Irritability

Irritability is the excitatory ability that living organisms have to respond to changes in their environment.{{Cite book|title=Taber's Cyclopedic Medical Dictionary|last=D|first=Venes|publisher=F.A. Davis Company|year=2013|isbn=978-0-8036-2977-6|location=Philadelphia, Pennsylvania}} The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli. Irritability can be demonstrated in behavioral responses to both physiological and behavioral stimuli, including environmental, situational, sociological, and emotional stimuli.

In humans, irritability may be a significant transdiagnostic symptom or disposition that occurs across or at any point during the lifespan.{{Cite journal |last1=Eshel |first1=Neir |last2=Leibenluft |first2=Ellen |author-link2=Ellen Leibenluft |date=2019-12-04 |title=New Frontiers in Irritability Research—From Cradle to Grave and Bench to Bedside |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2756321 |journal=JAMA Psychiatry |language=en |volume=77 |issue=3 |pages=227–228 |doi=10.1001/jamapsychiatry.2019.3686 |pmid=31799997|s2cid=208621875 |url-access=subscription }} It is commonly defined as the tendency to react to stimuli with the experience of negative affective states (especially anger) and temper outbursts, which may or may not be aggressive.{{Cite journal|last1=Caprara|first1=G.V.|last2=Cinanni|first2=V.|last3=D'Imperio|first3=G.|last4=Passerini|first4=S.|last5=Renzi|first5=P.|last6=Travaglia|first6=G.|date=1985|title=Indicators of impulsive aggression: Present status of research on irritability and emotional susceptibility scales|journal=Personality and Individual Differences|volume=6|issue=6|pages=665–674|doi=10.1016/0191-8869(85)90077-7|issn=0191-8869}}{{Cite journal|last1=Holtzman|first1=Susan|last2=O'Connor|first2=Brian P.|last3=Barata|first3=Paula C.|last4=Stewart|first4=Donna E.|date=2014-05-15|title=The Brief Irritability Test (BITe)|journal=Assessment|volume=22|issue=1|pages=101–115|doi=10.1177/1073191114533814|pmid=24830513|pmc=4318695|issn=1073-1911}}{{Cite journal|last1=Toohey|first1=Michael J.|last2=DiGiuseppe|first2=Raymond|date=April 2017|title=Defining and measuring irritability: Construct clarification and differentiation|journal=Clinical Psychology Review|language=en|volume=53|pages=93–108|doi=10.1016/j.cpr.2017.01.009|pmid=28284170}} This definition is well known to have similarities with the definitions of anger and aggression. New hypotheses{{Cite journal|last1=Beauchaine|first1=Theodore P.|last2=Tackett|first2=Jennifer L.|date=2020|title=Irritability as a Transdiagnostic Vulnerability Trait:Current Issues and Future Directions|journal=Behavior Therapy|volume=51|issue=2|pages=350–364|doi=10.1016/j.beth.2019.10.009|pmid=32138943|s2cid=212565146 |issn=0005-7894}} and data-driven research{{Cite journal|last1=Bettencourt|first1=B. Ann|last2=Talley|first2=Amelia|last3=Benjamin|first3=Arlin James|last4=Valentine|first4=Jeffrey|date=2006|title=Personality and aggressive behavior under provoking and neutral conditions: A meta-analytic review.|journal=Psychological Bulletin|volume=132|issue=5|pages=751–777|doi=10.1037/0033-2909.132.5.751|pmid=16910753|s2cid=10793794 |issn=1939-1455}} are focused on identifying what is unique to irritability, anger, and aggression. The definition is broad. It is also consistent with special definitions that are relevant to research and treatment. One definition is that irritability is a low threshold for experiencing frustration.{{Cite journal|last1=Malhi|first1=Gin|last2=Bell|first2=Erica|last3=Outhred|first3=Tim|date=2019-06-27|title=Getting irritable about irritability?|journal=Evidence-Based Mental Health|volume=22|issue=3|pages=93–94|doi=10.1136/ebmental-2019-300101|pmid=31248977|pmc=10270366 |issn=1362-0347}} This definition is helpful for experiments because researchers can induce frustration by blocking desired rewards or doling out unexpected punishments. However, it is not particularly specific to irritability, as frustration is its own construct with a number of emotional and behavioral associations.{{Cite journal|last=Berkowitz|first=Leonard|date=1989|title=Frustration-aggression hypothesis: Examination and reformulation.|journal=Psychological Bulletin|volume=106|issue=1|pages=59–73|doi=10.1037/0033-2909.106.1.59|pmid=2667009|issn=1939-1455}}{{Cite web|url=https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/constructs/frustrative-nonreward.shtml|title=NIMH " Construct: Frustrative Nonreward|website=www.nimh.nih.gov|access-date=2020-04-10}} A second prominent special definition describes a group of behavioral issues often occurring in those diagnosed with an autism spectrum disorder.{{Cite journal|last1=Kaat|first1=Aaron J.|last2=Lecavalier|first2=Luc|last3=Aman|first3=Michael G.|date=2013-10-29|title=Validity of the Aberrant Behavior Checklist in Children with Autism Spectrum Disorder|journal=Journal of Autism and Developmental Disorders|volume=44|issue=5|pages=1103–1116|doi=10.1007/s10803-013-1970-0|pmid=24165702|s2cid=254571975 |issn=0162-3257}} This deserves mention here because this version of irritability has been a commonly used in a number of clinical trials and defines the current US Food and Drug Administration irritability indication.

