Current Treatment Options in Psychiatry

, Volume 5, Issue 1, pp 129–140 | Cite as

Psychosocial Treatment of Irritability in Youth

  • Katharina Kircanski
  • Michal E. Clayton
  • Ellen Leibenluft
  • Melissa A. Brotman
Child and Adolescent Psychiatry (M Brotman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Adolescent Psychiatry


Purpose of review

Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently, there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD.

Recent findings

In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N = 10) suggest feasibility.


Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.


Irritability Disruptive mood dysregulation disorder Cognitive-behavioral therapy Exposure Parent management training 


Funding information

The authors’ research is supported by the National Institute of Mental Health (NIMH) Intramural Research Program (ZIAMH002786–15, ZIAMH002778–17), conducted under NIH Clinical Study Protocols 15-M-0182 ( identifier: NCT02531893), 02-M-0021 ( identifier: NCT00025935), and 00-M-0198 ( identifier: NCT00006177).

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Katharina Kircanski
    • 1
  • Michal E. Clayton
    • 1
  • Ellen Leibenluft
    • 1
  • Melissa A. Brotman
    • 1
  1. 1.Emotion and Development BranchNational Institute of Mental HealthBethesdaUSA

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