Significant proportion of adolescents, adults report pattern of recurrent aggressive behavior

Recurrent aggressive behavior with clinically significant consequences to those who demonstrate it and those around them is common among both adolescents and adults, according to results of a survey study published in Journal of Clinical Psychiatry. However, researchers noted that most aggressive individuals do not receive treatment for their behavior.

“Recognition, and treatment, of these behaviors in our patients would do much to reduce these behaviors as well as their consequences, most importantly with regard to the use of guns and other weapons, in society,” wrote Emil F. Coccaro, MD, and Royce J. Lee, MD, both of the department of psychiatry and behavioral neuroscience at The University of Chicago Pritzker School of Medicine. “Given this, screening individuals for such behavior in one’s practice may do much toward identifying this problem and bringing such individuals into treatment.”

Previous research identified links between mental illness and violence along a complicated continuum, commonly defined by comorbidity relationships among disorders. Coccaro and Lee noted that this complexity is problematic because the general presence of psychiatric disorder is unable to clearly identify those at greatest risk for violence.

The DSM-V has labeled those with recurrent, impulsive aggressive behavior as having intermittent explosive disorder; thus, the researchers sought to determine the prevalence and correlates of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States. They reanalyzed community survey data collected between 2001 and 2004 as part of the National Comorbidity Survey-Replication (NCS-R) and Adolescent Supplement (NCS-AS), with recurrent aggressive behavior defined as three serious aggressive outbursts in any given year. Data were available for 10,148 adolescents and 9,282 adults. Along with prevalence, the investigators also assessed aggression severity, injury to others, intimate partner assault, property damage, use of guns and weapons to threaten, and treatment utilization for recurrent aggressive behavior.

Results showed approximately 17% of adolescents and 8% of adults reported a pattern of recurrent aggressive outbursts within at least 1 year. These individuals were significantly more impulsive and aggressive than nonaggressive controls and were more likely to carry and use guns and other weapons to threaten others, engage in intimate partner assault and be arrested by law enforcement. Moreover, few aggressive individuals tell their health care providers about this behavior, and fewer receive treatment for it.

“Combined with the urgent problem of violence in society, the data from this reanalysis should provide the rationale for reprioritizing public health research toward the causes of and treatments for recurrent, problematic, impulsive aggression,” the researchers wrote. – by Joe Gramigna

Disclosures: Coccaro reports serving on the scientific advisory board of Azevan Pharmaceuticals and consulting for Avanir Pharmaceuticals. Lee reports research grants from Avanir Pharmaceuticals and Azevan Pharmaceuticals.