Irritability

WHEN TO SEE YOUR DOCTOR

* Your irritability persists more than a week and is adversely affecting your job performance and relationships with your family, friends and co-workers.

* You also feel under constant pressure at home or at work.

* You also have persistent headaches.

What Your Symptom Is Telling You

That thick skin you used to have has suddenly worn thin. Gentle teasing from your spouse sparks a rage. A minor traffic snarl provokes a fury. A co-worker's well-intentioned criticism sets you off on a tirade that people in the office whisper about for days. The odd thing is you don't know why you're feeling so out of control.

"Occasional irritability is a normal part of being human," says Paul Horton, M.D., a psychiatrist in Meriden, Connecticut. "Adolescents, for example, go through periods of irritability. One moment they're surly and ten minutes later, they're fine. Parents shouldn't be overly concerned about that because adolescents are like tropical weather—they change from moment to moment.

"But irritability also can go hand in hand with almost any illness. Very often, people who are falling ill will become irritable but don't know why."

Irritability can be a sign of flu, a cold, premenstrual syndrome, fatigue, depression, anxiety, drug or alcohol abuse, stress, diabetes, schizophrenia, Alzheimer's disease, thyroid disease, stroke or brain tumor. It can also be a side effect of certain medications.

Symptom Relief

Because so very many things can produce irritability, repeated or persistent bouts should be brought to the attention of your doctor. If you just wake up on the wrong side of the bed, however, or when you feel on edge, try these suggestions.

Identify the cause. If you sense you're more irritable than usual, take a moment to think about what might be causing it. "Identifying a cause can help you realize that your irritability is temporary, and you just need to be more patient and extra careful with people around you for a while. It can help you restrain yourself from doing or saying something you'll regret later," says Betsy Comstock, M.D., a professor of psychiatry at Baylor College of Medicine in Houston. Just knowing that premenstrual syndrome makes you irritable for two days a month every month, for example, can help you keep yourself in check.

Don't hide it. Instead of trying to hide your feelings, warn people around you that you feel grumpy. "People get into trouble when they don't acknowledge their feelings to others. If you don't tell people you're irritable, they'll be absolutely perplexed by your behavior," says Roland D. Maiuro, Ph.D., director of the Anger and Domestic Violence Program at Harborview Medical Center in Seattle. "If I have one of those days, I'll say, 'I just wanted to let you know that I'm not doing too well today. So if I seem irritable, please forgive me.' That can help people understand where you're coming from and defuse the situation."

Take the pause that refreshes. Try doing a task that will distract you from whatever is irritating you. "There's an old saying, 'Busy hands avoid mischief.' Some people just need to keep their hands busy," Dr. Comstock says. "Take a walk, do the laundry, write a letter, water the lawn. You need to do something that's going to reduce your stress and absorb some time—it should take 15 minutes to an hour, depending on how much cooling-off time you need—so that you don't react impulsively."

Do a systems check. Before you confront someone, make sure your thoughts and actions are under control, Dr. Maiuro suggests. Are you thinking in words that exaggerate, such as "always," "should," "ought" or "never"? Are you focusing on what you think of the person rather than solving the problem? Are you having thoughts of revenge or getting back at this person? Are you unable to sit still? Are you speaking loudly and pounding your fist on a table? Do you feel muscle tension in your back or neck? "If you're having any thoughts or feelings like that, then you're probably not ready to deal with the situation," Dr. Maiuro says. "If you confront someone at that point, you're likely to distort or complicate the problem rather than solve it."

Set a time. If someone does irritate you and you sense you'll explode if you start talking about the problem at that moment, try to negotiate a time when you think you can discuss the situation with the other person calmly, Dr. Maiuro says.

Think positive. If you find you're having negative thoughts like, "This is going to be a horrible day," try replacing that thought with positive thoughts, says Dennis Gersten, M.D., a San Diego psychiatrist and publisher of Atlantis: The Imagery Newsletter. "If you wake up in a bad mood, then close your eyes for a moment and visualize the day going smoothly and successfully," he says. "Use positive self-talk like 'I wonder what kinds of challenges today will offer me?' 'I wonder what I will learn today?' Repeating positive mood words such as 'connect,' 'go for it' and 'succeed' over and over again in your mind also may help your irritability fade."