Dimensions of irritability in adolescents: longitudinal associations with psychopathology in adulthood

Abstract

BackgroundThere is an emerging consensus in developmental psychopathology that irritable youth are at risk for developing internalizing problems later in life. The current study explored if irritability in youth is multifactorial and the impact of irritability dimensions on psychopathology outcomes in adulthood.MethodsWe conducted exploratory factor analysis on irritability symptom items from a semi-structured diagnostic interview administered to a community sample of adolescents (ages 14–19; 42.7% male; 89.1% white). The analysis identified two factors corresponding to items from the mood disorders v. the oppositional defiant disorder (ODD) (Leibenluft and Stoddard) sections of the interview. These factors were then entered together into regression models predicting psychopathology assessed at age 24 (N = 941) and again at age 30 (N = 816). All models controlled for concurrent psychopathology in youth.ResultsThe two irritability dimensions demonstrated different patterns of prospective relationships, with items from the ODD section primarily predicting externalizing psychopathology, items from the mood disorder sections predicting depression at age 24 but not 30, and both dimensions predicting borderline personality disorder symptoms.ConclusionsThese results suggest that the current standard of extracting and compositing irritability symptom items from diagnostic interviews masks distinct dimensions of irritability with different psychopathological outcomes. Additionally, these findings add nuance to the prevailing notion that irritability in youth is specifically linked to later internalizing problems. Further investigation using more sensitive and multifaceted measures of irritability are needed to parse the meaning and clinical implications of these dimensions.

Developmental Patterning of Irritability Enhances Prediction of Psychopathology in Pre-adolescence: Improving RDoC with Developmental Science

“…Changes in irritability from preschool may reflect emotion development and regulation strategies. These developments presage internalizing and externalizing symptoms in pre-adolescence, when psychopathology is emerging and stabilizing (Class et al, 2019;Hawes et al, 2019;Jirsaraie et al, 2019). Additionally, early school age is a time of rapid gray matter volume maturation.…”

“…This approach has elucidated unfolding patterns of symptoms that predict later psychopathology and provide insight into etiology and inform developmentally-based interventions (Cicchetti & Sroufe, 2000;Mittal & Wakschlag, 2017;Wakschlag et al, 2010). Within this context, a wealth of evidence demonstrates that atypical patterns of early irritability are predictive of emerging and subsequent psychopathology (Brotman et al, 2017;Carter et al, 2013;Fishburn et al, 2019;Hawes et al, 2019;Humphreys et al, 2019;Kessel et al, 2020;Smith et al, 2019;Wakschlag et al, 2010, IRRITABILITY PREDITS CLINICAL OUTCOMES/GRAY MATTER VOLUMES 4 2015a, 2019. Despite the promise of irritability to predict psychopathology, it is not yet clear how a general behavioral phenotype of excessive irritability translates into diverse, specific symptoms of psychopathology.…”

“…This period also marks a shift in neurodevelopment, as cell and synaptic division peak; increased synaptic pruning, arborization, and myelination alter gray matter volumes, which peak in pre-adolescence (Giedd et al, 1999(Giedd et al, , 2012Kaczkurkin, Moore, et al, 2019). Despite this complex developmental context, preschool irritability can be measured reliably and is predictive of future psychopathology (Hawes et al, 2019;Kessel et al, 2020;Smith et al, 2019;Wiggins et al, 2020;Wiggins et al, 2018).…”

Differential outcomes of tonic and phasic irritability in adolescent girls

“…They reported that, compared to tonic irritability, phasic irritability was slightly more stable and heritable, and was a stronger indicator of the DMDD latent factor. Finally, Hawes et al (2019) conducted a factor analysis of the irritability items in the mood and disruptive behavior disorder sections of a diagnostic interview in a community sample of older adolescents and found two factors. One, reflecting three items from the mood disorders section, appeared to tap a tonic form of irritability, and the other, from three items in the disruptive behavior disorders section, seemed to reflect phasic irritability.…”

Using Item Response Theory to Compare Irritability Measures in Early Adolescent and Childhood Samples

“…Youth irritability is broadly defined as a mood of low frustration–tolerance characterized by anger and temper outbursts (Brotman et al, 2017; Stringaris, Zavos, et al, 2012). Irritability, a transdiagnostic construct, constitutes one of the most common reasons for pediatric psychiatric evaluation and predicts adult depression, anxiety, suicidality, and lower educational and financial attainment (Brotman et al, 2017; Copeland et al, 2014; Hawes et al, 2020; Stringaris et al, 2009). Despite recent examination of youth irritability, little empirical data are available to guide researchers and clinicians in its assessment.…”