Commentary: What to do with irritability? Do not give it a new diagnostic home—a commentary on Evans et al. (2020)

Abstract

Irritability is ubiquitous and therefore nonspecific. Evans and colleagues conducted an international study to test clinicians’ ability to differentiate chronic irritability from four ‘boundary’ presentations: nonirritable oppositionality, episodic bipolar disorder irritability, depressive disorders, and normative irritability. Clinicians assigned to rate vignettes according to the International Classification of Diseases and Related Health Problems-Eleventh Revision (ICD-11) fared best, while those assigned to the Diagnostic and Statistical Manual-5th Edition (DSM-5) condition had the most false positives and false negatives. Findings are consistent with a decade’s worth of investigation on the utility of irritability as a diagnostic criterion. Irritability is commonly associated with both internalizing and externalizing disorders. Multiple investigations of its new ‘home’ within the DSM-5 categorical diagnosis of DMDD indicate a poor fit. Irritability is more useful as a specifier for other disorders, consistent with how it is utilized within the ICD-11.