Increased Risk of Smoking and Pain in Individuals with Intermittent Explosive Disorder in the All of Us Dataset

Fiona Ralston¹Michael L. Thomas²Murray B Stein^1,3Emil F. Coccaro⁴Alejandro Daniel Meruelo^1*

• ¹Department of Psychiatry, University of California San Diego, La Jolla, United States
• ²Department of Psychology, Colorado State University, Fort Collins, United States
• ³Psychiatry Service, VA San Diego Healthcare System, San Diego, United States
• ⁴Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, United States

Intermittent Explosive Disorder (IED) is associated with substantial impairments in physical health and functioning, yet population-based studies examining these relationships are limited. Using data from the All of Us Research Program, this study investigated associations between IED, tobacco use, and pain compared to a propensity score–matched sample without IED. Individuals with IED were matched 10:1 to controls based on age, sex, race/ethnicity, and income. Chi-square tests and logistic regression models were used to estimate odds ratios and 95% confidence intervals across domains, with regression models additionally adjusting for major depressive disorder (MDD) and generalized anxiety disorder (GAD). Individuals with IED exhibited significantly higher odds of lifetime cigarette smoking relative to matched controls, independent of MDD and GAD. Participants with IED also reported greater odds of experiencing moderate to severe pain over the past seven days. These findings indicate that IED is linked to heightened vulnerability to smoking and pain, underscoring the need for integrated screening and intervention strategies—particularly smoking cessation and pain management—in clinical care for individuals with IED.