Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately¹

ABSTRACT

Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This “Future Directions” aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts “hang together,” but have important distinctions and thus also need to “hang separately.” Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.

Disclosure Statement

Dr. Carlson receives grant support from NIH and honoraria for lectures and courses given for the American Academy of Child and Adolescent Psychiatry.

Dr. Althoff receives or has received grant support from NIH and the Klingenstein Third Generation Foundation, honoraria for an editorial position at JAACAP and for presentations at the MGH Psychiatry Academy, and has an ownership interest in WISER Systems, LLC.

Dr. Singh has received or will receive research support from the National Institutes of Health, Patient Centered Outcomes Research Institute, AbbVie, Intracellular Therapeutics, and Bausch Health. She is on a data safety monitoring board for a study funded by the National Institute of Mental Health. She is on the national scientific advisory board for Skyland Trail. She receives honoraria from the American Academy of Child and Adolescent Psychiatry, and royalties from American Psychiatric Association Publishing.