Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
J Psychiatr Res. 2018 Nov;106:15-21. doi: 10.1016/j.jpsychires.2018.08.013. Epub 2018 Aug 10.
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.
在精神病学分类学中，反复发作的愤怒和攻击行为的解释存在模糊性。一个不确定的领域是间歇性爆发障碍 (IED) 与人格障碍 (PD) 的重叠程度和区别。因此，我们对患有 IED 和 PD 的个体进行了研究，以了解这两种精神病理学领域中看到的共病关系的性质。共有 1521 名成年人参与了研究（441 名健康对照 (HC)、430 名精神病对照 (PC) 和 650 名 IED 受试者），并评估了 DSM-5 精神障碍、攻击性行为史、特质攻击性、状态和特质愤怒反应性和冲动性。虽然近一半的 IED 研究参与者存在共患 PD 诊断，但近一半的人存在 B 群人格障碍，几乎同样多的人存在其他人格障碍。IED 预测了愤怒症状和攻击性行为史，超出了 PD 诊断的预测。IED 与反社会 (AsPD) 或边缘 (BPD) PD 共病与最高水平的攻击性行为相关。然而，IED 与 AsPD 和/或 BPD PD 共病与更高水平的冲动性无关。与愤怒、情感和社会行为相关的潜在人格特质，但与身份障碍无关，有助于 IED 和 PD 的共同症状特征。IED 通常与 PD 共病，但与任何单一 PD 没有独特的关系。当与 PD 共病时，IED 的诊断预测更严重的愤怒和攻击，但不一定增加冲动性。这些结果表明，当同时符合两者的标准时，IED 和 PD 的诊断保留了临床实用性。
