The relationship between Intermittent Explosive Disorder and offending behavior

Intermittent Explosive Disorder is significantly associated with a wide array of violent offending. That is the bottom line of a recently published article in International Journal of Forensic Mental. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health 2017, Vol. 16, No. 4, 293–303

Criminally Explosive: Intermittent Explosive Disorder, Criminal Careers, and Psychopathology among Federal Correctional Clients


Matt DeLisi, Department of Sociology, Iowa State University
Michael Elbert, United States Probation, Iowa
Daniel Caropreso, United States Probation, Iowa
Katherine Tahja, United States Probation, Iowa
Timothy Heinrichs, United States Probation, Iowa
Alan Drury, United States Probation, Iowa


‘Intermittent Explosive Disorder (IED) is a relatively rare psychiatric condition characterized by aggression, explosive outbursts towards people and property, and very poorly regulated emotional and behavioral control, but has rarely been studied in a criminal justice context. Drawing on data from 863 federal correctional clients from a supervised release population in the Midwestern United States, the current study examined the lifetime prevalence and correlates of IED and its associations with criminal careers. The lifetime prevalence of IED was 2.6% with another 1% of clients exhibiting symptoms of the disorder. Poisson and negative binomial regression models have shown that IED was significantly associated with arrests for murder, attempted murder, interference with police, aggravated assault, simple assault, and domestic assault despite controls for serious behavioral disorders, age of first arrest, and demographics. Clients with IED were also dramatically more likely to be habitual offenders and accumulate chronic arrests for assault-related crimes. These offenders pose considerable risk to staff safety and should be supervised with the highest level of supervision.’


Intermittent Explosive Disorder, crime, psychopathology, criminal careers, violence

Summary of the Research

“Intermittent Explosive Disorder (IED) has existed in various incarnations throughout psychiatric history. Since the initial Diagnostic and Statistical Manual of Mental Disorders published in 1952, the condition has been referred to as “passive-aggressive personality, aggressive type,” “explosive personality,” “isolated explosive disorder,” and “intermittent explosive disorder.” Despite variations in the actual name of the disorder, Intermittent Explosive Disorder has always been characterized by features relating to aggression, explosive outbursts towards people and property, and very poorly regulated emotional and behavioral control and is commonly comorbid with other psychiatric conditions” (p.293)

“By its very definition, IED is an important clinical disorder with explicit linkages to criminal offending; however, the construct has been largely overlooked by researchers. The current study seeks to examine the prevalence and correlates of IED in a population of federal correctional clients in the United States and examine its association with diverse forms of serious and pathological forms of criminal offending.” (p.295)

“The current study was based on archival data from the total population of 865 active clients in a federal probation juris- diction in the Midwestern United States (two clients had incomplete data thus the analytical sample is 863). All clients were on supervised release after a term of supervision in the Bureau of Prisons. The sample was 84% male and 16% female. The preponderance (79.4%) of clients were white, 20.6% were African American. 92% were non-Hispanic and 8% are Hispanic and the mean age was 44 years. The most prevalent conviction offenses were distribution of methamphetamine (35%), felon in possession of firearm (13%), bank fraud, money laundering, and/or identity theft (13%), distribution of cocaine base (crack) (12%), possession or manufacturing of child pornography (6.5%), distribution of marijuana (6%), use of firearm during a drug trafficking offense (4.5%), and distribution of cocaine (3.6%).” (p.295)

“Data collection occurred via two procedures. First, all data in the client’s Probation/Pretrial Services Automated Case Tracking System (PACTS) file were electronically extracted and converted to an Excel spreadsheet. PACTS is a case management platform used in all 94 federal districts to track federal defendants and offenders. This electronic extraction contained information on 110 variables including demographics, case information, conditions, federal post-conviction risk assessment (PCRA) and assorted risks, criminal history indices, and other documents relevant to the client’s social and criminal history.” (p.295)

“Second, information on 108 additional variables was manually collected by the senior author. These variables were extracted from presentence reports (PSR), offender dossiers from the Bureau of Prisons, local, state, and national criminal histories, confidential psychological and psychiatric reports, treatment reports, and other relevant documents located in PACTS.” (p.295)

