Irritability in child and adolescent psychopathology: An integrative review for ICD-11
Abstract
In preparation for the World Health Organization's development of the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11) chapter on Mental and Behavioral Disorders, this article reviews the literature pertaining to severe irritability in child and adolescent psychopathology. First, research on severe mood dysregulation suggests that youth with irritability and temper outbursts, among other features of hyperactivity and arousal, demonstrate cross-sectional correlates and developmental outcomes that distinguish them from youth with bipolar disorder. Second, other evidence points to an irritable dimension of Oppositional Defiant Disorder symptomatology, which is uniquely associated with concurrent and subsequent internalizing problems. In contrast to the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Disruptive Mood Dysregulation Disorder, our review of the literature supports a different solution: a subtype, Oppositional Defiant Disorder with chronic irritability/anger (proposal included in Appendix). This solution is more consistent with the available evidence and is a better fit with global public health considerations such as harm/benefit potential, clinical utility, and cross-cultural applicability. Implications for assessment, treatment, and research are discussed.
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There continues to be controversy about the empirical support for the designation of Social (Pragmatic) Communication Disorder and Disruptive Mood Dysregulation Disorder as separate diagnostic categories.
“There continues to be controversy about the empirical support for their designation as separate diagnostic categories 31,32 , and the ICD-11 Working Groups viewed the available evidence as insufficient to justify their inclusion in the ICD-11.”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
DMDD was added to the DSM-5 to provide a prominent diagnostic 'home' for children who were being misdiagnosed as having bipolar disorder and were therefore receiving inappropriate treatments such as antipsychotics and mood stabilizers.
“DMDD was added to the DSM-5 to provide a prominent diagnostic 'home' for children who were being misdiagnosed as having bipolar disorder and were therefore receiving inappropriate treatments such as antipsychotics and mood stabilizers 31,77 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
Substantial upticks in research activity can already be seen in some areas of ICD-11/DSM-5 divergence, such as PTSD/CPTSD, Personality Disorders, and childhood irritability/anger.
“Indeed, substantial upticks in research activity can already be seen in some areas of ICD-11/DSM-5 divergence, such as PTSD/ CPTSD 59-61 , Personality Disorders 96-99 , and childhood irritability/anger 31,83 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
Chronic irritability-anger is predictive of later depression, anxiety and suicidality.
“Such chronic irritability-anger is predictive of later depression, anxiety and suicidality 31 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
There is substantial evidence supporting the validity and clinical utility of the symptom structure of ODD subtypes based on the presence of a pattern of chronic irritability-anger.
“The rationale for considering a pattern of chronic irritabilityanger as a subtype of ODD in the ICD-11 rather than a distinct disorder relates to: a) substantial evidence supporting the validity and clinical utility of the symptom structure of ODD subtypes based on the presence of a pattern of chronic irritability-anger 31 ; and b) what the ICD-11 Working Group considered to be the questionable”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
The irritability and behavioural symptom dimensions of ODD are not separable into different disorders.
“Studies in clinical and community samples have found that 70-100% of children with DMDD have symptoms that meet the diagnostic requirements for ODD 77,79-82 , suggesting that the irritability and behavioural symptom dimensions of ODD are not separable into different disorders 31,78 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [31]
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References 166 · Cited by 186
- Authors
- Evans, S. C., Burke, J. D., Roberts, M. C., Fite, P. J., Lochman, J. E., de la Peña, F. R., & Reed, G. M.
- Affiliations
- University of Kansas (US)
- University of Connecticut (US)
- University of Alabama (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Evans, Spencer C.
- ORCID
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 53
- Pages
- 29-45
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2574370300
- Cited by
- 186
- References
- 166
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 23 · 2023: 35 · 2022: 30 · 2021: 21 · 2020: 15 · 2019: 17 · 2018: 5 · 2017: 10
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- irritability, child and adolescent psychopathology, ICD-11, mood dysregulation, temper outbursts, bipolar disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, internalizing problems, diagnostic classification
- MeSH terms
- Adolescent, Affective Symptoms, Bipolar Disorder, Child, Child Behavior Disorders, Humans, Irritable Mood, Attention Deficit and Disruptive Behavior Disorders, International Classification of Diseases
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