Relationship between psychopathy, aggression, anger, impulsivity, and intermittent explosive disorder

A latent class analysis of cognitive-affective heterogeneity in current intermittent explosive disorder

Intermittent Explosive Disorder (IED) is a common, chronic, and impairing psychological condition characterized by recurrent, affective aggressive behavior. IED is associated with a host of cognitive and affective symptoms not included in the diagnostic criteria which may be a valuable indicator of heterogeneity in IED-such information can be useful to enhance understanding and treatment of this disorder in mental health settings. A preliminary investigation conducted on cognitive-affective symptom heterogeneity in individuals with a history of IED demonstrated that level of emotional dysregulation primarily differentiated IED subgroups, however the sample size was limited, and almost half of the individuals did not have current IED (only lifetime IED). The present study addressed these limitations by conducting a latent class analysis of cognitive-affective symptoms among a large (n = 504) sample of individuals diagnosed with current IED. The latent IED classes were then externally validated on several adverse outcomes, historical precursors, and demographic variables. Statistical and clinical indicators supported a four-class model, with classes primarily distinguished by patients' severity of emotion dysregulation. The two moderate emotion-dysregulated classes both endorsed callous-unemotional traits and low empathy relative to other classes, a finding which differs from the initial investigation. An external validation of the four classes revealed that they significantly differed on severity outcomes (e.g., aggression, suicide attempts, antisocial behavior, global functioning, comorbidities) and historical precursors (e.g., aversive parental care, childhood maltreatment). These findings provide further insight into the heterogeneity within IED and the associations of such variability with important precursors and clinical outcomes.

Self-control problems in Intermittent Explosive Disorder: Presentation of an explanatory approach

BACKGROUND AND OBJECTIVES

Intermittent Explosive Disorder (IED) is an impulsive aggression disorder with self-control problems. However, the mechanisms underpinning the self-control problems in IED have not been clearly investigated. Therefore, this study examined the nature of self-control problems and their types, including cognitive inhibition, behavioral inhibition, and emotional interference in IED.

METHODS

Participants included three groups: IED (n = 54), psychiatric control (n = 59), and healthy control (n = 62). They were first screened with SCL-90-R, and then they were clinically interviewed. They all did computerized neurocognitive tasks, including Color-Word Stroop Task, Emotional Stroop Task, Go-NoGo Task, and Stop-Signal Task.

RESULTS

MANOVA analyses showed that the IED group had poorer performance in cognitive inhibition, response inhibition, and increased emotional interference than the two psychiatric and healthy control groups. They performed much worse than the other two groups, particularly in action cancellation (Stop-Signal Task), and showed increasingly emotional interference.

LIMITATIONS

The brain reaction of individuals while doing the tasks was not examined, and some variables were not measured. Also, it is unclear how the emotional eruption interferes with cognitive content and behavioral inhibition.

CONCLUSIONS

These findings indicate that self-control problems in IED can be due to deficient cognitive, emotional, and behavioral inhibitions, each appearing sequentially during a step-by-step process and facilitating the onset of IED signs and symptoms. Such a distinguished understanding of the role of neurocognitive mechanisms can lead to the development of accurate explanatory approaches and increase the effectiveness of treatment.

Exploring the impact of childhood maltreatment and BPD on impulsivity in crimes of passion

Background

Crimes of passion, characterized as unpremeditated impulsive aggression, have garnered increasing attention in recent years. Impulsivity, a major factor in crimes of passion, is also a common feature of various health conditions, including Borderline Personality Disorder (BPD). Childhood maltreatment is considered a significant precursor to BPD and is closely related to impulsivity. Although prior research has affirmed the relationship between impulsivity, childhood maltreatment, BPD, and criminal behavior, few studies have examined these variables' interconnections within the context of crimes of passion. This study seeks to explore the relationship between childhood maltreatment, BPD, and impulsivity in crimes of passion, assessing the former's impact on the latter.

Method

Our research examined 133 crimes of passion offenders and 149 other offenders from the Shenzhen male prison in China. All 282 participants completed The Abbreviated Version of The Barratt Impulsiveness Scale (ABIS), The UPPS Impulsivity Scale (Urgency, Premeditation, Perseverance, Sensation Seeking), The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), and The Childhood Trauma Questionnaire (CTQ).