“Intermittent Explosive Disorder: IED was measured based on secondary diagnostic information from psychological reports in the offender’s file and the client’s presentence reports where there was evidence that the offender exhibited symptoms of the disorder or had received a formal lifetime diagnosis. IED was coded on a 3-point scale with no evidence/ no symptoms D 0, some evidence/symptoms of IED but not enough for a formal diagnosis D 1, and definite evidence evidenced by a formal diagnosis D 2. The lifetime prevalence of IED (x D .06, SD D .33) was 3.6% (n D 31) with nine clients displaying lifetime symptoms of IED (1%), and 22 clients having a formal lifetime diagnosis (2.6%). Most—96.4%—clients had no evidence of IED in their psychiatric history.” (p.295)

“Even when controlling for serious behavioral disorders, age of arrest onset, and demographic characteristics, IED was significantly associated with a mélange of violent crime and chronic/sustained involvement in total arrest charges and assault-oriented charges. In other words, the DSM-5 criteria are consistent with the manifest severe criminal acts among federal correctional clients.” (p.298)
“IED exerts unique variance for serious crimes above and beyond the associations between other serious behavioral disorders, arrest onset, and demographic characteristics. IED is not just part and parcel of CD, ADHD, or ASPD, but instead captures offenders whose arrest records are disproportionately comprised of offenses suggesting a bellicose, reactive, unstable behavioral repertoire. For instance, the mean assault-related charges among clients who displayed no evidence of IED were 1.5 charges. Among those with symptoms of IED, the mean assault-related charges were 8.8 and among those with an IED diagnoses the mean was 12.7. Put another way, clients with the disorder had nearly 8.5 times more arrest charges on average for assault-related crimes than clients without the disorder” (p.299).

Other Interesting Tidbits for Researchers and Clinicians

“Given the association between the disorder and various forms of assault and physical noncompliance with police (e.g., the interference with police charge), correctional staff must be vigilant when interacting with them. A practical approach to enhancing the safety of officers who supervise defendants and offenders with IED diagnosis is to require at least two officers partner on all field contacts. Another advisable course is to ensure the district’s mental health specialist, supervisor and contract or non-contract mental health treatment professional are consulted regularly regarding the status and needs of the case. Given the heightened propensity for violence to be perpetrated by offenders and defendants with IED, it is imperative that parole and probation systems consider this condition as an important marker for future violence and develop individual case plans accordingly.”(p.299)

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Authored by Charlie McNess

Charlie McNess is currently the Clinical Coordinator of EAC Brooklyn CRAN, she received her Master’s degree in General Psychology from New York University in 2016. Her research interests include criminal justice diversion.

Non-Violent, Repeat Offenders Impact the Accuracy of Risk Assessments

DarkBlue-Forensic-Training-AcademySpecification of outcome can significantly improve the predictive accuracy of both actuarial and clinical assessments for violence amongst discharged prisoners but with limits. This is the bottom line of a recently published article in International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

 Featured Article | International Journal of Forensic Mental Health | 2015, Vol. 14, No. 1, 23-32

Improving Accuracy of Risk Prediction for Violence: Does Changing the Outcome Matter?ijfmh


Jeremy W. Coid, Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Royal London Hospital, London, United Kindgom
Min Yang, School of Community Health Sciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom
Simone Ullrich and Tianqiang Zhang, Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Royal London Hospital, London, United Kingdom
Stephen Sizmur, Picker Institute Europe, King’s Mead House, Oxford, United Kingdom
David P. Farrington, Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
Mark Freestone, Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Royal London Hospital, London, United Kingdom; Forensic Personality Disorder Service, East London NHS Foundation Trust, London, United Kingdom
Robert D. Rogers, School of Psychology, University of Bangor, Gwynedd, United Kingdom


Accuracy of risk assessment instruments in predicting violence may appear poor if substantial numbers of study participants subsequently reoffend non-violently instead of violently as predicted. This study examined effects of changing the violent outcome on predictive accuracy of five instruments (OGRS, RM2000(V), VRAG, PCL-R, HCR20) for 1,353 male and 304 female released prisoners in England and Wales. Adding self-reported violence to criminal convictions resulted in a moderate increase in violent outcome among women, but was small among men. After removing offenders who subsequently reoffended non-violently, significant improvement in accuracy was found on all instruments for men, but not women. We concluded that risk assessment instruments for violence may be more accurate than previously described, but improvement can only be achieved with certain samples. Instruments relying heavily on previous criminal history for predictive power can demonstrate improved accuracy, but only after removing non-violent offenders from samples with extensive previous offending.

