Of Triggers, Tigers, and Tactics: Managing Emotional Dysregulation.

The frustration of defining, understanding, and addressing irritability in child psychiatry and the difficulties that children with emotion dysregulation face on a daily basis can be seen as parallel processes. We know that irritability is one of the most common reasons for which children are referred for evaluation.1 We also know that the stakes are extremely high, with persistent irritability associated with suicidality.2 Despite this, we do not have a readily available nosological paradigm. Our current clinical approach remains muddled by outbursts' transdiagnostic nature. We find ourselves listing things such as posttraumatic stress disorder, disruptive mood dysregulation disorder, attention-deficit/hyperactivity disorder, anxiety, and depressive disorders in the chart, but feeling that we have not fully captured the unique neurobiological and subjective essence of a child's irritability syndrome.3 Furthermore, despite extensive research, we lack accessible diagnostic tools or effective treatment protocols to implement on a community-wide basis. So, we (JC, CU) think we have every right to be irritable as we experience frustrative non-reward (thinking and focusing on this issue with blocked goal attainment) and face existential threat (desperately wanting children and families to enjoy better developmental trajectories, and wanting it now!).4.