Disruptive mood dysregulation disorder (DMDD) is a pediatric mood disorder marked by chronic irritability and frequent, intense outbursts that are disproportionate to situations. It affects emotional regulation, social interactions, and academic performance.
- DMDD is a childhood mood disorder characterized by chronic irritability and frequent, intense temper outbursts, affecting emotional and social development.
- Diagnosis of DMDD requires a thorough evaluation, distinguishing it from conditions like ADHD and bipolar disorder, with symptoms present before age 10.
- Treatment includes behavioral therapies like CBT and DBT, parental training, and, in some cases, off-label medications to manage symptoms and co-occurring disorders.
.jpg?v=1740466679)
What is disruptive mood dysregulation disorder?
Disruptive mood dysregulation disorder (DMDD) is a psychological condition affecting children. [1] Children with DMDD experience intense frustration and they struggle to manage those feelings in the same way as other children. They will have frequent angry outbursts and may become aggressive or violent. This is distressing for them and the people who care for them.
It was only introduced in the latest version of the Diagnostic and Statistics Manual (DSM-5) which medical practitioners use to define and diagnose different mental health conditions. As a result, it is less well understood than conditions such as autism or ADHD.
Symptoms of DMDD
Children with DMDD show two main symptoms.[2] They are generally very irritable for much of the time and they have frequent, disproportionate outbursts of anger.
Naturally, most children are irritable from time to time and will sometimes become angry. Even temper tantrums are considered normal occasionally. For children with DMDD, however, they happen multiple times per week and are especially severe.
DMDD symptoms are severe and the consequences can be serious. Their mood and outbursts can negatively impact all aspects of their lives and development, including their social skills and academic progress.
Typical vs. Severe irritability
Children vary widely in terms of their emotional responses and moods, especially as they move through adolescence. This can make it difficult to identify the difference between typical irritability and the severe type found in DMDD.
DMS-5 states that outbursts in DMDD must be grossly disproportionate to the situation that led to them and developmentally inappropriate.[3] A 6-year-old screaming with frustration, for example, may be developmentally appropriate. The same behavior would be considered severe in a 15-year-old.
DSM-5 doesn’t define what kinds of behavior count as developmentally inappropriate or disproportionate during an outburst. Doctors, psychologists, and psychiatrists make that decision based on their clinical experience and based on other aspects of a child’s presentation.
Some examples of behaviors during an outburst that are likely to be signs of severe irritability include:[2]
- Self-harm
- Breaking things
- Daily outbursts
- Outbursts that take place in the classroom
- Verbal or physical aggression that impacts others around the child
Other behaviors may be typical if they happen infrequently but a sign of severe irritability if they happen a lot. Outbursts that include physical violence to their peers fall into this category.
Irritable moods that last for an hour or less are considered typical. Those that last longer than a few hours are unusual. Children with DMDD have irritable moods that last for most of the day almost every day.
Diagnosing DMDD
DMDD can be complicated to diagnose, particularly because many children with DMDD also have another disorder such as ADHD.[4][5]
A diagnosis will often be made by a child psychologist or psychiatrist. a diagnostic assessment usually involves an interview with both the child and their parents, additional information from school teachers and others who spend time with the child, and possibly observations of the child.
A structured interview, such as the Children’s Interview for Psychiatric Syndromes, can be used to help doctors and healthcare professionals get the information they need to be sure of their diagnosis.
When diagnosing a child with DMDD, the clinician has two tasks. They need to make sure that the child has the symptoms of DMDD but they must also check that those symptoms aren’t fully explained by another diagnosis, such as bipolar disorder. They will ask about possible episodes of mania or hypomania. These are periods lasting for longer than a day when the child is extremely energetic, upbeat, or excitable. If they find episodes of mania, DMDD cannot be diagnosed, as the child’s presentation is more likely attributed to another medical condition.
What age can you get a diagnosis for DMDD?
Children can’t be diagnosed with DMDD before they are 6 years old. Temper tantrums are very common before this age, meaning that outbursts are developmentally appropriate. A diagnosis of DMDD also can’t be given to anyone over the age of 18. When diagnosing older children, the first symptoms must have been present by the age of 10.
Outbursts must be classed as severe and inappropriate based on the age of the child and the situation. These outbursts must happen more than three times per week and take place in multiple settings such as at home, school, or when playing with friends. All symptoms must have been seen for 12 months.
