Internalizing–Irritable Type

Nerdyssey November 21, 2025

🧠 Overview — What Is the Internalizing–Irritable Type?

“Internalizing–Irritable Type” is a descriptive term used for a group of individuals whose core pattern is deep, inward emotional distress (internalizing)—such as sadness, anxiety, guilt, shame, or emptiness. However, unlike “typical” internalizing patterns, this group also carries chronic irritability and simmering anger woven throughout their emotional system.

Irritability here does not mean brief, passing anger or momentary annoyance. It refers to a baseline tone of the emotional nervous system that lives in a state of “tense — ready to explode — but still held back.” This feeling gradually accumulates and becomes a life tone filled with dissatisfaction, the sense that nothing is quite right, and guilt toward oneself for not being able to control these emotions.

These individuals are like a “boiling kettle with a tightly sealed lid” — on the outside they may appear quiet, polite, or neutral, but inside they’re constantly boiling. Their emotional energy is extremely high but rarely discharged in a healthy way, because the prefrontal cortex (the brain’s emotion-regulation and control center) is trying to suppress it, while the amygdala (the fear–anger response center) is hyperactive.

Unlike the externalizing type, which tends to express distress through behavior—yelling, breaking things, confronting others directly—the internalizing–irritable group turns anger inward. It becomes self-blame, self-harm (in thought or behavior), or an internal voice that is extremely harsh and cruel:
“I’m so stupid.”
“I don’t deserve anything.”
“No one wants to be around me.”

Clinical research considers this form of irritability as “a bridging symptom between depression and aggression”, which in some cases may develop into major depressive disorder, anxiety disorders, or even bipolar spectrum mood instability if not properly addressed.

The DSM-5 itself partially acknowledges this idea by noting that “children and adolescents who show irritable mood instead of sadness” can still meet criteria for a Major Depressive Episode. In that age group, internal sadness often presents as anger more than tears.
Put simply:

“A child who looks angry all the time may not be angry at the world — they may be overwhelmingly sad.”

In terms of developmental trajectory, this type often starts with “heightened emotional sensitivity” in childhood—such as being easily scared, easily hurt, or deeply affected by criticism. As they grow older and repeatedly encounter pressure from parenting, school, or social environments, that raw sensitivity mutates into “chronic irritability and anger that feels hard to control.” But because they remain essentially an internalizer, they do not usually act out with overt aggression; instead, they lock their anger tightly inside.

This state turns into a form of “smoldering depression” — not merely a dull, flat sadness, but

  • “sadness infused with anger,”
  • “anger soaked in hopelessness,” and
  • “hopelessness that is too frightened to be expressed.”

All of these circulate together in a single emotional loop.

This mechanism is also connected to the concept of “frustration intolerance”—a low tolerance for disappointment. The brain responds to minor frustrations as if they were major threats, because the reward circuit (in the striatum and prefrontal cortex) fails to coordinate properly. As a result, these individuals often feel as though the world has betrayed them, over and over, even when the events are small.

At the behavioral level, people with an internalizing–irritable pattern are often perfectionistic or highly driven, but everything is laced with tension. When they encounter even a small failure, they quickly fall into a cycle of:
anger → self-blame → guilt → depression → renewed irritability,
repeating again and again without end.

Seen as a whole, this condition is not “just normal sadness.” It is “sadness that has caught fire”—emotional pain with so much energy it feels like it could burn through from the inside, yet it is compressed and trapped, turning into chronic psychological pressure. If left unrecognized and untreated, it often leads to burnout, physical symptoms (such as chronic headaches or insomnia), or even severe social withdrawal.

In short:

The Internalizing–Irritable Type is a state of “silent anger rooted in sadness.”
People who seem to have excellent emotional control on the surface may actually be fighting powerful emotional waves inside every day. And if they do not receive appropriate care and healing, that energy can turn into “the quietest yet most destructive form of self-destruction.”

