Low Rate of Violent Disorder in Iraq

Intermittent explosive disorder more common among Americans than among Iraqis

(RxWiki News) Americans have been fortunate not to have the ongoing violence of war-torn Iraq. But surprisingly, one of the more violent mental health conditions is less common in Iraq.

A recent study found a much lower rate of intermittent explosive disorder in Iraqis than in Americans. Yet the condition still affects youth the most.

"Seek help if you're experiencing or committing violence."

The study, led by Ali Al-Hamzawi, MD, of Al-Qadisia University's College of Medicine in the Diwania Governorate in Iraq, aimed to find out how common this disorder is among Iraqis.

This information could be useful for soldiers still in Iraq and for Iraqi public health officials who are trying to treat mental health conditions among the country's residents.

The disorder is linked to growing up in a violent environment, according to the Mayo Clinic, and Iraq has seen a great deal of war and violence over the past thirty years.

The researchers analyzed data from a 2006-2007 Iraq Mental Health Survey taken by a representative sample of the Iraqi population.

Of 4,332 adults, 95.2 percent completed the survey, which used an interview assessment tool from the World Health Organization to determine what mental health conditions the person might have, including intermittent explosive disorder.

Intermittent explosive disorder is a psychiatric condition in which a person repeatedly overreacts to a situation with aggressive and violent behavior that usually lasts 10 to 20 minutes.

People with intermittent explosive disorder may show road rage, have angry outbursts, throw sudden temper tantrums or abuse their family members.

Symptoms include irritability, increased energy, rage, tremors, tingling, rapid heartbeat, tightness in the chest and a headache or a feeling of intense pressure in the head.

Dr. Al-Hamzawi's team, which included other Iraqi researchers as well as American researchers from Harvard Medical School, found that 1.7 percent of Iraqis experienced intermittent explosive disorder at least once in their lifetimes.

The percent who experienced it once in 12 months was 1.5 percent. This rate is significantly lower than what Dr. Al-Hamzawi's team had found in their surveys of American adolescents, which was a rate of 8 percent.

Among Iraqis, the average age of the condition's first appearance is 18 years old, and the average number of intermittent explosive disorder episodes in a person's lifetime was 142 attacks.

Further, 61 percent of the Iraqis who had it experienced a physical injury related to the disorder.

Similar to what the team found among Americans, the disorder often occurs alongside mood disorders and/or anxiety conditions. However, there was no link to substance abuse disorders.

"Despite the widespread exposure to war, terrorism, and violence – which are associated strongly with subsequent perpetration of violence – the lifetime prevalence of intermittent explosive disorder is lower in Iraq than in the United States," the researchers wrote.

However, the characteristics of the condition appear to be similar in both populations.

"Intermittent explosive disorder begins early in life, exhibits a chronic course and is associated with high rates of comorbidity with other mental disorders and considerable functional impairment," they wrote.

One limitation of the study is that it used data that is five years old, so the information may not reflect the current rate of intermittent explosive disorder in Iraq.

Further, because the disorder has not been studied much outside the U.S., the researchers had to use the same assessment tool used in the U.S., which might differ culturally from what is most appropriate to use with Iraqis.

The study was published in the September issue of the journal Acta Psychiatrica Scandinavica. The research was supported by the United Nations Development Group Iraq Trust Fund and the World Health Organization World Mental Health Survey Initiative.

Funding was provided by the U.S. National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the U.S. Public Health Service, the Fogarty International Center, the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb.

One author, Dr. Ronald Kessler of Harvard Medical School, has received financial support, served as a consultant or served on an advisory board for a long list of pharmaceutical companies and other institutes and companies.

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Review Date: 
September 4, 2012