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Abstract

Irritability, defined as proneness to anger that may impair an individual’s functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.

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Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 275 - 290
PubMed: 38419494

History

Received: 30 March 2023
Revision received: 14 August 2023
Accepted: 6 September 2023
Published online: 29 February 2024
Published in print: April 01, 2024

Keywords

  1. Anger
  2. Child and Adolescent Psychiatry
  3. Depressive Disorders
  4. Development
  5. Disruptive Mood Dysregulation Disorder
  6. Frustration

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Notes

Send correspondence to Dr. Leibenluft (leibs@mail.nih.gov).

Funding Information

Supported by NIMH Intramural Research Program grants (ZIAMH002786 to Dr. Leibenluft, Dr. Kircanski, and Ms. Malone; ZIAMH002969 to Dr. Brotman; ZIAMH002781 to Dr. Pine; and ZIAMH002957 to Dr. Stringaris), NIMH grants (R01MH069942 to Drs. Carlson and Klein; R01MH110379, R01MH111542, and K24MH110402 to Dr. Dickstein; P50MH130957 to Dr. Mazefsky; R01MHR3759105 to Dr. Nigg; R01MH124266 and R01MH130007 to Dr. Perlman; K23MH113731 to Dr. Stoddard; R00MH110570 to Dr. Tseng; R01MH107652 to Dr. Wakschlag); Charles H. Hood Foundation Major Grant (Dr. Dickstein); National Institute of Child Health and Human Development grant (R01DH079512 to Dr. Mazefsky); Wolfson Foundation (Drs. Shakeshaft and Thapar); National Science Foundation Graduate Research Fellowship Program (award 16–588 to Dr. Silver); Brain and Behavioral Research Foundation (Dr. Stoddard); Children’s Colorado Hospital Foundation (Dr. Stoddard); Charles H. Hood Foundation (Dr. Tseng); Fund to Retain Clinical Scientists and Yale Center for Clinical Investigation (Dr. Tseng); MCIN/AEI/10.13039/501100011033 grant (RYC2021-033369-I to Dr. Vidal-Ribas); European Union (NextGenerationEU and PRTR) (to Dr. Vidal-Ribas); University College London (Dr. Stringaris); Wellcome Trust (grant 226785/Z/22/Z to Dr. Stringaris).Dr. Althoff is a founder of and has received royalties from WISER Systems and has received honoraria from the Massachusetts General Hospital Psychiatry Academy and the Journal of the American Academy of Child and Adolescent Psychiatry. Dr. Roy has received book royalties from Oxford University Press and Springer Publishing. Dr. Stringaris has received royalties from Oxford University Press and Cambridge University Press and codeveloped the Affective Reactivity Index. The other authors report no financial relationships with commercial interests.

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