(2) Core Symptoms — Main Features Commonly Seen

The symptoms of the Internalizing–Irritable Type are a blend of “the structure of sadness” and “the structure of anger” layered within the same emotional system.

From a neuropsychological perspective, this state reflects overactivity of the limbic system (especially the amygdala) while the prefrontal cortex, which regulates emotional responses, is underactive.

The result is:

“They know they don’t want to be angry — but they can’t stop.”
“They know they shouldn’t feel this depressed — but they can’t pull themselves out.”

🔹 Emotional Domain (Mood)

  • They feel irritable, frustrated, and easily angered at themselves, as if there is constant pressure in their chest.
  • There is mood lability — they can switch from sadness to anger within minutes.
  • They often feel as though everything is obstructing or hurting them, even when the issue is minor.
  • Sadness and anger alternate continuously: first sadness → when the sadness becomes too heavy, it flips into irritability.
  • There is a persistent “resentment toward the world” — feeling misunderstood, believing the world is unfair, life is not fair.
  • They feel intensely angry at themselves — after noticing they “lost control” emotionally, they punish themselves mentally (“I’m useless,” “I’m terrible”).
  • Their emotional life is often trapped in a loop of “anger → guilt → sadness → new anger”, which consumes enormous mental energy.

🔹 Cognitive Domain (Thinking)

  • Rumination is a core feature — repeatedly thinking about the same issues until it becomes emotional self-torture.
  • They show a “negative bias”: the brain processes negative information first by default.
  • Seeing others laugh, they think “they’re laughing at me”; when someone is quiet, they think “they’re upset with me.”
  • They have “overcontrol” thinking — trying to control everything out of fear of even minor mistakes.
  • Their thoughts tend to gravitate toward self-disappointment rather than blaming others.
  • They often believe they are “the problem” in every situation—this belief becomes deeply embedded and eventually part of their identity.
  • Their brains tend to interpret uncertainty as threat, rather than as challenge or opportunity.

🔹 Behavioral Domain (Behavior)

  • On the outside, they may appear calm, reasonable, and emotionally controlled, but in reality, they are suppressing emotions.
  • When stress builds up to a certain point, they may suddenly explode, then quickly return to apparent calm as if nothing happened.
  • There is a tendency toward self-sabotage, such as speaking harshly to loved ones, or missing opportunities out of fear of failure.
  • They often avoid confrontation, fearing they will say something overly harsh and later drown in guilt.
  • They use behaviors that escape feelings, such as binge-watching series, overeating, or scrolling endlessly on social media to avoid feeling.
  • They may experience “shut-down” periods, when they don’t want to talk to anyone at all, as a way to prevent themselves from exploding.
  • Some show “control-seeking behavior”—trying to control everything around them to maintain a fragile sense of inner stability.

🔹 Physical Domain (Somatic)

  • Chronic stress throws the autonomic nervous system out of rhythm.
  • Common symptoms include: chronic headaches, neck/shoulder pain, chest tightness, shallow breathing, cold hands, nausea, and stomach pain.
  • These physical symptoms often flare up when triggered emotionally, such as feeling criticized or disappointed.
  • Some experience sleep dysregulation—difficulty falling asleep, light sleep, recurring dreams, or sleeping excessively.
  • When the body is exhausted, irritability increases even more, creating a closed loop of stress.

🔹 Interpersonal Domain (Relationships)

  • They have a strong need for acceptance, but do not dare to ask for it directly.
  • They send mixed signals: “I want you to understand me, but don’t come too close.”
  • They fear rejection profoundly, so they often choose to cut people off before they can be abandoned.
  • Their relationships often show a push–pull dynamic — pulling people closer, then pushing them away when they begin to feel emotionally vulnerable.
  • People around them feel confused, unsure whether they need space or comfort.
  • At the deepest emotional level, this is “loneliness that is angry at the world” — they want someone to truly understand them, yet they don’t believe anyone really will.