Results

Our findings indicated that (1) crimes of passion offenders scored significantly higher in emotional neglect, physical neglect, and overall childhood maltreatment than did other offenders, and childhood maltreatment scores were notably higher in the high BPD trait group. (2) Crimes of passion offenders demonstrated significantly elevated impulsivity in attention and nonplanning scales compared to other offenders. Impulsivity scores across all scales were also significantly higher in the high BPD trait group. (3) Emotional neglect was found to significantly influence the urgency scale in crimes of passion offenders. An interaction effect was noted between physical abuse and high BPD traits, leading to increased impulsivity in crimes of passion offenders.

Conclusion

This study underscores the predictive roles of childhood maltreatment and BPD in determining impulsivity within the context of crimes of passion.

Salivary cortisol awakening levels are reduced in human subjects with intermittent explosive disorder compared with controls

BACKGROUND

The role of the hypothalamic-pituitary-adrenal (HPA) axis in human aggressive behavior is poorly characterized, though some studies report that, unlike depression, circulating or salivary levels of cortisol are low compared with controls.

METHODS

In this study, we collected three salivary cortisol levels (two in the morning and one in the evening) on three separate days in 78 adult study participants with (n = 28) and without (n = 52) prominent histories of impulsive aggressive behavior. Plasma C-Reactive Protein (CRP) and Interleukin-6 (IL-6) were also collected in most study participants. Aggressive study participants meet DSM-5 criteria for Intermittent Explosive Disorder (IED) while non-aggressive participants either had a history of a psychiatric disorder or no such history (Controls).

RESULTS

Morning, but not evening, salivary cortisol levels were significantly lower in IED (p < 0.05), compared with control, study participants. In addition, salivary cortisol levels correlated with measures of trait anger (partial r = -0.26, p < 0.05) and aggression (partial r = -0.25, p < 0.05) but not with measures of impulsivity, psychopathy, depression, history of childhood maltreatment, or other tested variables that often differ in individuals with IED. Finally, plasma CRP levels correlated inversely with morning salivary cortisol levels (partial r = -0.28, p < 0.05); plasma IL-6 levels showed a similar, though not statistically significant (rp = -0.20, p = 0.12) relationship with morning salivary cortisol levels.

CONCLUSION

The cortisol awakening response appears to be lower in individuals with IED compared with controls. In all study participants, morning salivary cortisol levels correlated inversely with trait anger, trait aggression, and plasma CRP, a marker of systemic inflammation. This suggests the present of a complex interaction between chronic-low level inflammation, the HPA axis, and IED that warrants further investigation.

A latent class analysis of intermittent explosive disorder symptoms

Intermittent explosive disorder (IED), the sole diagnosis in the DSM-5 for which the cardinal symptom is recurrent affective aggressive outbursts, is a common and substantially impairing disorder. IED is also associated with several cognitive and affective impairments. However, little is known about the heterogeneity of the disorder and how this may correspond to aggression severity and related adverse outcomes. The current study employed a latent class analysis (LCA) among individuals diagnosed with lifetime DSM-5 IED to derive distinct subgroups that differed in the quality and/or frequency of cognitive-affective symptoms. These subgroups were then externally validated on a number of adverse outcomes. Statistical and clinical indicators supported a four-class model. Classes were distinguished mainly by the level of emotion dysregulation participants endorsed, with two moderate emotion dysregulation classes differing on their emotional information processing and impulsive tendencies. The external validation analysis revealed that classes differed in terms of various adverse outcomes (e.g., interpersonal problems, life satisfaction, suicide risk). Overall, the present study suggests distinct cognitiveaffective symptom profiles among those with IED that differ meaningfully with regard to risk for adverse outcomes. These findings provide evidence of the heterogeneity within IED and may suggest a more personalized therapeutic approach to patients with IED.

