Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis.

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.

Laboratory assessment of aggression: The Taylor Aggression Paradigm in adults with and without a disorder of impulsive aggression.

INTRODUCTION: The modified Taylor Aggression Paradigm (TAP) has been used to study impulsive aggression in experimental designs and has been relatively successful in addressing critiques of aggression paradigms; however, little has been done to examine the potential of using the TAP as a direct measure of aggression. This study aimed to explore the psychometric properties of the TAP behavioral indexes as measures of aggression. METHODS: A community sample of 962 adults were divided into three groups based on diagnostic assessments: Intermittent Explosive Disorder; Non-Aggressive Psychiatric Disorder; or healthy controls. Participants then completed the TAP and self-report measures to assess construct validity. A subset of 47 participants completed a second TAP within one year to assess reliability. TAP indexes were based on number of "extreme" shocks selected (high shock index), average shock levels selected (mean shock index), and shocks levels selected without provocation (unprovoked aggression). RESULTS: Overall, TAP indexes were consistent and reliable. IED participants had the highest high shock and mean shock indexes of all groups (X2 = 49.93, p < 0.001). High shock index was related to trait aggression (ß = 0.184, p < 0.001) after including covariates; mean shock index had a trending association with trait anger (ß = 0.102, p = 0.059). CONCLUSION: TAP behavioral indexes demonstrated promising psychometrics as a measure of aggression. High shock index appears to be more strongly associated with aggressive behavior; mean shock index may better measure general hostile responding. Future research might include comparisons specifically with impulse control disorders.

BDNF and stress/mood-related interactions on emotional disorder symptoms, executive functioning, and deliberate self-harm.

Some prior research has suggested that the brain-derived neurotrophic factor (BDNF) gene may amplify responses related to life stress (e.g., depression and anxiety) or associated with negative moods (e.g., self-harm and diminished cognitive functioning). The purpose of this study was to investigate whether stress/mood-related associations with depressive and anxiety symptoms, deliberate self-harm, and executive functioning (EF) are moderated by genotypic variations in BDNF rs10835210 (a relatively understudied BDNF polymorphism) in a nonclinical sample. As part of a larger study, European American social drinkers (N = 132; 43.9% female; M age = 26.0, SD = 7.6) were genotyped for BDNF rs10835210 and were administered self-report measures of subjective life stress, depressive and anxiety symptoms, and history of non-suicidal self-injury (NSSI) and behavioral measures of EF and deliberate self-harm. Results indicated that BDNF significantly moderated the life stress associations with depressive symptoms and NSSI, the anxious mood association with EF, and the depressed mood association with deliberate self-harm behavior. Each of these BDNF × stress/mood interactions were characterized by stress/mood associations that were stronger in individuals with the AA genotype (homozygous for the minor allele) than in individuals possessing a genotype that included the major allele (AC or CC). The main limitations of the present study were use of a cross-sectional design, modest sample size, and investigating only one BDNF polymorphism. Despite these limitations and though preliminary, current findings suggest that variations in BDNF may confer vulnerability to stress or mood, which may result in more adverse emotional, cognitive, or behavioral outcomes.

Cluster-b personality disorder traits and impulsivity: Indirect associations with alcohol use severity through positive alcohol expectancies.

Prior theory and research suggest that both Cluster-B personality pathology and trait impulsivity are indirectly associated with alcohol use through positive alcohol expectancies. Yet, no prior study has investigated whether features of each of the Cluster-B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) and rash impulsiveness are indirectly associated with alcohol use severity through positive alcohol expectancies. In a cross-sectional design, social drinkers (N = 200; 51% female; Mage = 26 years) completed self-report measures of trait (rash) impulsivity, Cluster-B personality disorder (PD) traits, positive alcohol expectancies, and alcohol use severity. Simple and serial mediation analyses were used to test positive alcohol expectancies and the association between trait impulsivity and alcohol expectancies as potential mediators of personality disorder trait relations with alcohol use severity. Simple mediation analyses evidenced that trait impulsivity and traits specific to each of the Cluster-B (PDs) were indirectly associated with alcohol use severity through positive alcohol expectancies. Serial mediation analyses further evidenced that the Cluster-B (PD) traits were indirectly associated with alcohol use severity via positive alcohol expectancies both uniquely from and together with trait impulsivity. Current findings are novel and suggest that positive alcohol expectancies may be important to connecting the rashly impulsive aspects of Cluster-B (PDs) with greater alcohol use severity. However, current findings also suggest that features of the Cluster-B (PDs) probably increase risk for alcohol use disorder due to other reasons (e.g., other aspects of personality or forms of impulsivity). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Life history of experienced and witnessed aggression: Development of a new assessment instrument.

