Mental Health Guide

Disruptive Mood Dysregulation Disorder

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What is it?

Disruptive mood dysregulation disorder (DMDD)  is a condition in which a child is chronically irritable and experiences frequent, severe temper outbursts that seem grossly out of proportion to the situation at hand. DMDD is a new disorder created to more accurately categorize some children who had previously been diagnosed with pediatric bipolar disorder. These children do not experience the episodic mania or hypomania characteristic of bipolar disorder, and they do not typically develop adult bipolar disorder, although they are at elevated risk for depression and anxiety as adults. Unlike pediatric bipolar disorder, DMDD is thought to occur more often in boys than girls.

What to look for

Disruptive mood dysregulation disorder is characterized by temper outbursts that are frequent, severe, inconsistent with the situation at hand, and inconsistent with a child's developmental level. But key to the disorder is not just the pattern of a child's outbursts, but his mood between outbursts. If he is persistently irritable or angry, that is a sign that he may have DMDD. This irritable or angry mood should be observable by parents, teachers and peers. That is, strained interactions only between a child and his parents, or the child and his teacher, are not a sign of DMDD.

Risk Factors

Children with a history of chronic irritability are more likely to be diagnosed with disruptive mood dysregulation disorder.

Diagnosis

A clinician considering disruptive mood dysregulation disorder would looking for severe temper outbursts that occur, on average, three or more times per week. In addition, the child's mood between outbursts must be consistently and observably angry or irritable. For diagnosis of DMDD to take place, a child must experience this pattern of frequent outbursts, plus consistent anger or irritability between outbursts, for 12 or more months. During this 12-month period, the child must show symptoms consistently, meaning that he does not experience a break of three or more months without symptoms of DMDD. Outbursts, or elevated or expansive moods that last for longer than a few hours or for days on end, are more likely to be signs of mania, which would rule out DMDD.The diagnosis of DMDD should not be made before age 6 or after age 18, and the onset of symptoms typically takes place before age 10.

Treatment

Medication, psychotherapy and a combination of the two are used as treatments for disruptive mood dysregulation disorder. Because the diagnosis is a new one, clinicians are still researching which treatments work best. Stimulant medication, antidepressant medication like SSRIs, and a kind of therapy known as applied behavior analysis have all been used. Parents should work closely with the doctor to learn what works best for their child. Parents and other caregivers should also be taught specific strategies they can use when responding to a child's disruptive behavior. 

Other disorders to look out for

The diagnostic criteria for disruptive mood dysregulation disorder  are meant to separate children who have chronic trouble regulating their moods from children who are afflicted with other mental disorders that may also express themselves in intermittent outbursts, irritability and anger, including bipolar disorder, autism, intermittent explosive disorder, or oppositional defiant disorder. But DMDD can occur alongside ADHD, major depressive disorder, conduct disorder, an anxiety disorder, or substance use disorder.

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