Structural and functional brain networks of individual differences in trait anger and anger control: An unsupervised machine learning study

The ability to experience, use and eventually control anger is crucial to maintain well-being and build healthy relationships. Despite its relevance, the neural mechanisms behind individual differences in experiencing and controlling anger are poorly understood. To elucidate these points, we employed an unsupervised machine learning approach based on independent component analysis to test the hypothesis that specific functional and structural networks are associated with individual differences in trait anger and anger control. Structural and functional resting state images of 71 subjects as well as their scores from the State-Trait Anger Expression Inventory entered the analyses. At a structural level, the concentration of grey matter in a network including ventromedial temporal areas, posterior cingulate, fusiform gyrus and cerebellum was associated with trait anger. The higher the concentration, the higher the proneness to experience anger in daily life due to the greater tendency to orient attention towards aversive events and interpret them with higher hostility. At a functional level, the activity of the default mode network (DMN) was associated with anger control. The higher the DMN temporal frequency, the stronger the exerted control over anger, thus extending previous evidence on the role of the DMN in regulating cognitive and emotional functions in the domain of anger. Taken together, these results show, for the first time, two specialized brain networks for encoding individual differences in trait anger and anger control.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

Differentiating irritable mood and disruptive behavior in adults

Introduction

Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability.

Methods

The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators.

Results

Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior.

Conclusions

Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.

Threat-Avoidance Tendencies Moderate the Link Between Serotonin Transporter Genetic Variation and Reactive Aggression

The short (S) allele of the serotonin transporter-linked promoter region (5-HTTLPR) polymorphism has been linked to reactive aggression in men, but this association is less consistent in females. Reactive aggression has been particularly described as a result of fear-driven defense to threat, but how this interaction between defensive behavior and aggression is expressed in S-allele carriers remains unknown. In order to explore this interplay between 5-HTTLPR genotype, defensive behavior and reactive aggression, we combined genotyping with objective measures of action tendencies toward angry faces in an approach-avoidance task (AAT) and reactive aggression in the Taylor aggression paradigm (TAP) in healthy females, N = 95. This study shows that female S-allele carriers in general display increased implicit reactive aggression (administering aversive white noise) toward opponents. Furthermore, we found that threat-avoidance tendencies moderate the association between 5-HTTLPR genotype and aggression displayed on the TAP. Together, these findings indicate a positive correlation between avoidance of angry faces in the AAT and reactive aggression in the TAP exclusively present in S-allele carriers.

Rage attacks in Tourette Syndrome and Chronic Tic Disorder: a systematic review

Tourette syndrome (TS) and chronic motor/vocal tic disorder (CTD) are neurodevelopmental conditions defined by the occurrence of multiple tics. Besides the well-known association with attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), rage attacks (RA) represent common and detrimental symptoms for patients. Inorder to explore prevalence of RA in tic disorders, relation to tic severity/comorbidities and available treatments, we performed a systematic literature review based on PRISMA Guidelines. 32 studies published between January 2008 - December 2019 were deemed suitable for the analysis and provided a prevalence of 20-67 %. Most findings showed a direct correlation with tic severity and a significant impact on psychosocial functioning. Although apparently related to comorbid ADHD, RA also frequently occur as independent manifestations. Association with other comorbidities, such as OCD, impulse control and mood disorders has also been reported, not yet fully established. Behavioral interventions appear to be effective, whereas there is limited evidence concerning the efficacy of medication. In TS/CTD, RA may be regarded as a major comorbidity that requires clinical investigation in order to develop personalized treatments.

Attention deficit hyperactivity disorder and comorbidity: A review of literature

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood. It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents. This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders, learning disorders, externalising and internalising disorders. Challenges in screening for, diagnosing and managing comorbidity with ADHD are summarised. Also, methodological challenges and future directions in research in this interesting field are highlighted.

The Predictive Value of Early-Life Trauma, Psychopathy, and the Testosterone-Cortisol Ratio for Impulsive Aggression Problems in Veterans

Background

In this study, we examined whether early-life trauma, psychopathy, and the testosterone/cortisol ratio predicted impulsive aggression problems in veterans.

Method

A sample of 49 male veterans with impulsive aggression problems and 51 nonaggressive veterans were included in the study. Logistic regression analysis was performed with early-life trauma, primary and secondary psychopathy, and testosterone/cortisol ratio as continuous predictor variables; impulsive aggression status was entered as a binary outcome measure. Correlation analyses were conducted to examine pairwise relations among the predictors.