Keywords: risk assessment, predictive accuracy, violence, criminal careers, prisoners

Summary of the Research

The overall aim of this study was to observe the effects of changing the outcome variable on the predictive accuracy of five risk and psychopathology assessment instruments: Psychopathy Checklist Revised (PCL-R); Violence Risk Appraisal Guide (VRAG); Historical-Clinical Risk Management-20 (HCR-20); Risk Matrix 2000 Violence (RM2000(V)); and the Offender Group Reconviction Scale II (OGRS). Three associated research questions were considered: to observe whether predictive accuracy differed between qualitatively different outcome measures of violence, including self- reported and officially recorded violence; whether by improving the criterion variable to detect a greater proportion of the violent outcome by combining both measures resulted in improved accuracy; and whether the removal of individuals who had been convicted, but for non-violent offending rather than actual violence, further improved accuracy.

Improving the Criterion for Violent Outcomes

To increase the prevalence of the criterion variable of violence, self-reports of violence were combined with recorded criminal convictions. By adding self-reports, the base rate increased by 15% in men and 22% in female prisoners. When all prisoners who reoffended non-violently were removed from the combined outcome (self report + criminal convictions), there was only a slight decrease in self-reported violence. The authors explain this outcome as a result of criminals engaging in many different types of crime and a criminal specialization in violence is rare.

Improving the Predictive Accuracy of the Instruments

Removal of non-violent offenders resulted in significantly higher AUC values. Base rates of AUC (area under the curve) values are insensitive to base rates for violence thus the addition of self-reported violence did not create a change in AUC values.

For both self-reported violence and recorded criminal convictions, all instruments demonstrated improvement in predictive accuracy when non-violent offenders were removed. This result was only applicable for men and not female prisoners. Only the PCL-R, VRAG and HCR20 demonstrated significant improvement while the OGRS and RM2000-V each demonstrated increases in AUC values, but the difference was not significant. Overall, actuarial instruments showed no greater accuracy for self-reported violence while clinical assessments showed a more noticeable difference in AUC values for the ‘all participants’ and ‘violent offender only’ groups.

Translating Research into Practice

There may be fundamental differences in the effect of removing non-violent reoffenders for female risk assessments. This removal effect produced small, statistically insignificant differences in predictive validity. “Actuarial measures, including the OGRS, VRAG, and RM2000-V, performed less accurately than the PCL-R and the HCR20 for each outcome. For the OGRS, confidence intervals indicate significantly worse performance than the PCL-R and HCR-20 for outcomes of violent convictions and self-reported violence before removal of nonviolent offenders. The PCL-R performed significantly better than the OGRS after removal of nonviolent offenders for violent convictions, self-reported violence, and the combined outcome. The HCR20 performed significantly better than the OGRS after removal of nonviolent offenders for the combined outcome.” However, the main difference is accounted for by differences in men and women prisoners’ criminal careers and the degree to which the five instruments rely on these factors for their predictive accuracy. The gender differences in accuracy may be explained by the need to modify existing clinical risk assessment tools to capture female-specific risk factors.

Though outcome specification significantly improved the accuracy of the risk assessment tools, a significant amount of variability for in the prediction of violent reoffending is unexplained. This may be explained by prisoners’ tendency to reoffend more non-violently than violently throughout their criminal careers. A greater degree of accuracy could be improved by combining all sources of information regarding the prisoner.

Other Interesting Tidbits for Researchers and Clinicians

Instrument properties examined in this study along with sample effects may offer an interesting perspective: “For example, OGRS and RM2000-V contrast with the HCR-20 and PCL-R in that they are actuarial instruments developed using experimental samples whereas the HCR-20 was developed to guide clinical risk assessment and the PCL-R as a diagnostic measure of psychopathic personality. All five instruments lack outcome specificity, with each able to predict acquisitive offending as well as violence.”

It has been argued that these measures may be limited to measuring a general construct of criminal risk rather than specific tendencies to violence as originally intended, although it must be pointed out that the OGRS was developed specifically to measure the risk of general reoffending. It is possible therefore that lack of outcome specificity is more a characteristic of the three actuarial instruments (RM2000v, OGRS and VRAG), which show somewhat larger increases in predictive ability for violent convictions compared to the PCL-R and HCR-20 when non-violent reoffenders are excluded.

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As always, please join the discussion below if you have thoughts or comments to add!

Authored By: Andrea Patrick


Andrea Patrick is a first year masters student studying Forensic Psychology at John Jay College of Criminal Justice. In the future, she hopes to be directly working with forensic populations providing risk assessments and clinical evaluations.