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Child Adolesc Psychiatry Ment Health. 2009 Oct 24;3(1):35. doi: 10.1186/1753-2000-3-35.

Irritable mood and the Diagnostic and Statistical Manual of Mental Disorders.

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1
Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland USA. dsafer@jhmi.edu

Abstract

BACKGROUND:

The terms 'irritable mood' and 'irritability' have been applied to describe and define a variety of different categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM). More precise diagnostic terms and concepts are needed.

METHODS:

A concise critical historical review of DSM categories characterized by irritability, anger, and aggression is presented followed by recommendations.

RESULTS:

This analysis describes the broad ranging and imprecise use of the term irritability since the first DSM in 1952. A more age-appropriate and functional realignment of psychiatric categories linked to dysfunctional anger is suggested. Among other recommendations, this realignment would remove irritability as a problematic definer in the present DSM mood categories: expand oppositional defiant disorder to include adults; link the callous unemotional subtype of conduct disorder in adolescents to antisocial personality disorder; move intermittent explosive disorder to an appropriate category: and expand the term 'mood' to apply also to dysfunctional anger and anxiety.

CONCLUSION:

The non-specific term 'irritability' commonly used in the DSM has had an adverse effect on diagnostic specificity and thereby on treatment. Dysfunctional anger is a major mood disorder which merits a more prominent and better defined representation in psychiatric nomenclature.

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