A Lifetime History of Experienced Aggression and a Lifetime History of Witnessed Aggression assessment was developed and its psychometric properties examined in a modest sample of individuals with and without history of psychopathology. Following this, the two assessments were administered to 400 subjects with or without histories of major psychiatric and personality disorders. These studies demonstrated good to excellent psychometric properties as well as evidence of convergent and divergent validity. Since both assessments quantify the occurrence of aggressive behaviors directed at a person and the occurrence of aggressive behaviors witnessed, the researchers propose that these assessments represents a needed modular assessment of aggression in the environment for behavioral science research.

Analgesic Effect of Alcohol Mediates the Association between Alcohol Intoxication and Deliberate Self-Harm.

We examined whether the analgesic effect of alcohol mediates the association between alcohol and deliberate self-harm (DSH) using data from a larger study on alcohol effects. Men (n = 106) and women (n = 104) low-risk alcohol drinkers (ages M = 26.00, SD = 6.98) recruited from the community who had no suicide attempt or episode of deliberate self-harm within the past year were randomly assigned to either a placebo drink condition or a drink calibrated to reach approximately .050%, .075%, or .100% blood alcohol concentration. Notable within-condition BAC variability, as well as overlap between conditions, suggested that BAC would be a more accurate indicator of intoxication compared to condition assignment. Pain tolerance was assessed by increasingly intense 1-s shocks delivered via fingertip electrodes. Self-reported pain associated with the pain tolerance index was also examined. A laboratory task of DSH, the Self-Aggression Paradigm, was then completed, with DSH operationalized as the number of self-administered shocks the participant was led to believe were twice the intensity of his or her pain tolerance and could cause "minor tissue damage that would quickly heal." A negative binomial parallel mediational model for count data revealed that pain tolerance, but not self-report pain, mediated the effect of alcohol on DSH. As such, the current study provides preliminary experimental evidence that the analgesic effect of alcohol is partially responsible for link between alcohol intoxication and deliberate self-harm.

Gender Moderates the Association Between Exposure to Interpersonal Violence and Intermittent Explosive Disorder Diagnosis.

Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of intermittent explosive disorder (IED). We also examined potential pathways that might differentially account for the association between EIV and IED in men and women, including emotion regulation and social information processing (SIP). Adult men and women (N = 582), who completed a semistructured clinical interview for syndromal and personality disorders, were classified as healthy controls (HC; n = 118), psychiatric controls (PC; n = 146) or participants with an IED diagnosis (n = 318). Participants also completed the life history of experienced aggression (LHEA) and life history of witnessed aggression (Lhwa) structured interview and self-report measures of emotion regulation and SIP. Men reported more EIV over the lifetime. In multiple logistic regression analysis, experiencing and witnessing aggression within the family and experiencing aggression outside the family were associated with lifetime IED diagnosis. We found that the relationship between EIV and IED was stronger in women than in men. Affective dysregulation mediated certain forms of EIV, and this relation was observed in both men and women. SIP biases did not mediate the relation between EIV and IED. EIV across the lifespan is a robust risk factor for recurrent, clinically significant aggressive behavior (i.e., IED). However, the relationship between EIV and IED appears to be stronger in women. Further, this relation appears partially mediated by affective dysregulation.

Emotion attribution in intermittent explosive disorder.

BACKGROUND: Accurate recognition of the emotions of others is an important part of healthy neurological development and promotes positive psychosocial adaptation. Differences in emotional recognition may be associated with the presence of emotional biases and can alter one's perception, thus influencing their overall social cognition abilities. The present study aims to extend our collective understanding of emotion attribution abnormalities in individuals with Intermittent Explosive Disorder (IED). METHODS: Two-hundred and forty-two adults participated, separated into groups of those diagnosed with IED according to DSM 5 criteria, Psychiatric Controls (PC), and Healthy Controls (HC). Participants completed a modified version of the Emotional Attribution Task wherein they attributed an emotion to the main character of a short vignette. RESULTS: Participants with IED correctly identified anger stories and misattributed anger to non-anger stories significantly more often than PC and HC participants. They were also significantly less likely than HC participants to correctly identify "sad stories." LIMITATIONS: We utilized self-report assessments in a community-recruited sample. Replication in a clinical is suggested. CONCLUSIONS: Findings from this study support the validity of IED as a diagnostic entity and provide important information about how individuals with psychiatric disorders perceive and experience emotional cues.

