Comorbidity Risk High in Intermittent Explosive Disorder

TOPLINE:

Intermittent explosive disorder (IED) is associated with significantly higher odds of having psychiatric, neurologic, and somatic comorbidities, with 96% of patients having at least one additional mental health diagnosis, a new study showed.

METHODOLOGY:

• Analysis included electronic medical record data for 117.7 million patients (mean age, 26 years; 70% men) across 87 healthcare organizations in the United States through January 2024.
• Researchers identified 30,357 individuals with IED and matched them 1:1 with demographically similar individuals without IED based on age, sex, race, ethnicity, and US Census region.
• The average follow-up duration was 4.8 years.

TAKEAWAY:

• A total of 96% of patients with IED had another psychiatric condition, including increased odds of substance use disorder (hazard ratio [HR], 2.1; 95% CI, 2.0-2.2) and disorders of adult personality and behavior (HR, 76.6; 95% CI, 65.4-89.6) compared with the control group.
• Among neurologic conditions, neurodegenerative diseases (HR, 5.0; 95% CI, 4.1-6.1) and epilepsy (HR, 4.9; 95% CI, 4.3-5.6) showed the strongest associations with IED.
• Significant associations were also found between IED and somatic conditions, including obesity (HR, 1.6; 95% CI, 1.5-1.7), hyperlipidemia (HR, 1.5; 95% CI, 1.4-1.5), hypertension (HR, 1.6; 95% CI, 1.5-1.7), and gastroesophageal reflux disease (HR, 1.7; 95% CI, 1.7-1.9).
• A total of 38% of patients with IED vs 5% of control individuals had ADHD diagnoses, and about 15% of patients with IED vs 4% of control individuals had alcohol-related disorders.

IN PRACTICE:

“These findings highlight the extensive comorbidities between IED and psychiatric, neurological, and somatic disorders, emphasizing the need for integrated diagnostic and treatment approaches addressing both psychological and physical health aspects of IED,” the investigators wrote.

SOURCE:

The study was led by Yanli Zhang-James, MD, PhD, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York. It was published online January 22 in JAMA Psychiatry.

LIMITATIONS:

The study relied on medical records, which may have led to diagnostic inaccuracies and differences from structured interview samples. The low prevalence of IED in the dataset raised concerns about misclassification, potentially diluting the findings. The high psychiatric comorbidity and low diagnostic rates of IED were additional limitations.

DISCLOSURES:

The study received no direct funding. One investigator reported holding stocks in multiple pharmaceutical companies and owning a psychoeducational business outside the submitted work, while another reported receiving grants, consulting fees, honoraria, and royalties and holding stocks from various pharmaceutical and healthcare companies, along with travel support. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.