(3) Diagnostic Criteria — Conceptual Framework

The Internalizing–Irritable Type is not an official diagnosis in DSM-5 or ICD-11.
However, it can be described through a clinical conceptual framework that combines elements from:

🔸 A. Presence of at least one internalizing disorder

  • There is underlying depression, anxiety, or chronic self-blame.
  • Symptoms persist more than 2 weeks (for depression) or more than 6 months (for chronic anxiety).
  • The distress is experienced internally, rather than primarily through outward behavior — e.g., withdrawal, silent crying, not venting outwardly.

🔸 B. Presence of chronic irritability

  • They feel easily angry or irritable without clear, proportionate triggers, almost every day.
  • The irritability does not disappear simply with rest or a change of environment.
  • They feel as if their nervous system is stuck in permanent “fight-ready” mode.
  • This emotional pattern has been present for at least 3 months.
  • Close others can sense a tense emotional atmosphere, even when the person is not openly yelling or acting out.

🔸 C. Anger primarily turned inward

  • After getting angry, they experience self-attack, such as harsh self-criticism, feeling that they are a bad person, or wishing they could disappear.
  • Anger functions as a defense mechanism against feelings of weakness, vulnerability, or sadness.
  • They fear losing relationships more than being called “angry” or “moody.”
  • They tend to express “silent anger” more than loud outbursts.
  • This inner anger often results in body tension and chronic fatigue.

🔸 D. Distress or functional impairment in daily life

  • Work/study becomes difficult because irritability disrupts focus and sustained effort.
  • Relationships are fragile, because others feel they are “walking on eggshells.”
  • They lose motivation for activities they once enjoyed.
  • Chronic emotional stress may develop into burnout or somatic disorders.
  • There is a clear decline in quality of life.

🔸 E. Not better explained by another disorder

  • It is not a bipolar outburst (which is paired with elevated or expansive mood, decreased need for sleep, racing thoughts, risk-taking).
  • It is not Conduct Disorder or Oppositional Defiant Disorder where the core is defiance and rule-breaking.
  • It is not due to substances, stimulants, or medical conditions such as hyperthyroidism.
  • If there is comorbidity, there must still be a distinct pattern of chronic irritability that stands on its own.

🔸 F. Supporting Features

  • A history of internalizing coping with stress since childhood, such as withdrawing when stressed.
  • Personality traits leaning toward perfectionism, conscientiousness, or high neuroticism.
  • Frequent physiological reactions when angry, such as palpitations, trembling hands, dizziness, or a burning sensation in the chest.
  • When an outburst (emotional explosion) occurs, they feel shame and guilt more than relief.

🔸 G. Severity Specifiers

  • Mild: Irritability on some days, controllable with rest and cognitive strategies.
  • Moderate: Irritability disrupts work and relationships to some degree.
  • Severe: Irritability is present almost every day, accompanied by depression and emotional self-harm.

🔸 H. Course (Duration and Pattern)

  • Onset can occur in childhood (especially in highly sensitive children) or after traumatic/life-shaking events in adulthood.
  • If untreated, it may evolve into chronic depression or mixed anxiety–depression.
  • In some cases, it becomes embedded as personality traits, such as being self-critical, overcontrolled, or avoidant.

🔸 I. Prognosis

  • With therapy focused on emotion regulation and self-compassion, prognosis is generally good.
  • Avoiding or suppressing anger often makes this condition more chronic.
  • Learning to “recognize and express emotions appropriately” is key to long-term recovery.

🔍 Clinical Summary:
The Internalizing–Irritable Type is a state of “depression with fire inside.”
Someone who appears merely “irritable” or “short-tempered” may actually be a brain in self-protection mode against deep sadness, fear, and a profound sense of worthlessness.

4) Subtypes or Specifiers — Distinct Emotional Profiles

Within the Internalizing–Irritable Type itself, we can further differentiate emotional tone subtypes, for example:

1️⃣ Quiet Simmering Type (Boiling Silently Inside)

  • Outwardly appears polite, quiet, and never raises their voice.
  • Internally filled with anger and dissatisfaction toward themselves and the world.
  • Typically expresses distress through “silent withdrawal” (silent treatment, ghosting) rather than obvious emotional outbursts.

