Health In Focus
  • Intermittent explosive disorder (IED) is an aggressive behavioral condition marked by frequent physical or verbal outbursts that often affects young adults.
  • Although essentially a neurobiological disorder, it is often treated as a social-behavioral issue.
  • New findings suggest that frequent aggressive behavior increases the risk of future substance abuse by 5 times.

People who display frequent aggressive behavior have five times greater risk for abusing substances such as alcohol, tobacco and marijuana than those who do not display this behavior, according to a new study by a research team from the University of Chicago.

This condition is termed as intermittent explosive disorder (IED), which is marked by frequent physical or verbal outbursts affecting about 16 million Americans, more than bipolar disorder and schizophrenia combined.
Later Risk of Substance Abuse Linked with Aggressive Behavior

It often affects young adults, some of whom can be as young as 11 years before substance abuse problems usually develop.

IED runs in families and is thought to have a significant genetic component. But it is often treated as a social-behavioral issue instead of as a true neurobiological disorder.

"People don't see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn't. It has significant biology and neuroscience behind it," said Coccaro, who is the Ellen C. Manning Professor of Psychiatry and Behavioral Neuroscience at University of Chicago.

Though it is known that substance abuse, like excessive drinking, can make aggressive behavior worse, no studies have reported the relationship between onset of IED and chronic substance abuse.

Previous research had suggested that aggressive behavior in IED is due to the presence of other psychiatric disorders, such as anxiety or depression. But the new study found no such relationship.


The research team including Emil Coccaro, MD, and colleagues analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States.

They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use.

In cases where patients developed both aggressive disorder and chronic substance abuse, IED preceded substance abuse in 92.5% of the cases.

The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and that substance abuse can be prevented or delayed in young people by effective treatment of aggression.

The most effective therapies to prevent or delay substance abuse problems in adolescents diagnosed with IED are early psychological intervention, medication and cognitive therapy.

"What you're really treating is the emotional dysregulation that leads to aggression," Coccaro said. "The earlier you treat this dysregulation, the more likely you are to offset other disorders that come later down the road."

The study is published in the Journal of Clinical Psychiatry.

Intermittent Explosive Disorder

Intermittent explosive disorder is a chronic disorder that is characterized by sudden episodes of repeated, impulsive, aggressive, violent or angry verbal outbursts.

Young people, mostly males are commonly affected by IED. This behavior can be very destructive and lasts for years, though its severity diminishes with age.

The lifetime incidence of IED ranges from 5% to 7%, according to the National Comorbidity Survey Replication and the current prevalence is 3% to 4%.

Treatment involves medications and psychotherapy to help you control aggressive impulses.

References :
  1. Emil Coccaro et al. Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample. Journal of Clinical Psychiatry ; (2017)
  2. Intermittent Explosive Disorder - (
  3. Treating intermittent explosive disorder - (
Source: Medindia

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