Anhedonia and the Relationship Between Other Depressive Symptoms and Aggressive Behavior.

Depression has been linked to multiple forms of aggressive behavior in college students; however, it is unclear which aspects of depression explain this connection. Anhedonia, defined as the loss of interest and/or pleasure in previously enjoyed activities, may provide unique information about relationships between depression and aggression. Using cross-sectional data from two independent samples of college students (N = 747 and N = 736 for Study 1 and Study 2, respectively), we examined whether anhedonia helped explain the relationship between broader depressive symptoms and different forms of aggressive and antisocial behavior. Anhedonia accounted for variance in both self-directed aggression and antisocial behavior independent of gender, hostility, anger, other depressive symptoms, and cognitive distortions (Study 2). In addition, there were significant indirect effects of depressive symptoms on self-directed aggression (Studies 1 and 2) and antisocial behavior (Study 2) via anhedonia. Hypotheses involving other-directed aggression received mixed support, with anhedonia atemporally associated with other-directed aggression independent of broader depressive symptoms in Study 1, but not in Study 2. The current findings suggest that anhedonia is an important individual difference that helps explain the relationship between depression and aggressive and antisocial acts and that anhedonia may be differentially associated with various types of aggressive and antisocial behavior.

The role of therapeutic alliance in therapy for adults with problematic aggression and associated disorders.

The nature and quality of the relationship between therapist and client in psychotherapy, known as therapeutic alliance, have been proposed as one of the most important factors for successful treatment outcome, which has been has robustly supported across many types of treatment, populations, raters of alliance (i.e., client, therapist, or observer), and alliance measures. However, most research on alliance and treatment outcome has been conducted in children and adults with internalizing problems (e.g., mood and anxiety disorders) or children with externalizing problems (e.g., conduct disorder), despite the fact that alliance may be particularly important for adults with externalizing problems such as problematic aggression, who may have high levels of resistance, blaming, and interpersonal problems. Very limited research has examined the role of alliance in individuals who present to treatment due to high levels of aggressive behaviour specifically (e.g., those convicted of a violent offence). The current systematic review examined the extant research on the relationship between alliance and outcome in treatment of highly aggressive individuals, as well as those who are diagnosed with a disorder for which aggression is a primary symptom (i.e., post-traumatic stress disorder, antisocial personality disorder, and borderline personality disorder). Overall, it was shown that alliance has a positive impact on treatment outcome among those engaging in or at risk for problematic aggression. Additionally, the alliance-outcome relationship may be affected by therapy modality, alliance rater perspective, and potential mechanisms of alliance. Implications for future research, including utilizing more primarily aggressive samples, are discussed.

History of childhood abuse and alcohol use disorder: Relationship with intermittent explosive disorder and intoxicated aggression frequency.

Intermittent Explosive Disorder (IED), the only psychiatric diagnosis for which affective aggression is the cardinal symptom, is uniquely associated with both a history of childhood abuse and a diagnosis of an alcohol use disorder (AUD). Moreover, both childhood abuse and AUD are associated with increased general aggression and aggression while intoxicated. Yet, no study to date has examined the relative contributions of childhood abuse and AUD to IED, nor their effects on overall and intoxicated aggression among those with and without IED. The following study aimed to fill these gaps. Participants were 493 individuals (68% female; Age M = 26.65) either with (n = 265) or without (psychiatric control group; n = 228) IED. All participants completed a clinical interview to (a) diagnose AUD, IED, and other comorbid psychiatric disorders; (b) assess childhood abuse history; and (c) determine lifetime frequency of overall and intoxicated aggression. Results indicated that a history of childhood abuse, but not AUD status, was uniquely predictive of IED status. With regard to aggression frequency, IED, AUD and childhood abuse were all independently associated with overall aggression, although only those with IED showed increased intoxicated aggression as a function of AUD severity. Overall, these results suggest that a history of childhood abuse may increase the chances of engaging in overall aggression and developing IED, which in turn may increase the association between AUD severity and intoxicated aggression.

Does State Dissociation Mediate the Relation Between Alcohol Intoxication and Deliberate Self-Harm?