Results

Results indicated that early-life trauma and secondary psychopathy, but not the testosterone/cortisol ratio or primary psychopathy, were significant predictors of impulsive aggression status.

Conclusions

The current results indicate that early-life trauma and secondary psychopathy are risk factors for impulsive aggression problems among veterans. Future studies are needed to determine the exact causal relations among the variables examined here.

Intermittent Explosive Disorder in Male Juvenile Delinquents in China

Objective: Although several previous studies have focused on the mental health problems in detained juvenile offenders in China and found high levels of major psychiatric morbidity, the prevalence of intermittent explosive disorder (IED) in this group remains unknown. The purpose of this study is to discover the prevalence of IED among juvenile offenders in China as well as the difference in demographic characteristics and personality traits between IED offenders and the general population. Method: A total of 280 delinquent boys (Mean age 16.10 years) were interviewed by trained psychiatrists. The interview procedure included the recording of sociodemographic characteristics, criminal records, Composite International Diagnostic Interviews (CIDI), State-Trait Anger and Expression of Anger Inventory-2 (STAXI-2) and Modified Overt Aggression Scales (MOAS). Results: Of the 280 delinquent boys, 32 (11.4%) were diagnosed with IED, 129 (46.1%) were non-IED psychopathology controls (PC), and 119 (42.5%) were healthy controls (HC). Except for substance use disorder (SUD), no differences in psychiatric comorbidity were found between youths with IED and those with another psychiatric disorder. Compared with the PC and HC groups, those in the IED group were more likely to commit a violent crime such as rape, assault, or an affray but it is less likely that their motive can be explained by money or property. The IED group also had a higher rate of recidivism history than the HC group. The IED group displayed higher levels of state and trait anger and anger expression than the HC group and lower levels of anger control than both the PC and HC groups. MOAS also showed that those in the IED group were more aggressive than those in the PC and HC groups. Conclusion: The relationships between IED, anger and aggression reflect the need to develop and implement specific and individually tailored intervention approaches to correct IED juvenile offenders' behavior in order to prevent new crime.

The relationship between aggression and ability emotional intelligence: The role of negative affect

This study aimed to contribute to the understanding of the mechanisms underlying the relationship between aggressive behaviour and individual levels of ability emotional intelligence (EI). Three hundred and ninety-five participants took part in this study. Participants were assessed on ability EI, negative affect (NA), and aggression by the Mayer-Salovey-Caruso Emotional Intelligence Test, the Positive and Negative Affect Schedule, and the Buss-Perry Aggression questionnaires, respectively. The results revealed a negative relationship between aggression and ability EI, but this relationship depended on multiple factors: the type of EI branches and aggression dimensions, the influence of NA, and gender. Emotional management ability showed a direct relationship with aggression, while emotional perception ability presented an indirect relationship with aggression through the effect of NA. These EI abilities were related to different aggression dimensions, highlighting the direct relationship with physical aggression. Moreover, gender differences showed that women possess greater EI abilities, higher levels of NA, less aggressive behaviour, and a lower relationship between NA and aggression compared with men. This research offers a better understanding of the psychological processes explaining aggression. The inclusion of our findings in the design of prevention and treatment programs could be of great help in the control of aggressive behaviour.

Responsive Aggression Regulation Therapy (Re-ART): An Evaluation Study in a Dutch Juvenile Justice Institution in Terms of Recidivism

This article describes a quasi-experimental study of the effectiveness of Responsive Aggression Regulation Therapy (Re-ART) in terms of recidivism for 16- to 21-year-old juveniles with aggression problems and high risk of recidivism. In a Dutch juvenile justice institution, an experimental group received Re-ART ( n = 63, Re-ART group) and a waitlist control group received Treatment as Usual ( n = 28, TAU group). Results indicated that Re-ART is significantly more effective than TAU in reducing the juveniles' recidivism risk for violent offending. Compared with the TAU group, the Re-ART group showed significantly less violent crimes after 2 and 3 years, less property crimes after 2 years, and less general recidivism after 2 and 3 years. There was no significant difference between groups in recidivism of property crimes with violence. Ethnicity, mild intellectual disabilities, substance abuse, and age did not moderate the effects on recidivism outcome, which indicates that Re-ART was equally effective for various groups.

