History of childhood maltreatment in Intermittent Explosive Disorder and suicidal behavior

Intermittent Explosive Disorder (IED) is a relatively common disorder of impulsive aggression that typically emerges by adulthood. Maltreatment in childhood (CM) may contribute to the development of IED, but little is known about the association between CM and IED, including about how subtypes of CM may specifically relate to IED. This study aimed to test the association between CM and IED diagnosis. A second aim was to examine history of CM in suicide attempters, and to explore whether impulsivity and aggression account for the relationship between CM and suicide attempt (SA). Adults with Intermittent Explosive Disorder (IED; n=264), with non-IED psychiatric (Axis I or II) disorders (psychiatric controls; PC; n=199), and with no psychiatric disorder (healthy control subjects; HC; n=185) were assessed for history of childhood maltreatment, aggression, impulsivity, and history of SA. IED subjects reported significantly greater CM compared to PC and HC subjects, and suicide attempters (n=62) reported greater CM compared to non-attempters (n=586). Physical abuse in childhood was independently associated with IED, while sexual abuse and emotional abuse were independently associated with SA. Impulsivity and aggression were potential mediators of the relationship between physical abuse and IED and emotional abuse and SA, but sexual abuse was associated with SA independently of aggression and impulsivity. The results suggest pathways by which environmental factors may influence impulsivity and aggression and, in turn, clinically significant self- and other-directed aggression.