Research supports the notion that alcohol intoxication is a risk factor for deliberate self-harm (DSH). However, the underlying mechanisms for this relationship are poorly understood. We aimed to determine whether alcohol-induced dissociation mediated alcohol's effects on DSH. We used data from a dose-response study of alcohol intoxication and DSH to test the proposed model. Participants were assigned to reach target blood alcohol concentrations (BAC) ranging from 0.00% through 0.10% and then completed a behavioral measure of DSH. Dissociation was assessed using the Alcohol Dissociative Experiences Scale. BAC predicted both dissociation and DSH, but dissociation did not predict DSH. Although research on clinical populations suggests dissociation is related to DSH, our findings suggest dissociation does not mediate the effects of alcohol on self-harm.

Potential Mood Variation Following a Behavioral Analogue of Self-Injurious Behavior.

Despite increased use of behavioral analogues to identify casual mechanisms of self-injurious behavior (e.g., suicide attempts; non-suicidal self-injury), little is known about the impact on participants. The current study examined the impact of a specific behavior analogue, Self-Aggressive Paradigm (SAP), on participant affect. Community participants (n = 507) reported several affective ratings before and after completing SAP task procedures. Following the SAP, participants reported reductions in nervousness and fear and increases in calmness and anger (d = .21). Participants with a current anxiety disorder reported greater increases in happiness; those with a suicide attempt history reported greater increases in sadness. Findings demonstrate the SAP has no adverse mood effects, supporting its use in experimental research.

Assessing Non-Suicidal Self-Injury in the Laboratory.

The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings.

Effect of alcohol dose on deliberate self-harm in men and women.

OBJECTIVE: Nonexperimental survey and field research support the notion that alcohol use may be associated with deliberate self-harm (DSH) across the spectrum of lethality, from nonsuicidal self-injury (NSSI) through suicide. Nonexperimental studies, however, provide limited information about potential causal relationships between alcohol consumption and DSH. Two previous experiments showed that a relatively high-dose of alcohol increases the likelihood of engaging in DSH in men, with DSH defined by the self-administration of a "painful" shock (the self-aggression paradigm [SAP]; Berman & Walley, 2003; McCloskey & Berman, 2003). In this study, we examined whether (a) lower doses of alcohol also elicit DSH, (b) this effect occurs for women as well as men, and (c) individual differences in past nonsuicidal self-injury (NSSI) moderate alcohol's effects on DSH. METHOD: Nonalcohol dependent men and women (N = 210) were assigned either to .00%, .05%, .075%, or .100% blood alcohol concentration (BAC) drink conditions and completed a self-rating scale of NSSI (the Deliberate Self-Harm Inventory [DSHI]; Gratz, 2001). As in previous SAP studies, DSH was operationalized by shock setting behavior during a competitive reaction time (RT) game. RESULTS: Overall, a greater proportion of participants in the .075% and .100% (but not .050%) alcohol conditions self-selected a "painful" shock to administer compared to participants in the placebo condition. NSSI predicted self-administration of painful shocks, but did not moderate the alcohol effect. CONCLUSIONS: Results provide experimental evidence to support the notion that interventions for self-harm should include processes to monitor and limit alcohol intake. (PsycINFO Database Record

Development of a screening questionnaire for DSM-5 intermittent explosive disorder (IED-SQ).

OBJECTIVE: This study was designed to develop and test a screening approach to identify individuals with DSM-5 Intermittent Explosive Disorder (IED), a disorder of recurrent, problematic, impulsive aggression. METHODS: A screening approach to diagnose DSM-5 IED (IED-SQ) was developed by combining items related to life history of aggression and items related to the DSM-5 diagnostic criteria for IED. In study 1, the IED-SQ was studied in 72 adult participants; 33 that met DSM-5 criteria for lifetime IED and 39 that did not. In study 2, the IED-SQ was given to 740 undergraduates at a US university. Measures of aggression and anger expression and anger control were assessed in both studies. RESULTS: In study 1, the IED-SQ demonstrated strong concordance with the best estimate diagnoses (Kappa =.80) for lifetime IED by DSM-5 criteria and good test-retest reliability (kappa =0.71). In study 2, the IED-SQ identified 4.3% of the undergraduate sample as meeting DSM-5 criteria for lifetime IED, a rate comparable to that in recent epidemiological studies. Participants identified as meeting DSM-5 criteria for lifetime IED, in both studies, had higher aggression scores, and higher anger expression, and lower anger control scores, compared to participants that did not meet DSM-5 criteria for lifetime IED. CONCLUSIONS: These data suggest that the IED-SQ is a useful screening tool that can quickly identify the presence of IED by DSM-5 criteria in adults.

