authors: Diana M Steakleyfreeman, Royce Lee, Michael Mccloskey, Emil F. Coccaro
    Abstract:

    Individuals with DSM-5 Intermittent Explosive Disorder (IED) are often suspected of minimizing the nature of their recurrent, problematic, impulsive aggressive behavior due to the social undesirability of these behaviors. Our first study involved 400 study participants categorized as Healthy Controls (HC), Psychiatric Controls (PC) and as having IED and included the Crowne-Marlowe Social Desirability Scale (SDS), the Lie Scale from the Eysenck Personality Questionnaire-Revised (EPQ-R Lie), and the Readiness to Change (Anger) Questionnaire (RTC). IED study participants had lower SDS and lower EPQ-R Lie scores, while having higher RTC scores, compared with both HC and PC study participants. Thus, when studied in a clinical research setting, IED study participants do not provide socially desirable answers to questions and do not engaging in deceptive reporting; likely because they have recognized their need/interest in reducing their own impulsive aggressive behavior. The second study, part of a family study of 70 probands and their first-degree relatives revealed a very high positive (96.3%), but substantially lower negative (55.8%), predictive power for IED based on informant report. This suggests that, while interview of close informants can confirm the diagnosis of IED, informant interviews cannot rule out IED when such informants provide a negative report.

  • the co occurrence and correlates of anxiety Disorders among adolescents with Intermittent Explosive Disorder
    Aggressive Behavior, 2018
    Co-Authors: Todd Galbraith, Michael Mccloskey, Katie A Mclaughlin, Hannah Carliner, Katherine M Keyes, Richard G Heimberg
    Abstract:

    We examined the lifetime prevalence of anxiety Disorders (ADs) among adolescents with lifetime Intermittent Explosive Disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional Disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.

Jennifer R Fanning - One of the best experts on this subject based on the ideXlab platform.

  • evidence for the taxonic latent structure for dsm 5 Intermittent Explosive Disorder in adults
    Psychological Medicine, 2021
    Co-Authors: Jennifer R Fanning, David K Marcus, Jonathan Preszler, Emil F. Coccaro
    Abstract:

    BACKGROUND Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) Intermittent Explosive Disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum. METHODS This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 Disorders (n = 293), and adults without any DSM-5 Disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies. RESULTS Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results. CONCLUSION These findings support the proposition that DSM-5 IED represents a distinct behavioral Disorder rather than the severe end of an aggressive behavior continuum.

  • subtypes of aggression in Intermittent Explosive Disorder
    Journal of Psychiatric Research, 2019
    Co-Authors: Jennifer R Fanning, Royce Lee, Morgan Coleman, Emil F. Coccaro
    Abstract:

    Research in aggression has distinguished two major subtypes of aggressive behavior: hostile and instrumental. Previous research has examined these subtypes in healthy individuals and forensic samples but not in Intermittent Explosive Disorder (IED), a Disorder characterized by recurrent and severe aggressive behavior. We examined aggression subtypes in individuals with IED, healthy subjects, and psychiatric control subjects. We also considered the relationship between aggression subtypes and measures of trait anger and impulsivity to evaluate whether the hostile/instrumental dichotomy adequately captures the heterogeneity of aggressive behavior in this sample. Finally, we consider the implications of these results for research on aggression, including neuroscience research on aggression.

  • Intermittent Explosive Disorder and substance use Disorder analysis of the national comorbidity survey replication sample
    The Journal of Clinical Psychiatry, 2017
    Co-Authors: Emil F. Coccaro, Jennifer R Fanning, Royce Lee
    Abstract:

    Objective A relationship between aggression and substance use has been debated for many years. While substance use increases the risk of aggressive behavior, no studies have reported on the relationship between impulsive aggression and substance use/Disorder, specifically. Methods We analyzed data from the community-based National Comorbidity Survey Replication (N = 9,282 subjects) in order to examine the relationship between current DSM-5 Intermittent Explosive Disorder (IED), a Disorder of impulsive aggression, and current substance use Disorders (SUDs), overall, and with regard to alcohol, tobacco, and cannabis use Disorders and nonDisordered use. Results Occurrence of current SUD was elevated in current IED versus non-IED adult subjects, and onset of IED preceded that of SUD in 92.5% of comorbid IED + SUD cases. This relationship was not due to the presence, or absence, of current depressive or anxiety Disorders. Examination of the severity of IED and of SUD revealed that the presence of IED increases SUD severity but that the presence of SUD does not increase IED severity. Conclusions Subjects with IED are at increased risk of developing SUD, compared with 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. If so, effective treatment of impulsive aggression, before the onset of substance misuse, may prevent, or delay, the development of SUD in young people.