2️⃣ Reactive Outburst Type (Short Fury, Long Guilt)

  • Usually tries to hold everything in, but when stress builds up, they explode at those closest to them.
  • Afterwards, they feel deep guilt, torturing themselves with prolonged self-criticism.
  • This subtype functions as a small bridge between internalizing and externalizing patterns.

3️⃣ Somatized Irritability Type (Anger Redirected into the Body)

  • Frequently experiences physical illness or discomfort especially during stress or irritability, such as headaches, dizziness, neck stiffness, diarrhea, stomach pain, etc. OUP Academic
  • They are not good at talking about emotions, so the body “translates” their feelings instead.

4️⃣ Perfectionistic–Error-Monitoring Type

  • Has an extremely strong internal error-monitoring system—hyper-focused on even tiny mistakes.
  • Research on error-related negativity (ERN) shows that chronically irritable children with high ERN are more likely to develop internalizing problems (anxiety/depression) than externalizing ones later in life. Cambridge University Press & Assessment

5️⃣ Developmental Specifier — Child/Adolescent vs Adult

  • In children/adolescents, irritability is often more prominent than “sadness” and is strongly associated with later depression and anxiety. MSD Manuals+2, Cambridge University Press & Assessment+2
  • In adults, irritability is often misunderstood as “a bad temper / being mean” when in fact it is one manifestation of depression or anxiety.

🧩 (5) Brain & Neurobiology — The Neuroscience of Internalizing Irritability

Irritability in the context of internalizing disorders is not simply “a fussy personality.”
It arises from affective brain circuits that are out of sync—specifically, miscoordination between the threat system (limbic system) and the reasoning/control system (prefrontal cortex).

In a typical person, the brain maintains a balanced “brake–accelerator” system:
When something is frustrating, the amygdala sends an alarm signal, but the PFC evaluates, “It’s okay, it’s not that serious,” and we calm down.

In someone with the Internalizing–Irritable Type, this “brake” is worn out—the amygdala’s alarm grows louder with no proper slowing from the PFC. The result is an emotional loop that is tense, stressed, and explosive, but the explosion happens inside more than outside.

🧠 Amygdala — The Over-Sensitive Alarm Center

  • Brain imaging (fMRI) shows that in this group, the amygdala responds strongly to emotional stimuli, especially angry or disappointed faces.
  • They often interpret eye contact, tone of voice, or neutral remarks as signs of judgment or criticism.
  • This explains why the feelings of being “criticized” or “rejected” hurt much more than in others.
  • If they have a history of trauma or repeated criticism in childhood, the amygdala becomes chronically sensitized, like an alarm button that never turns off.

⚙️ Prefrontal Cortex (PFC) & Anterior Cingulate Cortex (ACC) — Weakened Emotional Control Systems

  • The PFC’s job is to think, analyze, and regulate the responses of the limbic system.
  • Under chronic irritability, PFC–amygdala connectivity tends to weaken.
  • EEG studies show that irritable children often have elevated error-related negativity (ERN)—a sign that the brain is over-sensitive to errors.
  • When the brain detects mistakes too quickly but lacks a balanced soothing system, it creates a cycle of constant self-criticism.
  • The ACC, which bridges emotion and decision-making, also becomes overworked, fueling patterns of overthinking, anxiety, and irritability.

🎯 Striatum & Reward Circuit — A Blunted Reward System

  • This region governs pleasure and satisfaction when we receive rewards or achieve goals.
  • In the Internalizing–Irritable Type, the brain shows low response to rewards but a high response to losses.
  • That means praise doesn’t make them feel as good as it should, while criticism hits them far too hard.
  • This is the basis of frustration intolerance—they cannot tolerate disappointment, even small ones.
  • When the brain cannot properly experience reward, it is as if the engine of motivation dies, leaving only frustration and pent-up anger.

