Disruptive mood dysregulation disorder (DMDD) is a psychiatric disorder observed in children and adolescents. Let us take a closer look at this condition and understand how parents may manage and treat it effectively.
- What Is Disruptive Mood Dysregulation Disorder?
- Understanding Disruptive Mood Dysregulation Disorder
- DMDD vs. Bipolar Disorder
- Signs And Symptoms Of Disruptive Mood Dysregulation Disorder
- Causes Of Disruptive Mood Dysregulation Disorder
- Diagnosis Of Disruptive Mood Dysregulation Disorder
- Treatment Of Disruptive Mood Dysregulation Disorder
- Coping Strategies For Parents And Caregivers
- Seek professional help
- DMDD At A Glance
What Is Disruptive Mood Dysregulation Disorder?
Disruptive mood dysregulation disorder (DMDD) is a mental condition in children. It is characterized by intense irritability, persistent anger and frequent, extreme temper outbursts. These severe reactions are more than just temper tantrums and are usually disproportionate to the current situation. The symptoms of DMDD are more severe than a simple “bad mood.” Children and adolescents suffering from this condition may experience extreme impairment which may necessitate medical attention.
It is a relatively new diagnosis that was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. According to the DSM-5, DMDD is classified as a form of depressive disorder diagnosis for young individuals. It is a mood disorder which makes it difficult for children to regulate and manage their emotions in an appropriate way. With proper diagnosis and effective treatment, affected children and adolescents can learn emotion-regulation skills and successfully overcome the condition. However, patients may develop anxiety and depression in adulthood, if left untreated.
Understanding Disruptive Mood Dysregulation Disorder
Most children appear irritable and exhibit temper tantrums from time to time. However, when their irritability is beyond normal expected levels for their developmental age, then it may indicate DMDD. The American Psychiatric Association explains “Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.” Individuals with this condition can have trouble managing, processing & responding to adverse social experiences and negative emotional stimuli in their daily lives. One 2016 study 1 shows that DMDD at age 6 can lead to severe functional impairment, problems with peer functioning as well as educational support service by the age of 9. This may happen even after managing all mental disorders when they were 6 years old.
The symptoms of Disruptive mood dysregulation disorder can be severe. The National Institute of Mental Health (NIMH) explains that “Youth who have DMDD experience significant problems at home, at school, and often with peers. They also tend to have high rates of health care service use, hospitalization, and school suspension, and they are more likely to develop other mood disorders.” Research shows that DMDD affects 2-5% of children with most of them being boys. One 2013 study 2 has found that among 3,200 children of 2-17 years of age, about 0.8-3.3% of the children met the DMDD criteria. However, the condition is more prevalent among children than teens.
According to the DSM-5, children diagnosed with this condition show constant irritability and extreme behavioral outbursts at least 3 times each week for a period of over 1 year. Moreover, the children may experience persistent negative moods during the period between the outburst and may appear sad or angry. According to the American Psychiatric Association, the symptoms of the condition may be observed every day by parents, teachers, or peers. The negative mood and tantrums are observed in 2 or more separate situations. The DSM-5 states that the onset of the condition must be before the age of 10 to be diagnosed with DMDD. Moreover, the child must not be diagnosed with this disorder before they are at least 6 years old. However, this condition is usually not diagnosed after the age of 18 years.
DMDD vs. Bipolar Disorder
The symptoms of DMDD are similar to childhood bipolar disorder, anxiety disorders, oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). The new diagnosis for DMDD was created so that children affected by disruptive mood dysregulation disorder could be diagnosed accurately. Earlier, children were often overly misdiagnosed with pediatric bipolar disorder by psychiatrists and psychologists, even if they did not experience hypomania or episodic mania observed in bipolar disorder. A 2016 study 3 reveals that “The chronic, severe, nonepisodic irritability seen in patients with DMDD contrasts with the characteristic episodic mood swing symptoms of bipolar disorder.”
