Irritability Disorders in Adults: Diagnostic Categories Missing in Plain Sight?

J Nerv Ment Dis. 2020 Jun;208(6):459-465. doi: 10.1097/NMD.0000000000001158.


Research into irritability has focused largely on its developmental and child-adolescent manifestations. Although irritability appears to be as elemental an experience as anxiety or depression, diagnoses highlighting irritability as the focal ingredient have yet to be delineated for adults. Instead, irritability-related diagnoses in adults have largely emphasized externalizing behaviors, depressed mood, and personality. Consequently, patients complaining of irritability are sometimes shoehorned into diagnostic categories that they do not experience as authentic representations of their lived experiences. This article proposes that the symptom of irritability might be productively reenvisioned as a focal point, analogous to anxiety and depression, around which irritability-related syndromes and disorders in adults might coalesce. If anxiety, depressive, insomnia, and pain disorders, why not irritability disorders? Both state and trait characteristics of irritability can lend themselves to DSM diagnostic frames. Based on clinical observations, specific irritability disorders in adults can be envisioned, modeled as Irritability Disorder of Adulthood, Irritability Disorder Secondary to Another Medical Condition, Substance-Induced Irritability Disorder, Adjustment Disorder With Irritable Mood, and the like. Further delineation of irritability phenomena, syndromes, and possible disorders in adults is warranted to advance investigation, guide assessment, and improve treatment.

MeSH terms

  • Adult
  • Anxiety / physiopathology*
  • Comorbidity
  • Depression / physiopathology*
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Humans
  • Irritable Mood / physiology*
  • Mental Disorders / diagnosis
  • Mental Disorders / physiopathology*
  • Mental Disorders / therapy
  • Psychosocial Intervention