Psychiatric Times November 2005 Vol. XXII Issue 13
Although most previous epidemiological surveys of mental disorders in adults neglected to track such impulse control disorders as attention-deficit/ hyperactivity disorder, intermittent explosive disorder (IED), conduct disorder (CD) and oppositional defiant disorder (ODD), the recently completed National Comorbidity Survey Replication (NCS-R) found that their combined lifetime prevalence is higher than that for either mood disorders or substance use disorders.
"Surprisingly, impulse control disorders ... were found in 8.9% (12-month prevalence) and 24.8% (lifetime prevalence) of the population with a greater proportion at the serious level than either anxiety or substance disorders," noted a commentary accompanying publication of four papers on the NCS-R in the Archives of General Psychiatry (Insel and Fenton, 2005).
For comparison, the lifetime prevalence of mood disorders was 20.8% and of substance use disorders was 14.6%. Only the lifetime prevalence of anxiety disorders at 28.8% exceeded that of impulse control disorders (Kessler et al., 2005a).
The $20 million NCS-R was a collaborative project between Harvard University Medical School, the University of Michigan Institute for Social Research and the National Institute of Mental Health Intramural Research Program. It is a nationally representative survey of 9,282 English-speaking household residents age 18 and older in the coterminous United States.
Ronald C. Kessler, Ph.D., professor of health care policy at Harvard Medical School and designer of the NCS-R, pointed out that all major psychiatric epidemiological studies in the past, particularly the Epidemiologic Catchment Area (ECA) study in the 1980s (Robins and Regier, 1991) and the National Comorbidity Survey (NCS) in the 1990s (Kessler et al., 1994), have essentially focused on anxiety and depression.
"Over the last decade, we have come to recognize that violence is not on anybody's radar screen, so I thought that when we did this survey, we really needed to talk about hostility, not just anxiety and sadness," Kessler told Psychiatric Times in an exclusive interview. "People who study moods think of it as a triumvirate--anxiety, hostility and depression, but hostility seems to have fallen off the radar screen in psychiatric epidemiology, so that was the simple-minded notion when I first started approaching this issue."