Although irritability is present in both bipolar disorder and DMDD, individuals suffering from DMDD experience persistent anger and irritability even when they are not engaging in tantrums or outbursts. Persistent bad mood is common for DMDD, while if their mood seems out of the ordinary, then a bipolar disorder diagnosis may be needed. Moreover, the persistent bad mood in DMDD doesn’t break for more than 3 consecutive months during the initial 12 months. There is also no more than 1 day of the inflated or expansive mood characteristics of hypomania or mania.
However, distinguishing between DMDD and bipolar may not be so simple or straightforward. This is why it is crucial to seek professional help for an accurate diagnosis.
Read More About Bipolar Disorder Here
Signs And Symptoms Of Disruptive Mood Dysregulation Disorder
Being a depressive disorder, substantial impairment in mood, specifically in the form of irritability and anger, can be clearly observed by others. Parents may also feel that their children are experiencing big and difficult emotions. Children suffering from this condition may experience situations and incidents more powerful than other children. They may also lack any self-regulation skills appropriate for their age to control such feelings.
According to the NIMH, children or adolescents with DMDD may experience the following:
- Frequent display of tantrums and outbursts that are not age-appropriate and are out of proportion to the situation.
- Intense verbal (yelling, screaming) or behavioral (physical aggression) temper outbursts for at least 3 times per week, on average.
- Persistent angry or irritable mood between tantrums, most of the time, almost every day.
- Irritability causing difficulty in functioning in more than one aspect of life, such as school, home or in a social setting.
If a child displays these symptoms constantly for over a period of 12 months or more, then they may be diagnosed with DMDD. The NIMH explains that “over time, as children grow and develop, the symptoms of DMDD may change… For these reasons, treatment may change over time, too.” Affected children may find it difficult to adjust in school or may have trouble establishing healthy relationships with their peers or family members. Moreover, they may also find it hard to socialize and refrain from participating in group activities or team sports. This is why proper diagnosis and treatment is essential for children with DMDD.
Causes Of Disruptive Mood Dysregulation Disorder
The exact causes of disruptive mood dysregulation disorder are unknown. However, it is believed that a number of factors may contribute to the development of this condition. Common contributing factors may include negative childhood experiences, genetics, co-occurring mental conditions and temperament. Research 4 shows that the condition usually develops during early childhood. Moreover, it may also occur with some other mental health conditions, like–
- Oppositional defiant disorder
- Depressive disorders
- Attention deficit hyperactivity disorder
- Anxiety disorders
Read More About Anxiety Here
One of the most common risk factors for the onset of DMDD is the temperament of a child. Generally, children with this disorder may exhibit the following temperamental vulnerabilities 5 :
- Difficult behavior
Here some of the other common risk factors related to the development of DMDD:
- Poor parental support
- Family conflicts
- Parental hostility
- Substance use
- Disciplinary problems at school
Read More About Family Here
As genetics is one of the most prominent contributing factors, a child may develop the disorder if a family member is suffering from a psychiatric condition.
Diagnosis Of Disruptive Mood Dysregulation Disorder
According to the DSM-5, the diagnosis of disruptive mood dysregulation disorder necessitates persistent, severe, frequent and out of proportion temper outbursts. The diagnostic criteria 6 for DMDD are similar to that of severe mood dysregulation (SMD).
The criteria for DMDD involves the following:
- Recurrent and severe temper outbursts 6 (verbally and/or behaviorally) at least 3 times a week or more. It should be inappropriate in duration and intensity to the situation. The outbursts must also be “inconsistent with the developmental level.”
- Persistently angry or irritable mood between temper outbursts present throughout the day and is observed by others almost everyday.
- There can be no symptom-free period for more than 3 consecutive months and all the symptoms mentioned above must be experienced during a period of 12 months or more
- The behaviors and symptoms must be experienced in multiple settings. It should be present in an extreme degree in at least one setting.
- The first diagnosis should not be made before the child is 6 years old or after 18 years of age. Onset should be before the age of 10.
