Keyes Katherine M, McLaughlin Katie A, Vo Thomas, Galbraith Todd, Heimberg Richard G
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Department of Psychology, University of Washington, Seattle, Washington.
Depress Anxiety. 2016 Feb;33(2):101-11. doi: 10.1002/da.22428. Epub 2015 Sep 30.
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.
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.
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.
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.
有证据表明，冲动攻击性和爆发性愤怒在焦虑症患者中很常见；然而，间歇性爆发性障碍（IED）对焦虑症患者的发病、病程、后果及共病模式的影响尚不清楚。
数据取自2001年至2004年期间进行的具有全国代表性的调查——全国共病调查复制版（N = 9282）和青少年补充调查（N = 9632）。诊断基于结构化的非专业人员访谈。使用结构化工具评估终生诊断情况。结果包括共病情况、功能和角色损害以及治疗利用情况。
患有终生焦虑症的青少年终生愤怒发作（68.5%）和间歇性爆发性障碍（22.9%）的患病率高于无终生焦虑症的青少年（分别为48.6%和7.8%），尤其是社交恐惧症和惊恐障碍患者。成年人中也发现了类似的升高情况。焦虑症的发病年龄和病程在有无间歇性爆发性障碍的患者中并无差异。患有间歇性爆发性障碍的青少年（39.3%）和成年人（45.7%）中，与焦虑相关的严重功能损害高于无间歇性爆发性障碍的患者（分别为29.2%和28.2%）。所有其他障碍的共病率都有所升高。然而，患有焦虑症和间歇性爆发性障碍的个体使用治疗服务的可能性并不比无间歇性爆发性障碍的焦虑症患者更高。
伴有焦虑症的间歇性爆发性障碍患者，尤其是社交恐惧症和惊恐障碍患者，面临功能损害更严重和共病负担更高的显著风险，但焦虑症的发病和病程并无差异，且患有焦虑症和间歇性爆发性障碍的患者使用治疗服务的可能性并不更高。在焦虑症背景下对愤怒进行评估、识别和专门治疗对于减轻负担至关重要。
