Differential outcomes of tonic and phasic irritability in adolescent girls

Abstract

Background: Irritable mood is a transdiagnostic clinical feature that is present in multiple psychiatric disorders. Although irritability is frequently examined as a unitary construct, two dimensions of irritability, tonic (i.e., irritable mood) and phasic (i.e., temper outbursts), have been hypothesized. However, few studies have examined whether tonic and phasic irritability are empirically separable and predict different forms of psychopathology. Methods: We utilized data from a longitudinal study of a community sample of 550 girls (age 13.5-15.5 years) followed at 9-month intervals for 3 years. We conducted exploratory factor analysis (EFA) using items from three self-report inventories: the International Personality Item Pool Anger scale, Temperament and Affectivity Inventory Anger scale, and Buss-Perry Aggression Questionnaire Anger scale. Results: The EFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability at baseline independently predicted the development of depressive disorders and generalized anxiety disorder (GAD) in subsequent waves. Phasic irritability independently predicted a decreased probability of GAD, but an increased probability of oppositional defiant, conduct, and substance use disorder, and greater risky sexual behavior and relational aggression during the follow-up. Conclusions: Tonic and phasic irritability appear to be separable constructs with unique implications for later psychopathology and related behavior among adolescent girls. It is important to consider this distinction in research on the etiology and pathophysiology of irritability and developing effective treatments.

Preschool Irritability Predicts Adolescent Psychopathology and Functional Impairment: A 12-Year Prospective Study

“…While it is possible that irritability may reflect a nonspecific liability to develop psychopathology, there is growing evidence that irritability in older youth and adolescents can be parsed into tonic (irritable, touchy mood) and phasic (temper outbursts) components, which may predict different clinical outcomes. 47,48 Distinguishing types of irritability may have important clinical relevance as phasic irritability often drives clinical referrals and critical treatment decisions. 47 Irritability may also be further parsed (e.g., by context of other impairments or setting) 47 in ways that could similarly explain its multifinality.…”

Heterogeneity of Irritability: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13)

“…Despite these unidimensional conceptualizations, there is growing evidence for the hypothesis that irritability is a multidimensional trait with subdimensions that represent different states, emotions and behaviors. [19][20][21][22] Thus, a measure that encompasses the variable sub-dimensions of irritability with strong internal reliability and discriminant validity would be an asset to clinical practice and scientific research progress. 8,9,17 Prior to this study, we developed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to measure a wide range of theoretical manifestations of the construct including proneness to anger (i.e., tonic irritability), 16 anger outbursts (i.e., phasic irritability), 10 12,18 negative emotional reactivity, 12 and frustration intolerance 13 (see supplementary materials).…”

“…Finally, we assessed the predictive validity of irritability subdimensions by examining their differential associations with age, gender, internalizing psychopathology and externalizing psychopathology. [19][20][21][22] We also tested the hypothesis that a sub-dimension pertaining to anger would show the strongest levels of convergence with the ARI, given that the ARI mainly measures proneness to anger. 8…”

Cardiovascular reactivity as a measure of irritability in a transdiagnostic sample of youth: Preliminary associations

“…Irritability is an impairing symptom in various childhood psychopathologies and a risk factor for later depression, anxiety, and suicidality . The clinical presentation of irritability, as formulated in the related diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), includes both a behavioral component of aggression/temper outbursts and a mood component of frustration, grouchiness, or annoyance (Avenevoli et al, 2015;Cardinale et al, in press;Copeland et al, 2013;Moore et al, 2019;Silver et al, 2021). While commonly measured using either clinician-or parent-and youth-reports (Haller et al, 2020;Stringaris et al, 2012), there is a need for more ecologically valid, objective measures of irritability in…”

“…Irritability is an impairing symptom in various childhood psychopathologies and a risk factor for later depression, anxiety, and suicidality (Brotman, Kircanski, et al., 2017 ). The clinical presentation of irritability, as formulated in the related diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), includes both a behavioral component of aggression/temper outbursts and a mood component of frustration, grouchiness, or annoyance (Avenevoli et al., 2015 ; Brotman, Kircanski, & Leibenluft, 2017 ; Cardinale et al., in press; Copeland et al., 2013 ; Moore et al., 2019 ; Silver et al., 2021 ).…”