“Outer-Directed Irritability”: A Distinct Mood Syndrome in Explosive Youth With a Disruptive Behavior Disorder?
J Clin Psychiatry 2003;64:698-701
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To examine whether
"outer-directed irritability," a mood construct from
the adult literature, characterizes a subgroup of disruptive
behavior disordered children and adolescents previously shown to
improve on divalproex, a mood stabilizer.
Method: A sample (N = 20) of disruptive
youth (aged 10-18 years) entering a divalproex treatment study of
temper and irritable mood swings was compared to normal controls
(N = 18) on measures of aggression/irritability directed against
others (externalizing symptoms) and on aggression/irritability
against self, anxiety, and depression (internalizing symptoms).
All patients met DSM-IV criteria for a disruptive behavior
disorder (oppositional defiant disorder of conduct disorder) in
addition to research criteria.
irritability" most clearly distinguished patients from
controls (effect size 4.1) and did not correlate with other mood
measures. Patients and controls showed no to minimal differences
on internalizing symptoms.
Conclusion: Disruptive behavior
disordered children and adolescents characterized by
outer-directed irritability exist, can be identified, and should
be further investigated, especially since they are potentially