As an emotional and behavioral symptom in humans, someone is considered to be irritable when they have a short temper, become easily frustrated, or feel grouchy or grumpy. Caregivers may report tension in the household or fatigue. They may make accommodations to avoid provoking their dependents. Irritability is associated with a number of mental health conditions.{{Cite book|title=Diagnostic and statistical manual of mental disorders : DSM-5.|date=2013|publisher=American Psychiatric Association|others=American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force.|isbn=978-0-89042-554-1|edition=5th|location=Arlington, VA|oclc=830807378}} It is a defining characteristic of any mood disorder, such as bipolar, depressive, and disruptive mood dysregulation disorders. It is also a major feature of a number of other disorders, including autism spectrum disorders, traumatic stress disorders, generalized anxiety disorder, etc. Finally, it is a notable characteristic of delirium, dementia, hormonal change, metabolic disturbance, chronic stress, pain, and substance/medication withdrawal.{{Cite book|last=Stringaris, Argyris|title=Disruptive mood : irritability in children and adolescents|others=Taylor, Eric|date=5 March 2015|isbn=978-0-19-166205-8|location=Oxford|oclc=905544004}}

Of course, given that irritability is not specific to any one condition, clinicians consider biological, social, psychological, and familial factors. Irritability may be an indicator of diagnosis, course of illness, or prognosis. For example, a major concern for clinicians is the time course of irritability. If a person presents as uncharacteristically irritable, then a clinician may become concerned a change or episodic illness, such as a neurologic insult or mood disorder. Understanding the time course of irritability is critical for establishing the diagnosis of pediatric bipolar disorder from disruptive mood dysregulation disorder.{{Cite journal|last1=Towbin|first1=Kenneth|last2=Axelson|first2=David|last3=Leibenluft|first3=Ellen|last4=Birmaher|first4=Boris|date=2013|title=Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation|journal=Journal of the American Academy of Child & Adolescent Psychiatry|volume=52|issue=5|pages=466–481|doi=10.1016/j.jaac.2013.02.006|pmid=23622848|pmc=3697010|issn=0890-8567}} In another example, chronic, severe irritability in older children (not including young children, e.g. preschool age, where normative irritability may be severe){{Cite journal|last1=Wiggins|first1=Jillian Lee|last2=Mitchell|first2=Colter|last3=Stringaris|first3=Argyris|last4=Leibenluft|first4=Ellen|date=2014|title=Developmental Trajectories of Irritability and Bidirectional Associations With Maternal Depression|journal=Journal of the American Academy of Child & Adolescent Psychiatry|volume=53|issue=11|pages=1191–1205.e4|doi=10.1016/j.jaac.2014.08.005|pmid=25440309|pmc=4254549|issn=0890-8567}} may predict later depression and anxiety and suicidality.{{Cite journal|last1=Pickles|first1=A.|last2=Aglan|first2=A.|last3=Collishaw|first3=S.|last4=Messer|first4=J.|last5=Rutter|first5=M.|last6=Maughan|first6=B.|date=2009-11-26|title=Predictors of suicidality across the life span: The Isle of Wight study|journal=Psychological Medicine|volume=40|issue=9|pages=1453–1466|doi=10.1017/s0033291709991905|pmid=19939326|s2cid=8465693 |issn=0033-2917|url=http://orca.cf.ac.uk/29782/1/Pickles%202010.pdf}}{{Cite journal|last1=Conner|first1=Kenneth R.|last2=Meldrum|first2=Sean|last3=Wieczorek|first3=William F.|last4=Duberstein|first4=Paul R.|last5=Welte|first5=John W.|date=2004|title=The Association of Irritability and Impulsivity with Suicidal Ideation Among 15- to 20-year-old Males|journal=Suicide and Life-Threatening Behavior|volume=34|issue=4|pages=363–373|doi=10.1521/suli.34.4.363.53745|pmid=15585458|issn=0363-0234}}{{Cite journal|last1=Brezo|first1=J.|last2=Paris|first2=J.|last3=Turecki|first3=G.|date=2006|title=Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review|journal=Acta Psychiatrica Scandinavica|volume=113|issue=3|pages=180–206|doi=10.1111/j.1600-0447.2005.00702.x|pmid=16466403|s2cid=12219596 |issn=0001-690X|doi-access=free}}

Several major neural systems have been implicated across a number of studies for idiopathic, chronic irritability.{{Cite journal|last1=Brotman|first1=Melissa A.|last2=Kircanski|first2=Katharina|last3=Stringaris|first3=Argyris|last4=Pine|first4=Daniel S.|last5=Leibenluft|first5=Ellen|date=2017|title=Irritability in Youths: A Translational Model|journal=American Journal of Psychiatry|volume=174|issue=6|pages=520–532|doi=10.1176/appi.ajp.2016.16070839|pmid=28103715|issn=0002-953X|doi-access=free}} These include the following: 1) prefrontal areas that underlying complex, goal directed behavior, especially inhibitory control and the regulation of emotions; 2) cortico-subcortical systems underlying reward processing, particularly in reaction to a frustrating stimulus; and 3) cortico-subcortical systems underlying threat and arousal processing, particularly in the context of social fairness or social threat.

• Aggression
• Annoyance
• Resentment
• Disruptive mood dysregulation disorder
• Oppositional defiant disorder

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| ICD9 = {{ICD9|799.2}}

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{{Cognition, perception, emotional state and behaviour symptoms and signs}}

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Category:Symptoms and signs of mental disorders

Category:Emotions

Category:Neurophysiology

Category:Symptoms or signs involving mood or affect