Irritable mood and the Diagnostic and Statistical Manual of Mental Disorders

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.