Extreme Irritability: When You're Beyond Cranky

THE DRIVER UP AHEAD IS crawling below the speed limit and you can't pass. Dude, there's a reason they call it rush hour. Your breakfast sandwich is sloppy and the extra-large coffee, loaded with sugar, is only lukewarm. At the office, a glimpse at your meeting-packed calendar provokes a loud, windy sigh. Once again, the printer's jammed and you're wrestling with the paper tray. That doesn't work, forcing you to head over to a distant machine while dropping dark looks on every co-worker you see.

Deadlines are looming, the meeting speaker is droning and your teeth are gritting with frustration. As you finally settle down at your desk, ready to dig into your inbox, your chatty supervisor interrupts and your pulse rises. At home your partner is too busy to listen to you vent; the TV's blasting the commercial you hate so much, and it's really getting under your skin. Each day is like this – filled with exasperation that never ends and resentment that's hard to suppress. You're always aggravated, always on edge. Is this normal?

Serious Irritability

Irritability: You know it when you see it – but what is it? It feels like anger, but there's a difference. "Anger is usually an emotion triggered by a specific event – so you're angry about something," says Susan Holtzman, an associate professor of psychology at the University of British Columbia–Okanagan. "Irritability is more typically described as a mood. So you can feel irritable all day but there's nothing in particular you're angry about. You're just sort of cranky." But the two are very much related, she says: "We see irritability as a proneness to getting angry."

Irritation is a normal experience, Holtzman notes – often it's just one of those days. "But of course, irritability can be much more than that," she says. "Sometimes if it's present at chronically high levels, over time it can be a red flag for some underlying physical or mental health issues." Depression and anxiety are among mental health conditions associated with irritability.

Lifestyle Connection

If it becomes disruptive enough, irritability may lead people to Anita Gadhia-Smith, a psychotherapist who practices in the District of Columbia and Bethesda, Maryland. "Generally, they wouldn't call it irritability," she says. "They would call it relationship problems. Or sometimes they would come in and say, 'I don't know what I'm doing wrong. But my life isn't working. My job, my relationships aren't working. Help me figure it out.'"

Irritability can have deep-seated roots but also day-to-day causes. "If I were to pinpoint one major factor that would contribute to severe irritability, I would look at sleep deprivation," Gadhia-Smith says. "Sleep is sort of the linchpin to our well-being. It controls our mood, our hormones, our affect state, our energy level, our concentration. A lot of people now are chronically sleep-deprived and just operating that way in kind of a low-grade irritability."

Lack of good nutrition can also contribute. Excess sugar and caffeine are major culprits, Gadhia-Smith says. With their initial stimulant effects, both appeal to people "who want those things more when they're exhausted and worn-out and cranky," she says. "They think that'll put them in a better mood. But on the back end, when they wear off, they actually create more irritability."

Other influences are societal, Gadhia-Smith believes. Rushed modern lives, less-connected communities and more electronic communications have altered the nature of interactions, she says, with people becoming less approachable, skilled at relating or willing to relate on a face-to-face level.

Mental Disorder?

Chronic medical conditions can contribute to irritability. "People living with chronic pain are uncomfortable all the time," Gadhia-Smith says. Certain medications, including opioid painkillers, can also cause irritability as a side effect. "That further isolates the person who's in chronic pain, and it's very difficult for them," she says.

For kids, irritability in itself is the main feature of a specific mental health condition known as disruptive mood dysregulation disorder. Only diagnosed in children and adolescents, DMDD encompasses continual irritable or angry moods; frequent, severe temper outbursts and trouble functioning because of irritability.

For adults with certain illnesses, irritability can be as symptom. For example, irritability is common with Huntington's disease – a genetic condition affecting the nerve cells in the brain – and may be treated with antidepressants or other medications. For adults in the general population, however, much less research exists around irritability.

To gain more insight, Holtzman and colleagues have conducted studies with adults who've experienced recent irritability. Everybody has their own triggers, the researchers found. "It's such a variable experience," Holtzman says. "We asked people what makes them irritable, and we had 100 things." One common thread emerged: Situations beyond people's control (like traffic jams) feed heavily into irritation.

Holtzman is one of the creators of a simple scale called the Brief Irritability Test. Participants rate themselves on five items such as how often they feel grumpy and how often other people get on their nerves. The test could help researchers and clinicians get a better handle on adult irritability.

"I'm Not in a Bad Mood!"

Even if you're not ready to admit to eternal exasperation, people around you notice. "A red flag may be that other people are telling you you're cranky or you're irritable," Holtzman says. "And if that makes you irritable, it's a sign."

Although patients may deny irritability, tell-tale behaviors crop up in therapy, Gadhia-Smith says: "It can be a dismissiveness. It can be an anger. It can be an agitation." Once irritability is recognized, therapy works to identify internal causes and help patients find ways to heal.

"We get fussy just like babies do," Gadhia-Smith says. "With babies, if you give them a nap and feed them and hold them, they tend to settle down. And adults still need to be held and soothed just like babies do in adult ways." The difference, she says, is adults have to learn how to soothe themselves.

Curmudgeons might just be wired that way, of course. Some people are naturally sunny, Gadhia-Smith points out, while other are just more negative, "Anxious and angry people are particularly prone to irritability," she says. "They have this excessive energy inside them and it's looking for a healthy way to get out. If they can channel the anxiety and anger in a constructive way, then they can use that energy very productively."

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