Hidden storms within: Psychiatric comorbidity in intermittent explosive disorder: A systematic review and Bayesian...

Area of Science:

• Psychiatry
• Mental Health Research
• Epidemiology

Background:

• Intermittent Explosive Disorder (IED) is characterized by sudden, disproportionate aggressive outbursts.
• High rates of psychiatric comorbidity suggest IED has a complex transdiagnostic profile.
• Previous quantitative synthesis of IED comorbidity profiles was lacking.

Purpose of the Study:

• To estimate the prevalence of psychiatric comorbidities in individuals with IED.
• To quantify the odds ratios for these comorbidities compared to non-IED populations.
• To identify factors influencing the associations between IED and comorbidities.

Main Methods:

• A meta-analysis following PRISMA guidelines, including 47 studies (over 80,000 participants).
• Random-effects and Bayesian models synthesized data for seven psychiatric disorders.
• Meta-regression and sensitivity analyses assessed moderators and robustness; publication bias was evaluated.

Main Results:

• Individuals with IED showed significantly elevated odds for Agoraphobia (OR=3.79), Alcohol Use Disorder (OR=3.08), Drug Use Disorder (OR=3.31), Generalized Anxiety Disorder (OR=3.45), Major Depressive Disorder (OR=2.12), Post-Traumatic Stress Disorder (OR=2.75), and Social Phobia (OR=2.90).
• Comorbidity prevalence ranged from 8.1% (Agoraphobia) to 30.7% (Drug Use Disorder).
• General population samples showed higher comorbidity estimates than clinical samples; diagnostic criteria did not significantly moderate associations.

Conclusions:

• This is the first meta-analysis of comorbidity with IED, revealing a pervasive burden across mood, anxiety, and substance use spectra.
• Findings support shared transdiagnostic mechanisms like emotional dysregulation and impaired impulse control in IED.
• Urgent need for integrated screening, transdiagnostic treatments, and formal recognition of IED in global mental health agendas.