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Meta-Analysis
. 2025 Jan-Feb;32(1):e70016.
doi: 10.1002/cpp.70016.

Comprehensive Review and Meta-Analysis of Psychological and Pharmacological Treatment for Intermittent Explosive Disorder: Insights From Both Case Studies and Randomized Controlled Trials

Fangqing Liu  1 , Xiaoshan Yin  1 , Wenting Jiang  2
Affiliations
Meta-Analysis

Comprehensive Review and Meta-Analysis of Psychological and Pharmacological Treatment for Intermittent Explosive Disorder: Insights From Both Case Studies and Randomized Controlled Trials

Fangqing Liu et al. Clin Psychol Psychother. 2025 Jan-Feb.

Abstract

Intermittent explosive disorder (IED) is characterized by sudden, disproportionate outbursts of anger that can severely impact individuals' quality of life, causing difficulties in maintaining relationships, issues at work or school and potential legal troubles. This study aimed to systematically review and meta-analyse the effectiveness of psychological and pharmacological treatments for IED, drawing insights from both case studies and randomized controlled trials (RCTs). A total of 12 RCTs and 14 case studies were included in this comprehensive analysis. The meta-analysis revealed that psychological treatments, particularly cognitive behavioural therapy (CBT), showed significant effectiveness in reducing aggression and achieving full remission compared to pharmacological treatments. However, the latter, notably fluoxetine, demonstrated notable efficacy in managing irritability and achieving treatment response. Subgroup analysis identified follow-up time and intervention type as significant moderators of treatment outcomes. The systematic review of case studies highlighted the successful application of deep brain stimulation (DBS) and various off-label medications, including SSRIs and mood stabilizers, in managing IED symptoms. Despite these insights, the study emphasizes the need for more robust evidence-based treatment protocols and further research into the underlying mechanisms of IED to develop targeted treatments.

Keywords: case studies; cognitive behavioural therapy; intermittent explosive disorder; pharmacological treatment; psychological treatment; randomized controlled trials.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection process in the meta‐analysis of RCTs (Page et al. 2021).
FIGURE 2
FIGURE 2
Flowchart of study selection in the systematic review of case studies.
FIGURE 3
FIGURE 3
Publication bias for OAS‐M aggression Doi plot.
FIGURE 4
FIGURE 4
Publication bias for OAS‐M irritability Doi plot.
FIGURE 5
FIGURE 5
Forest plot of meta‐analysis OAS‐M aggression and irritability.
FIGURE 6
FIGURE 6
Galbraith plot for OAS‐M aggression and irritability.
FIGURE 7
FIGURE 7
Forest plot of meta‐analysis for responders and remission.
FIGURE 8
FIGURE 8
Forest plot of STAXI.
See this image and copyright information in PMC

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