  • social cognition in Intermittent Explosive Disorder and aggression
    Journal of Psychiatric Research, 2016
    Co-Authors: Emil F. Coccaro, Jennifer R Fanning, Sarah K Keedy, Royce Lee
    Abstract:

    Social-emotional information processing (SEIP) was assessed in individuals with current DSM-5 Intermittent Explosive Disorder (IED: n = 100) and in healthy (n = 100) and psychiatric (n = 100) controls using a recently developed and validated self-rated questionnaire. SEIP vignettes depicted both direct aggressive and relationally aggressive scenarios of a socially ambiguous nature and were followed by questions assessing subjects' reactions and judgments about the vignettes. IED subjects differed from both healthy and psychiatric controls in all SEIP components. While hostile attribution was highly related to history of aggression, it was also directly correlated with negative emotional response. Further analysis revealed that this component, as well as response valuation and response efficiency, rather than hostile attribution, best explained history of aggressive behavior. A reformulated SEIP model, including self-reported history of childhood trauma, found that negative emotional response and response efficiency were the critical correlates for history of aggressive behavior. Psychosocial interventions of aggressive behavior in IED subjects may do well to include elements that work to reduce the emotional response to social threat and that work to restructure social cognition so that the tendency towards overt, or relationally, aggressive responding is reduced.

  • differential fmri bold responses in amygdala in Intermittent Explosive Disorder as a function of past alcohol use Disorder
    Psychiatry Research-neuroimaging, 2016
    Co-Authors: Emil F. Coccaro, Royce Lee, Jennifer R Fanning, Andrea C King, Sarah K Keedy, Luan K Phan, Stephanie M Gorka
    Abstract:

    Abstract Background Individuals with Intermittent Explosive Disorder (IED) were previously found to exhibit amygdala (AMYG) hyperactivation to anger faces during functional magnetic resonance imaging (fMRI). However, acute alcohol consumption, and/or life history of alcoholism, may blunt amygdala responses to negative emotional stimuli. Thus, we examined the influence of a past history of DSM-5 Alcohol Use Disorder (AUD) on the fMRI BOLD AMYG response to anger faces in IED. Method Forty-two IED participants, 18 with a past history of AUD (IED+AUD) and 24 without Past AUD (IED), and 32 healthy control (HC) participants, underwent fMRI scanning while viewing blocks of angry, fearful, and happy faces. Results Compared to HC and IED+AUD participants, IED subjects exhibited greater AMYG responses to angry, but not to fear or happy, faces in the left AMYG. There were no group differences in responses to anger, fear, or happy, faces in the OFC. Conclusion These findings suggest the possibility of a longstanding effect of AUD on AMYG response in IED to anger-related stimuli and highlight the possibility that history of AUD should be considered as an important factor in the interpretation of fMRI studies involving the AMYG response to negative emotional stimuli.

Derrick Silove - One of the best experts on this subject based on the ideXlab platform.

  • a wait list controlled study of a trauma focused cognitive behavioral treatment for Intermittent Explosive Disorder in timor leste
    American Journal of Orthopsychiatry, 2017
    Co-Authors: Kalhari Hewage, Natalino Tam, Alvin Kuowei Tay, Zachary Steel, Mohammed Mohsin, Jose Carlos De Oliveira, Marcio Da Piedade, Derrick Silove
    Abstract:

    We tested a trauma-focused, cognitive-behavior therapy treatment (TF-CBT-anger) for Intermittent Explosive Disorder (IED) and related dimensions of anger adapted to the local culture in postconflict Timor-Leste. The intention-to-treat sample (n = 78) comprised Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and wait-list (WL). Assessments were made at 1 week prior to therapy, immediately at posttreatment, and at 1 month follow-up. Primary measures included an IED diagnosis made according to the East Timor Explosive anger measure and the directionality of expression and control of anger assessed by 4 dimensions of the State-Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler scale and an index of posttraumatic stress Disorder (PTSD) assessed using the Harvard Trauma Questionnaire. In the TG, there was a decline in IED from 100% to zero at follow-up. In the WL, more than 70% (of the 100% at baseline) showed persisting IED at second and third assessments. The TG alone showed significant (p 0.80). Psychological distress and PTSD showed substantial reductions in the TG but not the WL group. Although based on a modest-sized sample, our findings provide the first evidence in support of the efficacy of TF-CBT-anger for IED in a culturally diverse, postconflict setting. (PsycINFO Database Record