DMDD vs. ODD
The symptoms of DMDD are very similar to another disorder known as oppositional defiant disorder (ODD). ODD is characterized by a child arguing, having temper tantrums, and refusing to perform tasks for adults.
DMDD and ODD share many symptoms and diagnostic criteria, although ODD also requires at least one defiance symptom, such as a refusal to comply, which DMDD does not.[3] If a child fulfills the criteria for both ODD and DMDD, they are only diagnosed with DMDD because it is the more severe disorder and is thought to lead to any symptoms of ODD.
Causes of DMDD
DMDD is still a relatively new condition, meaning that there is less evidence to explain how it is caused than other, more established, conditions. As with most psychiatric disorders, it is most likely due to a combination of biological, environmental, and genetic factors.
One possible difference in children with DMDD is their response to rewards. Children with DMDD show greater reward-related brain activity than other children, which may encourage them to form strong connections between actions and rewards.[6] This could then cause them to experience greater frustration when rewards don’t occur.[5]
Forming overly strong associations between action and reward can also lead to children repeating previous behaviors in an inflexible way rather than looking for novel solutions to a problem.[7] This can make it harder for them to adapt to changing environments or circumstances, reducing the likelihood that they will achieve their goals and increasing the frequency with which they experience frustration.
Treatment for DMDD
The symptoms of DMDD do typically decrease over time and the condition is only recognized in people under the age of 18. It is still important to seek treatment for DMDD, however, as intense frustration is associated with other mental health concerns in the long term.
Children with high levels of irritability are 1.3 times as likely to develop major depressive disorder (MDD) and 1.7 times as likely to develop generalized anxiety disorder (GAD) in later life.[8] Treatment can help reduce the negative impact DMDD has on their social and academic lives and allow them to form strong, healthy relationships.
Therapy
The most common form of talking therapy for DMDD is cognitive behavioral therapy (CBT). This aims to help children understand the connections between their thoughts, feelings, and actions. They are taught to recognize the signs of frustration and see alternative actions to handle those feelings.
Dialectical behavior therapy (DBT), which is based on CBT, can also be valuable. It was designed to help people deal with intense emotions, making it an effective tool for children with DMDD. Neither CBT nor DBT is trying to stop the children from experiencing feelings of frustration. Instead, they provide tools to manage that frustration.
Treatment for DMDD is most effective when it involves the whole family. While DMDD is not caused by parents, parental training can help parents and caregivers learn new ways to manage outbursts. It will also often emphasize the importance of offering praise for positive behavior.
Medications
No medications are currently approved by the FDA for the treatment of DMDD but some doctors are using them off-label to try to help. These include stimulants (which can increase dopamine in the child’s brain), antidepressants, or atypical antipsychotic medications (which are FDA-approved for treating irritability from autism).[1]
There is relatively little scientific evidence to confirm how effective these medications will be in treating DMDD but they can be useful in treating other conditions, such as ADHD, which commonly co-occur and can make the DMDD symptoms worse.[9]
Can DMDD be prevented?
Parents of children with DMDD can face judgment and stigma, especially among people who think that their child is just ‘naughty’.[10] They may feel as though they should have prevented their child’s condition but this isn’t the case.
DMDD is associated with differences in the way the brain processes information, especially around rewards and it also appears to have a genetic component. Although it is only diagnosed in children six years old and above, the differences can be seen by the time a child is three.[6] Given this evidence, DMDD is not a preventable condition.
Although DMDD itself is not preventable, treatment can mitigate some of the effects. Parents should seek help as soon as they recognize a problem.
Support for parents of children with DMDD
Being a parent of a child with DMDD can be intensely difficult, with feelings of fear, shame, and isolation. If you have more than one child, you may have the added difficulty of trying to balance their needs alongside the needs of the child with DMDD. Feeling blamed or stigmatized can make it difficult to seek help.[10]
Healthcare providers should offer a safe, non-judgmental place for you to seek support and advice. This includes pediatricians, nurses, child psychologists, psychiatrists, and others. Reach out where you can and don’t be afraid to ask questions.
Your child’s school can also be a valuable resource to support you and your child. Because DMDD is a relatively new diagnosis, the exact prevalence is not known but it appears to be up to around 3%. This means that your child won’t be the only student at the school with similar challenges.
Ensure that you prioritize your health and well-being as well as your child’s. Learning to manage your own stress and anxiety can make it easier for you to respond in a calm and focused way during outbursts.
-(1)-guide-detail.jpg?v=1722502701)
-guide-detail.jpg?v=1722503273)