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

Kate M. Scott, Carmen C W Lim, Irving Hwang, Tomasz Adamowski, Ali Al-Hamzawi, Evelyn J. Bromet, Brendan Bunting, M P Ferrand, Silvia Florescu, Oye Gureje, Hristo Hinkov, Chiyi Hu, Elie G. Karam, S. C. Lee, Jose Posada-Villa, Dan J. Stein, Hisateru Tachimori, M C Viana, Miguel Xavier, Ronald C. Kessler

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20 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)3161-3172
Number of pages12
JournalPsychological Medicine
Issue number15
Publication statusPublished - Nov 2016


  • Cross-national studies
  • DSM-IV
  • epidemiology
  • intermittent explosive disorder
  • World Mental Health Surveys


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