August 31, 2016

What Is Irritability?

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Usman Hameed, MD; Cheryl A. Dellasega, PhD; and Ahmad Hameed, MD

Pennsylvania State University College of Medicine, Hershey


The construct of irritability in mental health has evolved into a topic of increasing interest, especially among those who work with children and adolescents. Despite the potential for serious consequences of undetected irritability, we have discovered that many primary care providers vary in their definition, assessment, and treatment of this condition in school-aged children.

Irritability may be considered analogous to fever or pain. It exists on a continuum and can be associated with a large number of physical and mental health diagnoses; as such, the underlying cause is not always obvious. Irritability can present as an immediate or delayed response to overt or covert stressors the child may have experienced. For example, just as fever and pain can signal infection or inflammation from unknown causes, irritability can be a consequence of suppressed interpersonal or relational difficulties.

Personality traits such as emotional sensitivity and resilience, as well as environmental factors such as trauma exposure, rejection, and family discord, play an important role in the development of irritability.

Common examples of mental health diagnoses associated with irritability include major depressive disorder and attention-deficit/hyperactivity disorder (ADHD). Children with depression may find it easier to act out in an irritable way than to verbalize the emotional hurt. Those with ADHD may become frustrated with their inability to accomplish tasks, despite their best efforts.

Severe and persistent non-episodic irritability does not suggest a bipolar illness but may be misdiagnosed as such.

It is therefore necessary to explore possible antecedents, stressors, and comorbid conditions associated with irritability. Accurate differential diagnosis is critical, given the wide array of behaviors associated with irritability, ranging from mild oppositionality and verbal outbursts to physical aggression and serious violence. Moreover, the treatment approach for depression versus ADHD will vary remarkably, and the best treatment for irritability is to treat the comorbid disorder.

A better understanding of the broad construct of irritability will assist with the development of screening tools and accurate assessment methods, as well as treatment algorithms. This will in turn provide helpful guidelines for parents, personnel working with children and youth, primary care providers, and specialists in order to better define and understand this ambiguous concept.

Financial disclosure:Drs Hameed, Dellasega, and Hameed had no relevant personal financial relationships to report. ​

Category: ADHD , Depression
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