Psychosocial impairment in DSM-5 intermittent explosive disorder

The purpose of this study was to document the functional severity of DSM-5 IED in a clinical research sample. IED and control groups were compared on psychosocial functioning, life satisfaction, and on a variety of cognitive and behavioral issues. IED study participants reported significantly worse psychosocial function, quality of life, and higher job dysfunction than both psychiatric and healthy control study participants. The presence of DSM-5 IED is associated with significant psychosocial and functional impairment. Early intervention may aid in minimizing the consequences of impulsive aggressive behavior, and improving psychosocial functioning and quality of life.

Prevalence and clinical correlates of intermittent explosive disorder in Turkish psychiatric outpatients

OBJECTIVE

Intermittent explosive disorder (IED) is defined as the failure to resist aggressive impulses resulting in repeated acts of verbal and/or physical aggression. Although it is frequently encountered in clinical psychiatric practice, there is a paucity of data concerning IED in the scientific literature both internationally and in Turkey. The aim of this study was to evaluate the prevalence of IED and associated sociodemographic and clinical features in a clinical setting.

METHODS

A total of 406 patients who were referred to our psychiatry outpatient clinic for the first time in a six-month period were included in the study. The diagnosis of IED was made using both Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and DSM-5 criteria. Axis I disorder and personality disorder diagnoses were made according to DSM-5 criteria. Diagnoses were based on information from the Structured Clinical Interview for DSM-IV (SCID I) and the Structured Clinical Interview for DSM-IV personality disorders (SCID II), Symptom Checklist-90 (SCL-90), Wender Utah Rating Scale, Adult Attention Deficit Hyperactivity Disorder (ADHD) DSM-IV Based Diagnostic Screening and Rating Scale, a clinical interview conducted by the researcher, and a sociodemographic data form. In addition, participants were administered the Buss-Perry Aggression Scale and Barratt Impulsiveness Scale Version 11 (BIS-11) to assess aggression and impulsivity.

RESULTS

Lifetime and 12-month prevalence of IED according to DSM-5 were 16.7% and 11.3%, respectively. Mean age at onset was 16.4 years. The prevalence of lifetime IED was 3.8 times higher in males than females (95% CI = 1.9-7.5); twice as high in individuals living in rural areas compared to those living in urban centers (95% CI = 1.1-3.7); 2.7 times higher among those with lifetime suicide attempt versus those without (95% CI = 1.3-5.6); 4.5 times higher in those with lifetime self-injurious behavior compared to those without (95% CI = 2.3-8.7); and 3 times higher in individuals reporting aggression/anger problems in the family compared to those without (95% CI = 1.5-5.9). The prevalences of childhood ADHD, conduct disorder, and oppositional defiant disorder were significantly higher in the IED group.

CONCLUSION

The result of the current study has revealed that approximately one-sixth of respondents experienced lifetime IED according to DSM-5 diagnostic criteria. Statistically significant sociodemographic correlates of IED include gender, urbanicity, history of suicide attempt, history of self-injurious behavior, and family history of aggression/anger problems.

Trait anger modulates neural activity in the fronto-parietal attention network

Anger is considered a unique high-arousal and approach-related negative emotion. The influence of individual differences in trait anger on the processing of visual stimuli is relevant to questions about emotional processing and remains to be explored. Using functional magnetic resonance imaging (fMRI), we explored the neural responses to standardized images, selected based on valence and arousal ratings in a group of men with high trait anger compared to those with normative to low anger scores (controls). Results show increased activation in the left-lateralized ventral fronto-parietal attention network to unpleasant images by individuals with high trait anger. There was also a group by arousal interaction in the left thalamus/pulvinar such that individuals with high trait anger had increased pulvinar activation to the high-arousal (versus low arousal) unpleasant images as compared to controls. Thus, individual differences in trait anger in men are associated with brain regions subserving executive attentional and sensory integration during the processing of unpleasant emotional stimuli, particularly to high arousal images.

