Coccaro E F, Kavoussi R J, Berman M E, Lish J D
Department of Psychiatry, MCP-Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, PA 19129, USA.
Compr Psychiatry. 1998 Nov-Dec;39(6):368-76. doi: 10.1016/s0010-440x(98)90050-5.
The study of human aggression has been hindered by the lack of reliable and valid diagnostic categories that specifically identify individuals with clinically significant displays of impulsive aggressive behavior. DSM intermittent explosive disorder (IED) ostensibly identifies one such group of individuals. In its current form, IED suffers from significant theoretical and psychometric shortcomings that limit its use in clinical or research settings. This study was designed to develop a revised criteria set for IED and present initial evidence supporting its reliability and validity in a well characterized group of personality disordered subjects. Accordingly, research criteria for IED-Revised (IED-R) were developed. Clinical, phenomenologic, and diagnostic data from 188 personality disordered individuals were reviewed. IED-R diagnoses were assigned using a best-estimate process. The reliability and construct validity of IED-R were examined. IED-R diagnoses had high interrater reliability (kappa = .92). Subjects meeting IED-R criteria had higher scores on dimensional measures of aggression and impulsivity, and had lower global functioning scores than non-IED-R subjects, even when related variables were controlled. IED-R criteria were more sensitive than DSM-IV IED criteria in identifying subjects with significant impulsive-aggressive behavior by a factor of four. We conclude that in personality disordered subjects, IED-R criteria can be reliably applied and appear to have sufficient validity to warrant further evaluation in field trials and in phenomenologic, epidemiologic, biologic, and treatment-outcome research.
对人类攻击性的研究一直受到阻碍，因为缺乏可靠且有效的诊断类别来专门识别具有临床上显著冲动攻击行为表现的个体。《精神疾病诊断与统计手册》中的间歇性爆发性障碍（IED）表面上识别出了这样一组个体。就其目前的形式而言，IED存在重大的理论和心理测量缺陷，限制了其在临床或研究环境中的使用。本研究旨在为IED制定一套修订后的标准，并提供初步证据支持其在一组特征明确的人格障碍受试者中的可靠性和有效性。因此，制定了IED修订版（IED-R）的研究标准。对188名人格障碍个体的临床、现象学和诊断数据进行了回顾。使用最佳估计程序进行IED-R诊断。检验了IED-R的可靠性和结构效度。IED-R诊断具有较高的评分者间信度（kappa = 0.92）。符合IED-R标准的受试者在攻击性和冲动性的维度测量上得分更高，并且与非IED-R受试者相比，其整体功能得分更低，即使在控制了相关变量的情况下也是如此。在识别具有显著冲动攻击行为的受试者方面，IED-R标准比《精神疾病诊断与统计手册》第四版的IED标准敏感四倍。我们得出结论，在人格障碍受试者中，IED-R标准可以可靠地应用，并且似乎具有足够的效度，值得在现场试验以及现象学、流行病学、生物学和治疗结果研究中进行进一步评估。
