Disordered Aggression and Violence in the United States


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Objective: To determine the prevalence and correlates of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States.

Methods: Community survey data (collected between 2001–2004) from the National Comorbidity Survey—Replication (NCS-R) and Adolescent Supplement (NCS-AS) involving 10,148 adolescents and 9,282 adults, respectively, were reanalyzed with recurrent aggressive behavior defined as 3 serious aggressive outbursts in any given year. In addition to prevalence, assessments of aggression severity, property damage, injury to others, intimate partner assault, utilization of guns and weapons to threaten, and treatment utilization for recurrent aggressive behavior were also assessed.

Results: About 17% of adolescents and 8% of adults report a pattern of recurrent aggressive outbursts within at least 1 year. Such individuals are much more aggressive and impulsive than nonaggressive controls and are more likely to engage in intimate partner assault, carry and use guns and other weapons to threaten others, and be arrested by law enforcement. Few aggressive individuals speak with health care providers about this behavior, and fewer receive treatment for aggression.

Conclusion: Recurrent aggressive behavior is common in both adolescents and adults, with clinically significant consequences to those with this pattern and to others in their environment (ie, using guns and other weapons to threaten others). While this type of behavior can be reduced though pharmacologic/psychosocial treatment intervention, the vast majority of aggressive individuals do not engage in treatment for their aggressive behavior. Screening individuals for such behavior in one’s practice may do much toward identifying this problem and bringing such individuals into treatment.

J Clin Psychiatry 2020;81(2):19m12937