New Army soldiers with a history of impairing anger attacks were twice as likely to later develop major depressive disorder, generalized anxiety disorder, panic disorder, or suicidal ideation, according to a study published this week in JAMA Network Open.
When anger attacks, or sudden outbursts of verbal or physical aggression, cause substantial life impairment, they are a hallmark of intermittent explosive disorder (IED). IED is estimated to effect 4% to 7% of the U.S. population.
Diana M. Smith, A.B., and Murray B. Stein, M.D., M.P.H., of the University of California, San Diego, and colleagues analyzed data collected as part of Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study. This included about 39,000 Army soldiers who were entering basic training (average age 21) and were screened for a history of psychiatric diagnoses with an adaptation of the Composite International Diagnostic Interview, a PTSD checklist, and an inventory of suicidal behavior. The soldiers also completed a survey evaluating their history of anger attacks—described in the survey as “when all of a sudden you lost control and either broke or smashed something worth more than a few dollars, hit or tried to hurt someone, or threatened someone.” The episodes were counted as anger attacks only if respondents reported (1) that they had difficulty controlling the aggressive impulse, experienced attacks in situations where most people would not get angry, or had high frequency of attacks (defined as 10 or more lifetime attacks) and (2) that attacks had occurred when they were not using alcohol or drugs.
At the start of the study, about 9% of the soldiers reported a history of nonimpairing anger attacks (those that did not interfere with work or personal life), and about 6% reported a history of impairing anger attacks (those that did interfere with work or personal life). Soldiers with a history of impairing anger attacks in particular tended to report more frequent incidents, with more than one-quarter of them reporting more than 50 lifetime anger attacks.
Four to seven years after enlistment, the soldiers completed additional screenings via phone or web. After adjusting for such variables as sex, race and ethnicity, site of basic combat training, deployment history at follow-up, and military status at follow-up, the researchers found that soldiers who had impairing anger attacks before enlistment were about twice as likely to develop new onset of major depressive disorder, generalized anxiety disorder (GAD), panic disorder, or suicidal ideation than those who had not had anger attacks. The authors also found that soldiers with nonimpairing anger attacks at baseline were more than twice as likely to attempt suicide compared with those who did not have anger attacks.
When baseline psychiatric comorbidity was controlled for, impairing attacks remained associated only with new onset of GAD and suicidal ideation.
“It is unknown why impairing anger attacks would contribute uniquely to GAD and suicidal ideation, but not other emotional disorders,” wrote Smith, Stein, and colleagues. “However, the occurrence of anger attacks seems to imply serious deficits in emotion regulation and social problem-solving.”
They added, “These findings suggest that detection of impairing anger attacks could aid in assessing elevated risk of developing anxiety disorders, depression, and suicidality after enlistment.” Interventions to reduce the incidence of anger attacks or to improve emotional regulation and problem-solving deficits might help to prevent GAD and suicidal ideation in soldiers.
For related information, see the Psychiatric News article “STARRS Findings Shed More Light On Army Suicides.”
(Image: iStock/MivPiv)
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