Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury

Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. Results: The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. Conclusions: Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.

Trastorno explosivo intermitente: un diagnóstico controversial / Intermittent Explosive Disorder: A Controversial Diagnosis

Introducción: El trastorno explosivo intermitente (TEI) es un trastorno externalizante que se caracteriza por episodios recurrentes de agresividad. Aunque es un trastorno descrito desde hace varias décadas, y que ocasiona consecuencias personales y sociales, la producción bibliográfica sobre este tema es sorprendentemente escasa. Objetivo: Realizar una conceptualización sobre el TEI a partir de la revisión y el análisis bibliométrico de los artículos científicos disponibles. Material y métodos: Se realizó una búsqueda en las bases de datos con los términos en inglés intermittent explosive disorder, impulse control disorders [MeSH] en combinación con otros términos. Se realizó un análisis bibliométrico utilizando los datos obtenidos en el buscador GoPubMed®. Discusión: La prevalencia del TEI oscila entre el 1,4 y el 7%, con mayor frecuencia durante la adolescencia media, y con más repercusiones notorias en varones que en mujeres. El núcleo psicopatológico del TEI es la conducta agresiva impulsiva que se presenta en forma de «ataques¼ que ocurren en respuesta a un estímulo precipitante menor. Las publicaciones científicas sobre el TEI son pocas, relativamente recientes, y la mayoría de Estados Unidos (56,56%), en cabeza un solo autor. Este hecho resalta la necesidad de repetir los hallazgos descritos sobre el TEI para demostrar validez y confiabilidad de sus criterios diagnósticos. Es posible que las dudas sobre la existencia del diagnóstico estén conduciendo a que se publique tan escasamente sobre el TEI. Conclusiones: Los estudios disponibles sobre TEI permiten caracterizar un grupo de sujetos con episodios de agresividad impulsiva, pero esta descripción requiere que se repita en latitudes diferentes.

Introduction: Intermittent explosive disorder (IED) is aan externalizing externalising disorder characterized characterised by recurrent aggression episodes. Even though this disorder was described several decades ago, and it carries personal and social consequences, there is little in the medical scientific literature on this. bibliographic production about it is scanty. Objective: To perform a conceptualization conceptualisation of this disorder, through the review and bibliometric analysis of the available scientific articles. Material and methods: A search was performed in databases with the english English terms intermittent explosive disorder, impulse disorders control [MeSH], in combination with other terms. A bibliometric analysis in the GoPubMed® search engineer was also performed using all data obtained in the search. was also perfomed. Discussion: IED prevalence ranges from 1.4% to 7%, it presents more frequently during middle adolescence, and with more noticeable repercussions in men males than in womenfemales. The psychopathological core of IED is the impulsive aggressive behaviour that presents in the form of «attacks¼ that occurs in response to a lower precipitating stimulus. Scientific publications about IED are few and relatively recent, and the vast majority is provided bycomes from the United States (56.56%), and headed by a single author. This fact highlights the need to replicate the findings described about the IED in order to demonstrate the validity and reliability of its diagnostic criteria. It is possible that doubts about the existence of a diagnosis lead have led to such a scant literature about the IED. Conclusions: Available studies about IED allow have allowed characterizing a group of subjects with episodes of impulsive aggression to be characterised, but this description requires replication in different latitudes needs to be repeated in different areas.

Trastorno bipolar y trastorno explosivo intermitente: error diagnóstico a propósito de dos casos clínicos / Bipolar disorders and intermittent explosive disorder: diagnostic error in two clinical cases

Many bipolar patients, adolescents in particular, present with irritable mania rather than euphoric mania, which usually tends to be intense, persistent, and often violent. Their interepisode state, between one outburst and the next, has been described as permanent irritability and rage. These phenomenological characteristics tend to complicate the diagnostic process. In fact, in a youngster, the first bipolar episode, be it manic or depressive, may be mislabeled as a tempestuous reaction of puberty, as an adaptive behavioral reaction, or as a borderline personality disorder. Irritability, as a clinical manifestation, is a valuable tool in the process of bipolar disorder recognition. This notwithstanding, its presence may misleadingly result in diagnostic errors and false-positive judgments. It may make us miss a less-frequently diagnosed and recognized entity like intermittent explosive disorder, which, like bipolarity in the adolescent, counts irritability among its core symptoms. Differential diagnosis between these two clinical entities, however, is often possible on the basis of differing clinical phenomenology. This paper’s aim is to present two cases that illustrate diagnostic pitfalls between bipolar disorder and intermittent explosive disorder, highlighting the clinical and phenomenological differences between the two diagnostic entities.

Muchos pacientes bipolares, principalmente adolescentes, presentan una manía irritable más que eufórica la cual acostumbra a ser muy intensa, persistente y a menudo violenta. Su estado entre una explosión y otra es descrito como irritabilidad e ira permanentes. Toda esta fenomenología suele dificultar el diagnóstico. De hecho, en un menor, el primer episodio de un trastorno bipolar, sea maníaco o depresivo, puede confundirse con una reacción tempestuosa de la pubertad, con una reacción adaptativa de tipo conductual o con un trastorno límite de la personalidad. La irritabilidad ha cobrado un importante valor para el clínico en el reconocimiento del trastorno bipolar. Sin embargo, ante su presencia engañosamente podríamos cometer errores y falsos positivos, olvidándonos de un cuadro poco diagnosticado y reconocido como el trastorno explosivo intermitente cuyo eje central, tal como en la bipolaridad del adolescente es la irritabilidad, aunque difieren en cuanto a su fenomenología, la que permite discernir entre ambas patologías. El objetivo de este trabajo es presentar dos casos de error diagnóstico entre trastorno bipolar y trastorno explosivo intermitente, discutiendo los autores las diferencias clínicas y fenomenológicas entre uno y otro.