An Overview of Disruptive Mood Dysregulation Disorder (DMDD)

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Disruptive mood dysregulation disorder (DMDD) is a childhood condition that is characterized by severe anger, irritability, and frequent temper outbursts. While temper tantrums tend to be quite common in kids, DMDD is more than just normal childhood moodiness. The angry outbursts that kids experience are extreme, intense, and can lead to significant disruption in many areas of a child's life. 

This condition is a fairly new diagnosis, first appearing in the 2013 edition of the Diagnostic and Statistical Manual (DSM-5). This condition was added to the DSM-5 to help address concerns about possible over-diagnosis and treatment of bipolar disorder in children. 

Some controversy exists about the addition of this condition, however, due to the lack of empirical data on DMDD. 

Symptoms 

In order to be diagnosed with disruptive mood dysregulation disorder, a child must be between the ages of six and 18. The age of onset must occur before age 10.

The symptoms of DMDD include:

  • Severe, recurrent temper tantrums. Such outbursts can involve yelling, pushing, hitting, or destruction of property.
  • Outbursts occurring three or more times a week. A child may still be diagnosed with DMDD, however, if they only have don’t always have this many outbursts a week. Kids may have more tantrums one week, and fewer the next.
  • Tantrums that are out of proportion to the situation. For example, you might expect a child to get angry when they don’t get a toy they want, but a child with DMDD might act out with physical aggression and verbal outbursts that are excessive and intense.
  • Tantrums that are inappropriate for the child's age level. For example, while you might not be surprised if a very young child has a tantrum that involves falling to the floor crying and screaming, it is not something you would expect from a 12-year-old.
  • Irritable and angry moods between tantrums. In between bouts of intense emotional outbursts, kids with DMDD have moods that are consistently angry and extremely irritable. Such moods are present most of the time and are noticed by others.
  • Symptoms happen in multiple settings. This means that temper outbursts don’t just occur in a single setting, such as at school. DMDD is characterized by having such tantrums having tantrums in at least two settings such as at school, at home, or with peers.

In addition to the above criteria, these symptoms must be present for at least 12 months with symptom-free periods of no more than three consecutive months. In addition to meeting these criteria, psychiatrists will also rule out other causes such as substance use and developmental disability.

How Common Is DMDD?

Because this condition is so new, there is not a great deal of data available on prevalence rates. The results of one study suggest that between 0.8% and 3.3% of more than 3,200 participants between the ages of 2 and 17 met the diagnostic criteria for DMDD over a three-month period.

Causes

The exact causes of DMDD are not clear, although there are a number of factors that are believed to play a role. Such factors may include genetics, temperament, co-occurring mental conditions, and childhood experiences. 

The disorder appears to be more common during early childhood and is likely to co-occur with other psychiatric conditions, most commonly depressive disorders and oppositional defiant disorder.

A child's temperament may be a risk factor for developing DMDD. Some traits that are more commonly seen in kids with this condition include:

  • Moodiness
  • Anxiousness
  • Irritability
  • Difficult behavior

Other risk factors associated with DMDD include

  • Low parental support
  • Parental hostility and substance use
  • Family conflicts
  • Disciplinary problems at school

Diagnosis

If your child is experiencing symptoms of DMDD, you should start by making an appointment with your child's pediatrician. The doctor will evaluate your child and make a diagnosis or refer you to a psychiatrist for further evaluation and treatment.

The first step of diagnosis involves assessing a child's health, ruling out other health conditions, and then evaluating the child's symptoms. A doctor or psychiatrist may also interview the child, parents, other caregivers, and teachers to get a clearer view of a child's behaviors.

While there are no validated scales for assessing DMDD, health professionals may use different questionnaires, assessments, and caregiver ratings to measure irritability and tantrums in children. 

DMDD vs. Bipolar Disorder

During the 1990s, there was a dramatic increase in the diagnosis of bipolar disorder in children. Concerns over the effectiveness and long-term safety of atypical antipsychotics and mood-stabilizing drugs used to treat bipolar disorder in children led to the creation of the diagnosis of disruptive mood dysregulation disorder.

Disruptive mood dysregulation disorder is differentiated from bipolar disorder by chronic irritability. Where bipolar disorder is characterized by episodic changes in mood, children with DMDD have moods that are persistently angry or irritable.

Treatment

Because DMDD is a new diagnosis, there is not a great deal of research on which treatments are the most effective. Treatments are usually based on what has been helpful for conditions that share some of the same symptoms including oppositional defiant disorder and attention deficit hyperactivity disorder (ADHD).

Because the symptoms of DMDD can create such significant impairments in a child's life, it is important that parents obtain treatment for their child as soon as possible. The symptoms of irritability, anger, and outbursts that characterize this condition can damage a child's relationships with classmates and family members. Kids may find it difficult to cope with daily activities and may become depressed or anxious as a result.

There is no specific treatment for disruptive mood dysregulation disorder, but the condition is often treated with psychotherapy, medication, or a combination of both.

Therapy

Psychotherapy is usually considered the front-line treatment and may include cognitive-behavioral therapy (CBT) and parent training. CBT helps kids learn to recognize the thoughts that contribute to feelings of anger and learn new ways of responding to different situations. Therapists may also work with parents to help them learn new ways of responding to their child's anger and outbursts.

Medication

While Mome research is needed to help determine which types of medication may be the most effective for treating this condition, psychiatrists may prescribe stimulants, atypical antipsychotics, or antidepressants to treat symptoms of DMDD. 

Doctors may sometimes avoid treating the condition with stimulants and antidepressants out of fear of worsening symptoms of irritability or inducing symptoms of mania. However, researchers suggest that in children with symptoms that are more similar to ADHD, depression, and anxiety disorders, the risk of experiencing mania is low.

Coping

Coping with disruptive mood dysregulation disorder can present challenges for both children and caregivers. The disorder can make it difficult for kids to function at home and at school, and parents and other adults may find it tough to handle children's intense temper outbursts. 

Some coping strategies that can help:

Understand Your Child's Triggers

If your child is likely to have a tantrum in certain settings or situations, try to have a plan in place. Briefly removing your child from the situation can sometimes help. 

Keep Your Child Safe

If your child is prone to acting out physically, try to keep any potentially dangerous objects out of reach. For example, make sure that all of the furniture in your home is safely secured and keep heavy, sharp, throwable objects out of reach.

Teach Coping Skills

In one case study, a child with DMDD was taught to mentally recite song lyrics whenever she found herself becoming angry. This was also combined with using deep breathing and reciting verbal reminders to help interrupt angry outbursts before they began.

Encourage Positive Behaviors

Reward appropriate behaviors with attention, praise, and privileges. In multi-child households, kids sometimes go unnoticed when they are acting good, but are able to get one-on-one attention when they misbehave. This tends to reinforce misbehavior and discourage good behavior. Break this pattern by making sure that you notice and reward your child's positive actions.

A Word From Verywell

DMDD can be a challenging condition that can result in significant problems in a child’s life. It can also increase a child’s risk of experiencing depression and anxiety as an adult, so it is important to seek treatment if you suspect that your child may have this condition. While these temper outbursts can be upsetting, appropriate treatment can help your child manage such symptoms and improve relationships in school, home, and social settings.

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