The are certain exclusions in the criteria for this condition including:
- The behaviors must not be present “exclusively during an episode of major depressive disorder.”
- The symptoms should not be better explained by any other psychiatric disorder, like separation anxiety disorder, posttraumatic stress disorder, dysthymia/persistent depressive disorder or autism spectrum disorder
- Disruptive mood dysregulation disorder should not coexist or co-occur with bipolar disorder, oppositional defiant disorder (ODD) or intermittent explosive disorder
Apart from these, the medical professional may also conduct certain tests and exams to rule out other factors, like developmental disability or the effects of substance abuse. “If you think your child may be experiencing symptoms of DMDD, talk to your child’s health care provider,” suggests the NIMH. It adds “You also can ask your health care provider for a referral to a mental health professional who has experience working with children and adolescents.”
A medical doctor or psychologist will diagnose only after an assessment is done, which may involve meeting the child, observing them, asking them questions about the condition and interviewing the primary caregivers. The doctor may also interview other caregivers, teachers and may even visit the school for an effective assessment.
Treatment Of Disruptive Mood Dysregulation Disorder
As DMDD is a new diagnosis, not a lot of research has been conducted to determine the best treatment option available for this condition. According to NIMH, treatment for DMDD is usually based on treatment methods that have proven helpful for other disorders (like anxiety and ADHD) with similar symptoms, such as temper tantrums and irritability. Fortunately, most of these treatment options work effectively on DMDD patients. “It is important for parents or caregivers to work closely with their child’s doctor to make treatment decisions that are best for their child,” explains NIMH.
Currently, researchers believe these 2 major treatment methods help in successfully treating DMDD symptoms:
- Psychological treatments
Psychological treatments are considered as the first-line of treatment for this condition. However, medication may be prescribed later by the doctor to speed up the recovery process. The doctor may also recommend a combination of both psychological treatments and medications right from the start. Hence, it is crucial that primary caregivers or parents work closely with their doctor to make the best treatment decisions for the affected child, suggests NIMH.
1. Psychological treatments
Various types of psychological treatments 7 may be utilized for treating a child suffering from this disorder, such as:
- Parent training
- Computer based training
Let us take a look at each of these psychological treatment options:
The most common type of psychotherapy used for treating DMDD in children and teens is cognitive-behavioral therapy (CBT) 8 . It enables children to learn how to cope with difficult thoughts and emotions that may result in feelings of anxiety or depression. CBT is also helpful in teaching various coping skills for effectively regulating mood, managing anger, and improving tolerance for frustration. It can also help to identify and change unhealthy perceptions that lead to outbursts.
Apart from CBT, dialectical behavior therapy for children (DBT-C) can also be used in the treatment of DMDD. It can teach children how to avoid prolonged, extreme outbursts and regulate moods & emotions. One 2011 study 9 found that during the DBT-C post-treatment phase, “children reported a significant increase in adaptive coping skills and significant decreases in depressive symptoms, suicidal ideation and problematic internalising behaviours.” Dialectical behavioral therapy for children can also help sufferers become more mindful and develop skills to become more tolerant towards frustration.
Read More About Cognitive Behavioral Therapy (CBT) Here
B. Parent training
This involves teaching parents certain strategies for effectively responding to the temper outbursts of the affected child. Parents can learn skills that help them to effectively communicate with the child and strengthen the parent-child relationship. Moreover, it also teaches how to reduce irritable behavior and aggression, avoid supporting unpleasant behavior, reward positive behavior and calm the child.
A 2016 study 10 states “Evidence-based parent training interventions and other psychotherapeutic interventions should always be considered in the treatment of DMDD, given the high degree of overlap with ODD and the established efficacy of these treatments for reducing oppositional behaviors.” Parent training can help caregivers spend more quality time & be consistent with the child and manage the child’s behavior better.