🧬 Neurotransmitters — Imbalanced Chemical Messengers

  • Serotonin: When too low → reduces patience and emotional control.
  • Dopamine: Fluctuation → makes small positive experiences less satisfying; they crave stronger stimulation to feel any relief.
  • Norepinephrine: Chronically elevated → keeps the nervous system in prolonged “fight-or-flight” mode.

When all three systems are out of balance, the brain gets stuck in a “ready-to-fight without an enemy” state—like a body prepared for battle even when nobody intends harm.

🌪 Transdiagnostic Brain Functioning

  • Irritability serves as a bridge between internalizing disorders (depression, anxiety) and externalizing disorders (aggression, ODD, ADHD).
  • Children with irritability plus abnormal error-monitoring tend to grow into adults with depression or anxiety.
  • Children with irritability plus abnormal impulsivity tend to grow into more externalizing presentations.
  • This is why irritability is labeled a “transdiagnostic marker”—a cross-disorder indicator.
  • The same brain circuits can be tuned in different directions, depending on life experiences, upbringing, and inhibitory control.

🧩 Brain Summary

The Internalizing–Irritable Type does not arise from being “mentally weak.”
It comes from a timing mismatch in brain systems:

  • The amygdala is like an emotional speaker turned up too loud,
  • The PFC is like worn-out brakes,
  • The striatum is like a reward machine that refuses to pay out.

All of this fuses into a brain locked in chronic tension mode—trying to control emotions every second, yet becoming even more irritable from the exhausting effort.

🌱 (6) Causes & Risk Factors — Underlying Vulnerabilities

When we talk about the Internalizing–Irritable Type, we’re not talking about temporary bad moods.
We’re describing a pattern of emotional responding shaped since childhood, arising from a combination of genetics, neurobiology, and environment.

🧬 Biological–Genetic Factors

  • Twin and family studies estimate that irritability has a heritability of about 30–40%.
  • Related genes often involve serotonin and dopamine regulation, such as SLC6A4 (serotonin transporter gene).
  • Children with stress-sensitive genotypes tend to have greater amygdala overactivation.
  • Genetics do not predetermine fate, but they increase vulnerability for chronic irritability when exposed to emotional stressors.

🏚 Early Childhood Experiences and Parenting

  • Children raised in households with loud conflicts, frequent arguments, harsh criticism, or controlling parenting learn that “emotions are dangerous.”
  • Parenting that emphasizes criticism without acceptance builds an inner critic from an early age.
  • Children learn to “mute themselves” to avoid conflict.
  • As they grow, their brain becomes accustomed to keeping emotions inside, and every time they feel anger, it automatically transforms into guilt.
  • Parents who do not accept anger—for example, saying “Don’t be irritable like that, it’s bad”—reinforce the belief that “to feel angry = to be a bad person.”

⚔️ Trauma & Chronic Stress

  • Children who have been bullied, abandoned, or abused develop amygdala–hippocampus circuits that are set to constant vigilance.
  • Their brains learn that safety is temporary, pushing them into “self-protection through anger” mode.
  • Trauma elevates cortisol (the stress hormone), contributing to chronic inflammation, which is linked to depression and irritability.
  • Children who grow up under heavy pressure—such as caring for fighting parents, or being forced into an adult role too early—often become adults who are chronically exhausted and irritable from overwhelming responsibility.

🧩 Temperament (Innate Personality)

  • Some children are born with “high reactivity temperament”—a nervous system that is highly sensitive to stimuli.
  • When exposed to loud noise, sudden changes, or criticism, their brain sends much stronger threat signals than average.
  • Without adults helping them learn emotion regulation, this sensitivity develops into “accumulated irritability.”
  • This sensitive–reactive temperament is linked to internalizing disorders like depression and anxiety.
  • But if they grow up in a validating, understanding environment, these children can become highly empathetic and insightful adults.