The Forensic Symptoms Inventory-Revised (FSI-R Adults): Measurement and Structural Invariance Across Gender and Age Groups

This article investigates the measurement and structural invariance of a newly developed self-report questionnaire, the Forensic Symptoms Inventory-Revised, aimed at measuring eight cognitive, emotional, and behavioral deficits (aggression, lack of social support, problematic substance use, lack of concentration, anger, poor self-regulation, impulsivity, and sexual problems) among adult forensic outpatients. The sample consisted of 716 outpatients (603 males, 113 females) with a mean age of 38.19 (SD = 12.47). Multi-Group Confirmatory Factor Analyses supported the measurement and structural invariance with respect to gender and age groups (18-23 years and ≥24 years). Between-group comparisons revealed that, compared to females, male outpatients reported more substance related problems, as well as incapacities to control verbal and/or physical aggression. Compared to adults, young adults displayed more inadequate self-regulation skills and reported more social support. These findings may promote the formulation of gender- and age-specific treatment goals.

Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

BACKGROUND

Mental disorders can be associated with suicidal or aggressive ideation and behavior, especially in the context of embitterment. The aim of this study is to investigate the types, prevalence, and dangerousness of aggressive and suicidal ideations associated with embitterment.

METHODS

When therapists from the department of behavioral medicine detected signs of embitterment, aggression, or suicidal thoughts in their patients, they routinely filled out a questionnaire on aggressive ideation, assessed the embitterment, and contacted a senior psychiatrist. Additionally, patients answered an embitterment scale.

RESULTS

There were 127 patients (3.84% of all patients) with suicidal and/or aggressive ideation. They had an increased score of 2.93 (SD 0.74) on the embitterment scale, associated with personal vilification (62.7%), breach of trust (30.2%), public humiliation (25.4%), death/loss (5.6%), or attacks by another person (14.3%). We found that 83.5% of the patients harbored aggressive ideations; in 94.1% of this group, these were directed against the person who had caused the problem, 88.3% wanted to inflict severe damage, 38.8% to harm another person, 31.5% showed suicidal ideation, and 3.2% had fantasies of murder-suicide. Only 34.3% of the patients reported spontaneously about their current aggressive ideation. The limitations of the study are that the data come from an inpatient sample and patients were identified according to clinical judgement.

CONCLUSION

Aggressive ideation is regularly associated with embitterment. This deserves the attention of therapists for the prevention of aggressive acts.

More inflammation but less brain-derived neurotrophic factor in antisocial personality disorder

Antisocial personality disorder (ASPD) is highly comorbid with substance use disorders (SUDs). We hypothesize that chronic neuroinflammation and the loss of neurotrophic factors prompts the pathogenesis of both disorders. We used ELISA to measure plasma levels of proinflammatory (tumor necrosis factor-α [TNF-α], C-reactive protein [CRP]) and anti-inflammatory factors (transforming growth factor-β1 [TGF-β1] and interleukin-10 [IL-10]), and brain-derived neurotrophic factor (BDNF) in male patients with ASPD (n=74), SUDs (n=168), ASPD comorbid with SUDs (ASPD+SUDs) (n=438), and Healthy Controls (HCs) (n=81). A multivariate analysis of covariance (MANCOVA) controlled for possible confounders was used to compare cytokines and BDNF levels between groups. The results of MANCOVA adjusted for age showed a significant (p<0.001) main effect of diagnosis on inflammatory factors and BDNF expression in these groups. ASPD, SUDs, and ASPD+SUDs patients had significantly (p<0.001) higher TNF-α levels but lower TGF-β1 and BDNF levels. SUDs and ASPD+SUDs patients had higher IL-10 levels than did ASPD patients and HCs. There was no difference in IL-10 levels between HCs and ASPD. Moreover, subgrouping SUDs and ASPD±SUDs into opioid use disorder (OUD) and other SUDs groups showed that the IL-10 levels were specifically higher in OUD and ASPD±OUD groups than other SUDs (P≤0.001). We conclude that uncontrolled inflammation and losing neurotrophic factors, with or without comorbid SUDs, underlies ASPD. IL-10 expression might be more specifically associated with OUD.

Linking Y-chromosomal short tandem repeat loci to human male impulsive aggression

INTRODUCTION

Men are more susceptible to impulsive behavior than women. Epidemiological studies revealed that the impulsive aggressive behavior is affected by genetic factors, and the male-specific Y chromosome plays an important role in this behavior. In this study, we investigated the association between the impulsive aggressive behavior and Y-chromosomal short tandem repeats (Y-STRs) loci.

