Disruptive Mood Dysregulation Disorder (DMDD) is a childhood condition characterized by extreme irritability and anger, along with frequent, intense temper outbursts. This is a relatively new diagnosis introduced in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was published in 2013.
Prior to the DMDD diagnosis, many children with these symptoms (irritability and anger) were being misdiagnosed as having bipolar disorder. Follow-up research showed that these children often grew up without developing the manic or hypomanic episodes that are essential for a diagnosis of bipolar disorder. In other words, these children who were diagnosed as having bipolar disorder did not, in fact, have it. The DMDD diagnosis is useful for getting such children the psychiatric and psychological treatment they need without over-diagnosing bipolar disorder and, perhaps, without treating these children with powerful pharmaceuticals that could do more harm than good.
Symptoms of Disruptive Mood Dysregulation Disorder
The diagnosis of DMDD is age-dependent. Children between the ages of six and 18 years old may receive the diagnosis, and symptoms typically appear before the age of 10. Symptoms include the following and must be present nearly every day for at least one year straight:
- Irritability or anger most of the day nearly every day
- Severe temper tantrums (verbal or non-verbal) three or more times per week that are inappropriate for the situation and the child’s development level
- Trouble functioning due to irritability in more than one setting; for example, at home, at school, and with peers
Treating Children with Disruptive Mood Dysregulation Disorder
There is no single treatment protocol specifically for DMDD. Treatment often involves a combination of therapies and, in some cases, medications that have proven to be helpful in treating other disorders that have similar symptoms, including the following:
- Attention deficit hyperactivity disorder (ADHD)
- Oppositional defiant disorder (ODD)
Early intervention is one of the keys to improving outcomes, so if a child exhibits the symptoms of DMDD, we encourage you to schedule an evaluation as soon as possible. Left untreated, DMDD can negatively impact the child’s quality of life, school performance, and relationships with family members, teachers, and peers. Untreated DMDD also increases the risk of developing depression or anxiety later in life.
Treatments include the following, with non-medication interventions first followed by the addition of medication only if necessary:
- Therapies & training: The first-line treatment for DMDD typically includes one or more of the following therapies:
- Individual psychotherapy: One-on-one therapy between therapist and child can help the child develop the thought processes and skills necessary to manage their frustration and anger and communicate in healthier, more productive ways.
- Parent training: This type of training helps parents develop parenting skills that are more positive and consistent and result in less frustration for both parents and child. Parent training may include Parent-child interaction therapy (PCIT), which involves a therapist coaching the parents during interactions with their child.
- Family therapy: Family therapy can help to identify and address unhealthy family dynamics, improve relationships among family members, and help the family develop healthier communication and problem-solving skills, so that they can work together as a team.
- Cognitive-behavioral therapy (CBT): This therapy helps the child identify and modify thought patterns that result in behavioral problems. Teaching the child how to think more positively and productively leads to positive, productive decisions and behaviors.
- Social skills training: This type of therapy helps the child develop ways to interact more positively and effectively with his or her peers.
- Computer-based training: Some evidence suggests that the irritability characteristic of DMDD may be related to the child’s misperceiving ambiguous facial expressions as angry or threatening. Computer-based training can help a child interpret various facial expressions more accurately.
- Medications: While no medications are recommended specifically to treat DMDD, they may be used to treat other related conditions or specific symptoms. Medications sometimes used in relation to DMDD include the following:
- Stimulants: Stimulants are commonly used to treat ADHD by calming the child’s restlessness and improving the ability to concentrate.
- Antidepressants: An antidepressant may be helpful in treating depressed mood that may be at the root of a child’s irritability. However, many antidepressants carry a “black box warning” to alert patients, parents, and doctors that the medication carries an increased risk of triggering suicidal thoughts.
- Atypical antipsychotics: Atypical antipsychotics may be prescribed in extreme cases, when a child has severe temper outbursts that involve physical aggression toward people or property. However, this class of medications has the potential to cause serious side effects, including suicidal thoughts, weight gain, sedation, movement disorders, and hormonal changes.