C. Computer-based training
Currently, new treatment methods are being researched to understand how mobile and computer-based platforms may improve certain symptoms of DMDD in children, according to NIMH. It is believed that irritable children and adolescents with DMDD are more likely to to misperceive ambiguous facial expressions. The NIMH explains “There is preliminary evidence that computer-based training designed to correct this problem may help youth with DMDD or severe irritability.”
Presently, there is no specific medication for the treatment of disruptive mood dysregulation disorder in children or adolescents that has been approved by the U.S. Food and Drug Administration (FDA). As more research is required to understand what type of medication can be effective for treating DMDD, medical professionals may prescribe stimulants, antidepressants, atypical antipsychotics or mood stabilizers for treating the symptoms of DMDD. However, the NIMH warns that “All medications have side effects and the need for continuing them should be reviewed frequently with your child’s doctor.”
Stimulants are generally used for the treatment of ADHD. Research shows that stimulant medications can substantially help in reducing irritability in children. However, it should not be prescribed to individuals with severe heart problems.
This type of medication can help to treat mood problems and irritability in children with DMDD. According to NIMH, antidepressants, like citalopram, can be effective for this condition but it may lead to suicidal thoughts in children. Hence, it is crucial that parents closely monitor the child taking such medications.
Read More About Antidepressants Here
C. Atypical antipsychotic
These medications may be prescribed to children and teens with intense irritability, severe temper outbursts and aggression. Atypical antipsychotic medications, like aripiprazole and risperidone, have been approved by the FDA “for the treatment of irritability associated with autism and are sometimes used to treat DMDD,” adds NIMH. However, there may be some serious side effects, like weight gain, hormone changes, movement disorders, sedation and suicidal tendencies. This is why these medications are only used when other treatment options have proved ineffective.
Coping Strategies For Parents And Caregivers
Parents and caregivers of children with disruptive mood dysregulation disorder can often feel stressed, anxious and overwhelmed. Learning to cope with DMDD can enable parents to overcome challenges and help their child to function properly at school and home. Moreover, it can also allow primary caregivers to deal with severe temper outbursts of children.
Here are some effective coping strategies that may help parents to deal with their child’s condition better:
1. Learn about the condition
Do some research about DMDD online and talk to a medical professional or a mental health expert to know about the disorder. Find out about the risk factors, treatment options and prognosis of the condition. This will enable you to be better prepared to cope with your child’s symptoms.
2. Identify the triggers
Figure out exactly what triggers your child leading to temper outbursts. Observe in what kind of situations or settings they may throw a tantrum. Once you recognize the triggers, you will be better able to plan for future episodes by either controlling the situation or removing the affected child away from the trigger.
3. Talk to others
It can be a good idea to speak with a counselor, teachers, the school psychologist and even with your child’s peers to know exactly how your child behaves and what results in such undesirable behavior. Moreover, talking with other caretakers can help you figure out better plans and strategies to properly accommodate your child and help them thrive at home and in school.
4. Make sure your child is safe
If the child is likely to become suddenly aggressive or physically act out at unexpected times, then you need to take preventive measures to keep the child safe. Keep away any sharp or potentially dangerous items away from their reach. Moreover, you can also make sure that your home is child-proof and secure for them.
5. Teach your child valuable coping skills
You can teach your child simple coping strategies like deep breathing, reciting affirmations or verbal reminders or singing songs when they become frustrated or angry.
6. Motivate them to behave positively
Parents and caregivers should encourage children with DMDD. Make sure to reward positive and appropriate behaviors with praise, encouragement, attention and even privileges. Often misbehavior can be an attempt to gain attention from parents. But when you notice and reward good behavior, you can break the cycle.
7. Practice self-care
To make sure that you are able to take the best care for your child with DMDD, you need to take care of yourself first. Make sure you take good care of your physical and mental health by getting enough sleep, nutritious food and exercise. Moreover, it is also important that you take steps to reduce your stress and anxiety. The NIMH adds “manage your own stress to avoid the risk of negative health effects.”
