The prevalence and correlates of intermittent explosive disorder in Iraq


Ronald C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA.


Al-Hamzawi A, Al-Diwan JK, Al-Hasnawi SM, Taib NI, Chatterji S, Hwang I, Kessler RC, McLaughlin KA. The prevalence and correlates of intermittent explosive disorder (IED) in Iraq.

Objective:  Intermittent explosive disorder is common, begins early in life, and is associated with considerable impairment in the United States. The epidemiology of IED outside the United States is unknown. We examined the prevalence and correlates of IED in Iraq, where exposure to violence has been widespread during the last three decades.

Method:  Data were drawn from a national survey of the Iraq population, the Iraq Mental Health Survey (IMHS), conducted in 2006–2007. The WHO Composite International Diagnostic interview was used to assess DSM-IV disorders, including IED. The response rate was 95.2%.

Results:  Lifetime and 12-month prevalence estimates of IED were 1.7% and 1.5%. Mean age of onset was 18.5. The mean number of lifetime attacks was 141.6 attacks, and IED-related injuries occurred 61 times per 100 lifetime cases. IED was significantly comorbid with mood and anxiety, but not substance, disorders.

Conclusion:  Although the prevalence of IED is lower in Iraq than in the United States, the disorder has an early age of onset, is highly persistent, and is associated with substantial comorbidity and functional impairment. Iraq lacks national policies or systematic programmes to reduce aggression, highlighting the importance of implementing violence prevention programmes to reduce the societal burden of violence in Iraq.