  • the coherence and correlates of Intermittent Explosive Disorder amongst west papuan refugees displaced to papua new guinea
    Journal of Affective Disorders, 2015
    Co-Authors: Susan Rees, Derrick Silove, Alvin Kuowei Tay, Jack Chen, Moses Kareth
    Abstract:

    Questions remain about the nosological status of Intermittent Explosive Disorder (IED) as a universal diagnosis. Cross-cultural studies are needed to establish whether IED symptoms form a coherent pattern and are distinguishable from other related symptom constellations. A study amongst a refugee population also allows further inquiry of the relationship between exposure to potentially traumatic events (PTEs) and other adversities with the IED constellation. In the present study amongst West Papuan refugees residing in Port Moresby, Papua New Guinea, we apply culturally adapted interview modules to assess symptoms of IED, post-traumatic stress Disorder (PTSD), and depression, as well as the potentially traumatic events (PTEs) of conflict and ongoing adversity in the post-migration environment. Latent class analysis yielded a PTSD class (23%), a posttraumatic depressive class (14%), an IED class (12%), and a low/no symptom class (49%). Compared to the low/no-symptom class, the PTSD class had high levels of exposure to all PTE domains including childhood-related adversities, witnessing murder, human rights trauma, and traumatic losses, as well as ongoing adversity relating to displacement and separation from families, safety concerns, and lack of access to basic needs and health care. The posttraumatic depression class had greater exposure to traumatic losses and childhood-related adversities, higher levels of stress relating to material loss and deprivation, as well as to displacement and separation from families. In contrast, the IED class was distinguished only by the ongoing stress of displacement and separation from families in the homeland. Our findings provide support for the phenomenological distinctiveness of IED symptoms in this transcultural setting. Although not exclusive to IED, conditions of long-term displacement and separation appear to be a source of ongoing anger and Explosive aggression amongst this population.

  • achieving convergence between a community based measure of Explosive anger and a clinical interview for Intermittent Explosive Disorder in timor leste
    Journal of Affective Disorders, 2013
    Co-Authors: Belinda J Liddell, Derrick Silove, Natalino Tam, Kuowei Tay, Angela Nickerson, Robert Brooks, Susan Rees
    Abstract:

    BACKGROUND: There is growing research interest in understanding and analyzing Explosive forms of anger. General epidemiological studies have focused on the DSM-IV category of Intermittent Explosive Disorder (IED), while refugee and post-conflict research have used culturally-based indices of Explosive anger. The aim of this study was to test the convergence of a culturally-sensitive community measure of Explosive anger with a structured clinical interview diagnosis of IED in Timor-Leste, a country with a history of significant mass violence and displacement. METHODS: A double-blind clinical concordance study was conducted amongst a stratified community sample in post-conflict Timor-Leste (n=85) to compare a community measure of anger against the Structured Clinical Interview (SCID) module for IED. RESULTS: Clinical concordance between the two measures was high: the area under the curve (AUC) index was 0.90 (95% CI: 0.83-0.98); sensitivity and specificity were 93.3% and 87.5% respectively. LIMITATIONS: Response rates were modest due to the participant's time commitments. CONCLUSIONS: It is possible to achieve convergence between culturally-sensitive measures of Explosive anger and the DSM-IV construct of IED, allowing comparison of findings across settings and populations. Language: en

  • Intermittent Explosive Disorder amongst women in conflict affected timor leste associations with human rights trauma ongoing violence poverty and injustice
    PLOS ONE, 2013
    Co-Authors: Susan Rees, Derrick Silove, Teresa Verdial, Natalino Tam, Elisa Savio, Zulmira Fonseca, Rosamund Thorpe, Belinda J Liddell, Anthony B Zwi, Kuowei Tay
    Abstract:

    Introduction: Women in conflict-affected countries are at risk of mental Disorders such as posttraumatic stress Disorder and depression. No studies have investigated the association between experiences of abuse and injustice and Explosive anger amongst women in these settings, and the impact of anger on women’s health, family relationships and ability to participate in development. Methods: A mixed methods study including an epidemiological survey (n=1513, 92.6% response) and qualitative interviews (n=77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress Disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice. Results: Women with Intermittent Explosive Disorder (n=184, 12.2%) were more disabled than those without the Disorder (for .5 days out of role, 40.8% versus 31.5%, X 2 (2) =12.93 p=0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08–2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48– 3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09–3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27–2.77); extreme poverty (OR 1.23, 95%, CI 1.08–1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35–3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger. Conclusions: Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.