Intermittent explosive disorder in South Africa: prevalence, correlates and the role of traumatic exposures

Abstract

Background: The epidemiology of DSM-IV intermittent explosive disorder (IED) is not well characterized in developing country settings. In South Africa, given the high rates of violence and trauma, there is particular interest in traumatic exposures as potential risk factors for IED.

Methods: We examined the prevalence and predictors of IED in a nationally representative sample of 4,351 South African adults. IED and other diagnoses based on DSM-IV criteria were assessed using the World Health Organization Composite International Diagnostic Interview (CIDI). A 28-item scale was constructed to measure exposure to traumatic events.

Results: Overall, 2.0% of participants (95% CI: 0-4.9%) fulfilled criteria for the narrow definition of IED, and 9.5% (95% CI: 6.6-12.3%) fulfilled criteria for the broad definition of IED. Individuals with IED experienced high rates of comorbid anxiety, mood and substance use disorders compared to non-IED participants. In multivariate analysis, a diagnosis of IED was associated with Caucasian and mixed-race ethnicity, psychiatric comorbidity and exposure to multiple traumatic events.

Conclusion: These data suggest a relatively high prevalence of IED in South Africa. By reducing violence and trauma, and by providing appropriate psychological support to trauma survivors, we may be able to reduce rates of IED.