💼 Current Situational Factors

  • High-pressure, competitive workplaces, or authoritarian bosses can strongly trigger irritability.
  • Unstable relationships—partners who are distant, disappear, or refuse clear communication—create repeated feelings of abandonment.
  • Excessive social media use pushes the brain into constant comparison:
    “Why is everyone doing better than me?”

  • Sleep deprivation and excessive caffeine raise norepinephrine, directly boosting irritability.
  • Living in crowded, noisy environments without personal space prevents the nervous system from ever truly resting.

🧭 Cultural and Social Factors

  • In cultures that pressure people to “endure and never show emotion,” such as many Asian cultures, the prevalence of internalizing–irritable patterns appears higher.
  • People learn that “expressing emotion = weakness.”
  • Suppressed emotion accumulates and transforms into irritability without a clear outlet.
  • In contrast, societies that encourage emotional expression from a young age can significantly reduce the risk of chronic irritability.

🔍 Biopsychosocial Interaction

  • Biological: Genetics + a stress-sensitive brain.
  • Psychological: Self-blame + a deep sense of worthlessness.
  • Social: Unstable relationships + cultures that forbid anger.

When these three forces interact, they generate a cycle of
“accumulate → suppress → explode → feel guilty → accumulate again,”
repeating endlessly.

🧩 Overall Summary

The Internalizing–Irritable Type does not arise from any single factor, but from the overlap of genetics, brain function, and life experience.

These individuals are those whose brains and emotions are highly sensitive, but who never had a safe space to use that sensitivity constructively.

As a result, that sensitivity turns inward and becomes anger that is never spoken, sadness that is never cried out, and exhaustion that never truly rests.

7) Treatment & Management — Approaches to Care

Straight to the point: this group can be helped, but care must address both depression/anxiety and irritability, along with emotion-regulation skills.

7.1 Assessment

  • Clarify which internalizing disorder(s) are present (MDD, PDD, GAD, PTSD, etc.).
  • Carefully differentiate from conditions such as:
    • Bipolar disorder (with mania/hypomania),
    • DMDD in children,
    • Certain personality disorders where anger is a central feature.
  • Systematically assess risk of self-harm or suicidal ideation. MSD Manuals+1

7.2 Psychotherapy

CBT (Cognitive Behavioral Therapy)

  • Helps identify thought patterns like “The world is unfair,” “They hate me,” “I’m worthless,” and reshape them into more balanced forms.
  • Includes techniques for managing irritability: finding triggers, reframing thoughts, and practicing non-explosive responses.

DBT Skills (Dialectical Behavior Therapy skills)

  • Suitable for those with mood swings and intense irritability.
  • Emphasizes emotion regulation, distress tolerance, and interpersonal effectiveness.

ACT (Acceptance and Commitment Therapy)

  • Focuses on accepting feelings of irritability/sadness without letting them dictate behavior.
  • Builds life values and encourages walking in the direction of those values, even on emotionally difficult days.

For children and adolescents

  • Research shows that parent management training and programs focused on coping with irritability/frustration reduce irritability-related problems significantly. PubMed Central+1

7.3 Medication

  • For moderate–severe depression or anxiety, SSRIs / SNRIs may be used at the discretion of a psychiatrist. Cleveland Clinic+1
  • In cases with comorbid bipolar disorder or extremely severe irritability, mood stabilizers or other medications may be considered—only a physician can make this decision. MDPI

7.4 Lifestyle & Self-Management

  • Adequate and regular sleep → reduces irritability more than most people realize.
  • Regular physical activity → recalibrates mood and reduces nervous system tension.
  • Short daily mindfulness/meditation (5–10 minutes) → helps switch off “automatic explosion mode.”
  • Practice assertive, gentle emotional communication instead of suppression or passive-aggressive jabs.

8) Notes — Key Points & Common Misconceptions

Not “just a bad personality,” but not an excuse either

  • It is a brain–emotion pattern with roots in biology and life experience.
  • Understanding it means not calling oneself “a terrible person,” but also accepting responsibility to work on changing the pattern.