METHODS

The collected biologic samples from 271 offenders with impulsive aggressive behavior and 492 healthy individuals without impulsive aggressive behavior were amplified by PowerPlex^RY23 PCR System and the resultant products were separated by electrophoresis and further genotyped. Then, comparisons in allele and haplotype frequencies of the selected 22 Y-STRs were made in the two groups.

RESULTS

Our results showed that there were significant differences in allele frequencies at DYS448 and DYS456 between offenders and controls (p < .05). Univariate analysis further revealed significant frequency differences for alleles 18 and 22 at DYS448 (0.18 vs 0.27, compared to the controls, p = .003, OR=0.57,95% CI=0.39-0.82; 0.03 vs 0.01, compared to the controls, p = .003, OR=7.45, 95% CI=1.57-35.35, respectively) and for allele 17 at DYS456 (0.07 vs 0.14, compared to the controls, p = .006, OR=0.48, 95% CI =0.28-0.82) between two groups. Interestingly, the frequency of haploid haplotype 22-15 on the DYS448-DYS456 (DYS448-DYS456-22-15) was significantly higher in offenders than in controls (0.033 vs 0.004, compared to the control, p = .001, OR = 8.42, 95%CI =1.81-39.24). Moreover, there were no significant differences in allele frequencies of other Y-STRs loci between two groups. Furthermore, the unconditional logistic regression analysis confirmed that alleles 18 and 22 at DYS448 and allele 17 at DYS456 are associated with male impulsive aggression. However, the DYS448-DYS456-22-15 is less related to impulsive aggression.

CONCLUSION

Our results suggest a link between Y-chromosomal allele types and male impulsive aggression.

Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample

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.

Relationships between perceived emotional intelligence, aggression, and impulsivity in a population-based adult sample

A diminished capacity to reason about one's own or others' mood states (part of emotional intelligence, EI) may impair one's ability to respond to threat or frustration, leading to aggression and/or impulsivity. In this study, 1544 adult subjects completed the Trait-Meta-Mood Scale (TMMS), an assessment of perceived EI, in order to examine how attention to emotions, clarity of emotions, and repair of emotions were associated with aggression and impulsivity. Correlations among the TMMS subscales of Attention, Clarity, and Repair were all significant. Clarity moderated the relationship between Attention and Repair such that Attention correlated with Repair only at higher levels of Clarity. Aggression and Impulsivity were both associated with all three dimensions of perceived EI; however, Repair was associated more strongly with Aggression than Impulsivity, whereas the reverse was true for Clarity. Finally, a subsample of participants self-identified as having "anger problems" had lower TMMS scores for Clarity and Repair compared to "non-anger problem" participants. Adding aggression and impulsivity to the model eliminated these group differences. Results suggest that Clarity and Repair may be the most important aspect of perceived EI. Interventions that increase these components, along with effective mood regulation techniques, may potentially ameliorate impulsive aggressive behavior.

Self- and partner-reported psychopathic traits' relations with couples' communication, marital satisfaction trajectories, and divorce in a longitudinal sample

Given that psychopathy is composed in large part by an antagonistic relational approach and is associated with many troubling interpersonally relevant outcomes, its role in romantic functioning warrants greater attention. The current study used data from a community sample of 172 newlywed couples to examine spouses' psychopathic traits in relation to their partners' psychopathic traits, observed communication, 4-year marital satisfaction trajectories, and 10-year divorce rates. Spouses reporting greater levels of psychopathic traits were married to partners reporting greater levels of psychopathic traits. Psychopathic traits were correlated cross-sectionally with more negative affect and less positive affect during conversations regarding sources of tension in the relationship. Longitudinally, hierarchical linear modeling of spouses' 4-year marital trajectories indicated that psychopathic traits generally predicted lower initial and sustained marital satisfaction for spouses and their partners over time. In addition, wives' ratings of husbands' psychopathic traits predicted declines in husbands' satisfaction over time and elevated 10-year divorce rates. These findings highlight the relationship impairment associated with psychopathic traits, indicate that this impairment is present from the beginning of couples' marital trajectories, and show that psychopathic traits predict divorce. Findings also suggest that partner-ratings of psychopathic traits provide substantial incremental validity in the prediction of marital functioning outcomes relative to self-ratings. Future research on the pathways by which psychopathic traits undermine relationship functioning over time would be valuable. (PsycINFO Database Record

The cross-national epidemiology of DSM-IV intermittent explosive disorder

BACKGROUND

This is the first cross-national study of intermittent explosive disorder (IED).

