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

Intermittent Explosive Disorder (IED) is characterised by sudden, disproportionate outbursts of aggression. High rates of psychiatric comorbidity suggest that IED represents a complex transdiagnostic profile, yet its comorbidity profile has not yet been synthesised quantitatively.

This meta-analysis aimed to (1) estimate the prevalence of psychiatric comorbidities among individuals with IED, (2) quantify the odds ratios for these comorbidities relative to non-IED populations and (3) identify contextual and methodological factors that may shape the strength and nature of these associations.

Following PRISMA guidelines and PROSPERO registration (CRD420251048183), 47 studies comprising over 80,000 participants were included. Of these, 29 contributed quantitative data to the meta-analytic synthesis, although some studies drew on overlapping datasets. Random-effects and Bayesian models were used to synthesise data across seven psychiatric disorders. Meta-regression and sensitivity analyses were conducted to assess the influence of potential moderators and the robustness of findings. Publication bias was evaluated using funnel-plot asymmetry and Bayesian selection models.

Individuals with IED demonstrated markedly elevated odds of comorbidity across several domains, including Agoraphobia (OR = 3.79), Alcohol Use Disorder (OR = 3.08), Drug Use Disorder (OR = 3.31), Generalised 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 yielded relatively higher comorbidity estimates than clinical samples in most comorbid disorders, while diagnostic criteria did not significantly moderate these associations.

To our knowledge, this is the first meta-analysis of comorbidity with IED. The findings reveal a pervasive comorbidity burden that bridges mood, anxiety, and substance-use spectra, reinforcing the view that shared transdiagnostic mechanisms, including emotional dysregulation, impaired impulse control, and heightened arousability, underpin IED. Importantly, while the meta-analysis provides replicated evidence for these seven comorbidities, the qualitative review suggests that the comorbidity of IED extends to nearly every major diagnostic category. Our findings highlight the urgent need for integrated screening approaches, transdiagnostic treatment models, and formal recognition of IED within global mental health agendas.