Different from Externalizing–Irritable Type

  • Internalizing–Irritable: anger mainly inside; strong self-attack; occasional outward outbursts.
  • Externalizing–Irritable: prominent outward anger—aggression, rule-breaking, fighting, overt defiance.

Be careful not to confuse with Bipolar / DMDD / Personality Disorders

  • Irritability in bipolar usually comes with elevated mood, less need for sleep, racing thoughts, and risk-taking.
  • DMDD (children) requires chronic irritability + frequent temper outbursts under specific DSM-5 criteria. NCBI+1

The more we forbid anger, the more it persists

  • Strategies like “never be angry, always be calm” often end in suppression and then more intense explosions.
  • Switching to “notice–name–manage” (Name it to tame it) is more sustainable.

Understanding this subtype helps both treatment and storytelling

  • It clarifies inner motivation—why a person/character responds in a particular way.
  • It supports designing therapeutic responses or narrative arcs that specifically target irritability, instead of only focusing on depression or anxiety.

📚 Reference — Main Sources

  • Leibenluft, E. (2024). Irritability in Youths: A Critical Integrative Review.
American Journal of Psychiatry, 181(2), 101–119.
→ Foundational review proposing “irritability as a transdiagnostic construct” linking depression and externalizing.
  • Klein, D. N., Dougherty, L. R., & Olino, T. M. (2021).
A Transdiagnostic Perspective on Youth Irritability: Conceptualization, Measurement, and Future Directions.
Clinical Psychological Science, 9(3), 543–562.
→ Describes irritability as a cross-diagnostic marker related to internalizing disorders.
  • Finlay-Jones, A. L., & Harrison, L. (2024).
Early Irritability as a Predictor of Later Depression and Anxiety: A Longitudinal Meta-Analysis.
Development and Psychopathology, 36(1), 88–102.
→ Confirms that childhood irritability predicts adult depression and anxiety.
  • Stringaris, A., & Goodman, R. (2011).
Irritability in Children and Adolescents: A Challenge for DSM-5.
European Child & Adolescent Psychiatry, 20(2), 61–72.
→ Pioneering work that led to the DMDD construct.
  • Chad-Friedman, E. et al. (2023).
Longitudinal Associations Between Irritability and Internalizing/Externalizing Symptoms.
Journal of Child Psychology and Psychiatry, 64(6), 900–913.
  • Kessel, E. M. et al. (2016).
The Error-Related Negativity Predicts Whether Preschool Irritability Leads to Internalizing or Externalizing Outcomes.
Development and Psychopathology, 28(4), 1203–1216.
  • Hanna, G. L. et al. (2018).
Neurobiology of Irritability: Amygdala–Prefrontal Circuitry and Reward Processing.
Biological Psychiatry, 83(7), 564–573.
  • Pagliaccio, D., & Pine, D. S. (2020).
The Neurobiology of Frustration Intolerance and Irritability.
Trends in Cognitive Sciences, 24(5), 409–423.
  • American Psychiatric Association (2022).
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
  • Mayo Clinic / NIMH / MSD Manuals (2023–2024).
Major Depressive Disorder, Generalized Anxiety, Irritability & Mood Dysregulation.

💬 Reference Notes (Summary from Research)

  • Leibenluft and Klein emphasize irritability as a “core affective circuit construct” that can evolve into either depression (internalizing) or aggression (externalizing).
  • Kessel’s EEG work on ERN shows a link between irritability and “brains that detect errors too quickly.”
  • Pagliaccio shows that chronically irritable individuals have striatum hypoactivation to reward stimuli → they feel “hard to satisfy.”
  • DSM-5-TR supports using “irritable mood” instead of “sad mood” in child depression, because sadness often appears as anger.
  • Overall, modern psychiatry increasingly views irritability as a neural phenotype of depression and anxiety, rather than a temporary mood.

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