Seek professional help
Parents and caregivers with children suffering from disruptive mood dysregulation disorder must get professional support and see a doctor or a mental health specialist, like a psychiatrist, psychologist or therapist. You may also seek additional support from various mental health associations as well. It is also important that you regularly communicate with your child’s doctor to understand how better you can help them recover effectively.
DMDD is a challenging disorder that can be hard to identify and diagnose. Moreover, it can lead to serious problems in different aspects of the child’s life. If left untreated, it may also result in anxiety and depression in their adulthood affecting their ability to function in daily life. Although it can be difficult to deal with temper outbursts, you need to seek immediate treatment, if you think your child may have this disorder.
DMDD At A Glance
- Disruptive mood dysregulation disorder (DMDD) is a mental condition in children.
- It is a mood disorder which makes it difficult for children to regulate and manage their emotions in an appropriate way.It is a mood disorder which makes it difficult for children to regulate and manage their emotions in an appropriate way.
- The condition usually develops during early childhood.
- One of the most common risk factors for the onset of DMDD is the temperament of a child.
- Psychological treatments are considered as the first-line of treatment for this condition.
- Medication may be prescribed later by the doctor to speed up the recovery.
- Dougherty, L. R., Smith, V. C., Bufferd, S. J., Kessel, E. M., Carlson, G. A., & Klein, D. N. (2016). Disruptive mood dysregulation disorder at the age of 6 years and clinical and functional outcomes 3 years later. Psychological medicine, 46(5), 1103–1114. https://doi.org/10.1017/S0033291715002809
- Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. The American journal of psychiatry, 170(2), 173–179. https://doi.org/10.1176/appi.ajp.2012.12010132
- Noller, Diana T. MSPT, MMS, PA-C Distinguishing disruptive mood dysregulation disorder from pediatric bipolar disorder, Journal of the American Academy of Physician Assistants: June 2016 – Volume 29 – Issue 6 – p 25-28 doi: 10.1097/01.JAA.0000483092.35899.a7
- Copeland WE, Angold A, Costello EJ, Egger H. Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. Am J Psychiatry. 2013 Feb;170(2):173-9. doi: 10.1176/appi.ajp.2012.12010132. PMID: 23377638; PMCID: PMC3573525.
- Dougherty LR, Smith VC, Bufferd SJ, Carlson GA, Stringaris A, Leibenluft E, Klein DN. DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children. Psychol Med. 2014 Aug;44(11):2339-50. doi: 10.1017/S0033291713003115. Epub 2014 Jan 21. PMID: 24443797; PMCID: PMC4480202.
- Rao U. (2014). DSM-5: disruptive mood dysregulation disorder. Asian journal of psychiatry, 11, 119–123. https://doi.org/10.1016/j.ajp.2014.03.002
- Kircanski, K., Clayton, M. E., Leibenluft, E., & Brotman, M. A. (2018). Psychosocial Treatment of Irritability in Youth. Current treatment options in psychiatry, 5(1), 129–140. https://doi.org/10.1007/s40501-018-0141-5
- Tudor, M. E., Ibrahim, K., Bertschinger, E., Piasecka, J., & Sukhodolsky, D. G. (2016). Cognitive-Behavioral Therapy for a 9-Year-Old Girl With Disruptive Mood Dysregulation Disorder. Clinical case studies, 15(6), 459–475. https://doi.org/10.1177/1534650116669431
- Perepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas-Palumberi, H., & Miller, A. L. (2011). Adapting Dialectical Behaviour Therapy for Children: Towards a New Research Agenda for Paediatric Suicidal and Non-Suicidal Self-Injurious Behaviours. Child and adolescent mental health, 16(2), 116–121. https://doi.org/10.1111/j.1475-3588.2010.00583.x
- Baweja, R., Mayes, S. D., Hameed, U., & Waxmonsky, J. G. (2016). Disruptive mood dysregulation disorder: current insights. Neuropsychiatric disease and treatment, 12, 2115–2124. https://doi.org/10.2147/NDT.S100312