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Significant number of teens reported impulsive aggression

Nearly two-thirds of adolescents reported lifetime anger attacks in which they destroyed property, threatened violence or engaged in violence, according to recent study results.

“This is one of the most common adolescent disorders in America, and the most important ignored disorder among youth in America,” study researcher Ronald Kessler, PhD, said in a press release.

Kessler, the McNeil Family Professor of Health Care Policy at Harvard Medical School, and colleagues analyzed data from the US National Comorbidity Survey Replication Adolescent Supplement, a survey that includes nationally representative school and household samples of adolescents aged 13 to 17 years. The researchers focused on 6,483 adolescent–parent pairs to identify the prevalence and correlates of intermittent explosive disorder.

Kessler and colleagues excluded adolescents with a history of bipolar disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, which are associated with anger attacks and impulsive aggression.

Among the 63.3% of adolescents who reported having destroyed property, threatened violence or engaged in violence, 7.8% met DSM-IV criteria for intermittent explosive disorder. More detailed analyses showed that attacks involving threats of violence were the most common (57.9%), followed by attacks involving violence (39.3%) and destruction of property (31.6%). Among adolescents who reported anger attacks, 72.5% had attacks that involved more than one of these three behaviors. Almost half of adolescents who reported attacks (29.3% of the sample) had one or two lifetime attacks, and 20.1% had attacks that “were either proportional in response to provoking circumstances (8% of the sample) or not out of control (12.1% of the sample),” according to the researchers.

Most (63.9%) adolescents with intermittent explosive disorder met at least one additional DSM-IV disorder, including mood, anxiety and substance disorders. More than one-third (37.8%) of adolescents with 12-month intermittent explosive disorder received treatment a year before the interview, but only 6.5% were treated specifically for anger.

“Results strongly suggest that [intermittent explosive disorder] is a commonly occurring disorder among US adolescents and has high persistence and severity,” the researchers wrote. “However, the data also show that [intermittent explosive disorder] is undertreated, both in that a high proportion of youth with [intermittent explosive disorder] do not receive treatment for any emotional problems and, in those who do receive treatment, the focus for many is a disorder other than [intermittent explosive disorder].”

Disclosure: See study for full list of financial disclosures.