Neural Correlates of Aggressive Behavior in Real Time: a Review of fMRI Studies of Laboratory Reactive Aggression.

PURPOSE OF REVIEW: Aggressive behavior has adaptive value in many natural environments; however, it places substantial burden and costs on human society. For this reason, there has long been interest in understanding the neurobiological basis of aggression. This interest, and the flourishing of neuroimaging research in general, has spurred the development of a large and growing scientific literature on the topic. As a result, a neural circuit model of aggressive behavior has emerged that implicates interconnected brain regions that are involved in emotional reactivity, emotion regulation, and cognitive control. RECENT FINDINGS: Recently, behavioral paradigms that simulate provocative interactions have been adapted to neuroimaging protocols, providing an opportunity to directly probe the involvement of neural circuits in an aggressive interaction. Here we review neuroimaging studies of simulated aggressive interactions in research volunteers. We focus on studies that use a well-validated laboratory paradigm for reactive physical aggression and examine the neural correlates of provocation, retaliation, and evaluating punishment of an opponent. SUMMARY: Overall, the studies reviewed support the involvement of neural circuits that support emotional reactivity, emotion regulation, and cognitive control in aggressive behavior. Based on a synthesis of this literature, future research directions are discussed.

Using Propensity Scores to Examine the Association Between Behavioral Inhibition/Activation and Nonsuicidal and Suicidal Self-Injury.

BACKGROUND: Self-injurious behavior (e.g., nonsuicidal self-injury, suicide attempts) is a serious public health concern. One potentially important but understudied predictor of nonsuicidal and suicidal self-injury involves the behavioral inhibition and activation system (BIS/BAS). AIMS: The goal of the current study was to examine the relationship between nonsuicidal and suicidal self-injury and BIS/BAS, and to consider the influence of related variables in the relationship. Examination through this framework allowed us to consider BIS and BAS as potential unique risk factors of self-injury. METHOD: After examining the relationship between nonsuicidal and suicidal self-injury and BIS/BAS among 1,912 participants, we used propensity scores to match participants' propensity for nonsuicidal self-injury and suicide attempts based on demographic variables (e.g., gender, age) and related risk factors (e.g., anxiety, depressive symptomology, impulsivity, and substance use problems). RESULTS: Participants who reported nonsuicidal self-injury or attempted suicide scored higher on BIS and BAS compared with those without a history of these behaviors. After matching procedures, however, the only group difference found was on BIS between those with and without a history of nonsuicidal self-injury. CONCLUSION: Results support the notion that the behavioral inhibition system might play a role in nonsuicidal self-injury but not in suicidal self-injury.

Negative urgency and reward/punishment sensitivity in intermittent explosive disorder.

UNLABELLED: Intermittent explosive disorder (IED) is the sole psychiatric diagnosis in which affective aggression is the cardinal symptom. Previous research has been equivocal with regard to the relationship between IED and impulsivity. This inconsistency may reflect the varied facets of impulsivity, with some aspects of impulsivity (e.g. negative urgency) as well as some overlapping, albeit distinct constructs (e.g. reward and punishment sensitivity) yet to be studied. METHODS: The present study compared individuals diagnosed with IED (n=81) with psychiatric controls (PCs; n=52) and healthy volunteers (HVs; n=58) on the impulsivity domains of negative and positive urgency, perseverance, sensation seeking, and premeditation, as well as on reward and punishment sensitivity. We hypothesized that individuals with IED would show greater negative and positive urgency, reward sensitivity, punishment sensitivity, with negative urgency independently predicting IED status. We also hypothesized that negative urgency would predict levels of anger, aggression, and aggression control among those with IED. RESULTS: The IED participants reported greater negative urgency than both comparison groups, and greater levels of positive urgency, reward sensitivity, and punishment sensitivity compared to HVs. Further, heightened negative urgency was the sole predictor an IED diagnosis. Within the IED group negative urgency uniquely predicted decreased aggression control and increased trait anger. LIMITATIONS: Limitations included reliance on self-report measures to assess RS/PS, impulsivity, and aggression. CONCLUSIONS: These findings suggest that negative urgency is a key factor associated with IED and is associated with dampened control of aggression within those with IED.