METHOD

A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition.

RESULTS

Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13-23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset.

CONCLUSIONS

Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.

White Matter Integrity Reductions in Intermittent Explosive Disorder

Intermittent explosive disorder (IED), as described in DSM-5, is the categorical expression of pathological impulsive aggression. Previous work has identified neurobiological correlates of the disorder in patterns of frontal-limbic brain activity and dysregulation of serotonergic neurotransmission. Given the importance of short- and-long range white matter connections of the brain in social and emotional behavior, studies of white matter connectivity in impulsive aggression are warranted. Diffusion tensor imaging (DTI) studies in the related conditions of antisocial and borderline personality disorder have produced preliminary evidence of disturbed white matter connectivity in these disorders, but to date there have been no DTI studies in IED. A total of 132 male and female adults between the ages of 18 and 55 years underwent Turboprop-DTI on a 3-Tesla MRI scanner. Of these, 42 subjects had IED, 40 were normal controls, and 50 were clinical psychiatric controls with psychiatric disorders without IED. All subjects were free of alcohol, psychotropic medications, or drugs of abuse. The diffusion tensor was calculated in each voxel and maps of fractional anisotropy (FA) were generated. Tract-based spatial statistics (TBSS) were used to compare FA along the white matter skeleton among the three subject groups. IED was associated with lower FA in two clusters located in the superior longitudinal fasciculus (SLF) when compared with the psychiatric and healthy controls. Impulsive aggression and borderline personality disorder, but not psychopathy or antisocial personality disorder, was associated with lower FA in the two clusters within the SLF. In conclusion, IED was associated with lower white matter integrity in long-range connections between the frontal and temporoparietal regions.

Substance use disorders: Relationship with intermittent explosive disorder and with aggression, anger, and impulsivity

BACKGROUND

A relationship between substance use and aggression has been noted for decades. While substance use appears to be associated with an increased risk of aggressive behavior, no study has yet reported on the pattern of comorbidity and temporal relationship between impulsive aggression (i.e., intermittent explosive disorder) and substance use disorders (SUD), specifically.

METHODS

To specify these relationships, we examined DSM-5 diagnosis data from diagnostic interviews of 1355 adults who met one of five non-overlapping diagnostic subgroups: those with intermittent explosive disorder (IED; n = 339), those with SUD (n = 136), IED+SUD (n = 280), adults with psychiatric disorders but no SUD or IED (n = 320), and healthy

CONTROLS

HC, n = 282).

RESULTS

Occurrence of lifetime SUD was elevated in IED vs. all Non-IED subjects (Odds Ratio: 3.61 [95% CI: 2.82-4.63]) and onset of IED preceded SUD in 80% of comorbid IED+SUD cases. Examination of the severity of impulsive aggression and SUD revealed that IED increased SUD severity but the presence of SUD did not increase severity of IED core features, including aggression, anger, or impulsivity.

CONCLUSIONS

Subjects with IED are at increased risk of developing substance use disorder, compared to 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. Thus, effective treatment of impulsive aggression, before the onset of substance misuse, may prevent or delay the development of SUD in young individuals.

Personality predictors of anger. The role of FFM traits, shyness, and self-esteem

The present study was designed to verify hypothesized predictor effects for five anger-related variables, i.e. trait anger, anger expression-out, anger expression-in, anger control-out, and anger-control-in. A sample of 138 students completed measures for FFM personality traits (NEO-FFI), self-esteem (SES), shyness (RCBS), and anger (STAXI-2). The study confirmed the effects of neuroticism and agreeableness as being the chief personality predictors of anger; however, for the domain of anger expression-in, an unexpected role of extraversion was revealed. Furthermore, introducing self-esteem and shyness changed some effects of FFM traits. Entering self-esteem as an additional predictor improved the predictability of anger control-in. Additionally, a mediation effect of shyness was revealed for the relation between extraversion and anger expression-in.