Abstract
Background: There are no validated or agreed upon criteria for diagnosing chronic traumatic encephalopathy (CTE) in a living person. In recent years, it has been proposed that anger dyscontrol represents a behavioral clinical phenotype of CTE. This is the first study to examine the specificity of the diagnostic research criteria for traumatic encephalopathy syndrome (TES, the clinical condition proposed to be CTE) in men from the US general population who have anger dyscontrol problems. It was hypothesized that a substantial percentage of these men would meet the research criteria for TES.Methods: Data from 4,139 men who participated in the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were included in this study. Men who were diagnosed with intermittent explosive disorder in the past year were the clinical sample of interest (n = 206; 5.0% of all men in the database), and the remaining men were used as a comparison sample. They were classified as meeting the research criteria for TES if they presented with the purported supportive clinical features of CTE (e.g., impulsivity/substance abuse, anxiety, apathy, suicidality, headache).Results: In this sample of men from the general population with intermittent explosive disorder, 27.3% met a conservative definition of the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one assumes the delayed-onset criterion is present, meaning that the men in the sample are compared to former athletes or military veterans presenting with mental health problems years after retirement, then 65.0% of this sample would meet the research criteria for TES.Conclusions: These results have important implications. Using conservative criteria, at least one in four men from the general population, who have serious anger control problems, will meet the symptom criteria for TES. If one considers former athletes and military veterans with anger control problems who present many years after retirement and who experienced a documented decline in their mental health, nearly two-thirds will meet these research criteria. More research is needed to examine risks for misdiagnosing TES and to determine whether anger dyscontrol is a clinical phenotype of CTE.
Highlights
There is tremendous interest in chronic traumatic encephalopathy (CTE)
This specific neuropathology has been identified after death in the brains of young athletes [20, 21], active NFL players [20, 21], former collegiate athletes from multiple sports [20], retired boxers [20], retired professional hockey players [20], retired NFL players [18, 20, 21], and military veterans [22]
This assertion remains in doubt because CTE neuropathology has been identified in some people from the general population with no known exposure to repetitive neurotrauma and in association with substance abuse, temporal lobe epilepsy, multiple system atrophy, amyotrophic lateral sclerosis, and other neurodegenerative diseases [29,30,31,32,33,34,35,36]
Summary
There is tremendous interest in chronic traumatic encephalopathy (CTE). In the twentieth century, CTE was considered to be a neurological disorder affecting a subgroup of long-career boxers [1, 2], and the clinical features were usually described as reflecting rather obvious chronic brain damage and cognitive impairment [3, 4]. In its modern form, CTE is considered to be a postmortem neuropathological diagnosis [18, 19], with the defining pathological feature being the accumulation of hyperphosphorylated tau (p-tau), in a patchy distribution at the depths of the cortical sulci around small vessels [18, 19] This specific neuropathology has been identified after death in the brains of young athletes [20, 21], active NFL players [20, 21], former collegiate athletes from multiple sports [20], retired boxers [20], retired professional hockey players [20], retired NFL players [18, 20, 21], and military veterans [22].
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