Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive Mood Dysregulation Disorder (DMDD) is a condition where a child is always irritable and has frequent, strong temper outbursts that seem way too big for the situation. Children with DMDD cannot control their emotions like other kids their age.

DMDD is a new disorder created to better categorize some children who were previously diagnosed with pediatric Bipolar Disorder. For children with DMDD, their behavior is steady and not in episodes, like in Bipolar Disorder.

What are the symptoms of DMDD?

Specific DMDD symptoms are as follows:

Core Symptoms

– Severe verbal and/or behavioral temper outbursts (e.g., yelling, physical aggression) that are too much for the situation

– The outbursts are not typical for kids their age

– The outbursts happen three or more times per week

– The child’s mood between outbursts is persistently irritable or angry most of the day

How is DMDD diagnosed?

A child-adolescent psychiatrist will diagnose a child with DMDD after checking if the symptoms they have meet the requirements, are happening often enough, and are causing problems in everyday life (e.g., social, academic, etc.).

The psychiatrist may interview and/or assess both the child and a caregiver to figure out the specifics of the child’s verbal and/or behavioral symptoms. Many practitioners also use behavior and emotion rating forms to help with the diagnosis. The practitioner will also try to determine that the child’s symptoms are not related to something unexpected.

A child-adolescent psychiatrist will diagnose a child with DMDD after checking if the symptoms they have meet the requirements, are happening often enough, and are causing problems in everyday life (e.g., social, academic, etc.).

The psychiatrist may interview and/or assess both the child and a caregiver to figure out the specifics of the child’s verbal and/or behavioral symptoms. Many practitioners also use behavior and emotion rating forms to help with the diagnosis. The practitioner will also try to determine that the child’s symptoms are not related to something unexpected.

DMDD facts

Worldwide frequency of the condition:
It is estimated that DMDD affects between 0.08% and 3.3% of the global population. Currently, there is no representative national data in Brazil.

Gender ratio:
Available data indicate that boys are diagnosed with DMDD at a ratio of 3 to 1 compared to girls.

Peak age of onset:
Most diagnoses of DMDD occur in the preschool age group, this being the most frequent period of onset.

Proportion of the condition that emerges before age 18:
DMDD must necessarily begin before age 10. Therefore, 100% of people with DMDD are diagnosed before age 18.

What are the associated factors for DMDD?

Some common factors linked with DMDD are:

– Genetic and familial factors: Most likely a combination of multiple genes interacting with environmental factors.

– Environmental factors: These include stressful life events, such as childhood neglect or abuse, and caregivers with mental health problems.

What other disorders co-occur with DMDD?

Co-occurrence rates for DMDD are high, and DMDD is rarely diagnosed alone. Children and teens with DMDD might typically have a wide range of disruptive behavior, mood, anxiety, and ASD-related symptoms or diagnoses.

How is DMDD treated?

The goal in DMDD treatment is to help children or teens learn to control their emotions and stop having temper tantrums. Treatment involves psychotherapy and sometimes medication. Because DMDD is a relatively new condition, most of the evidence that supports its treatment comes from conditions that occur with it such as anxiety and depression.

A type of psychotherapy called Cognitive-behavioral therapy (CBT) is commonly used to help kids and teens better control their mood. This therapy also teaches coping skills and ways to re-think the ideas that contribute to outbursts.

Parent Training is also often used to help parents interact with a child in a way that will reduce irritable behavior and improve family relationships.

When therapy is not an option or when therapy alone is not working, medication to help the child control their emotions is sometimes given, especially when irritability happens with other symptoms. Antidepressants (e.g., escitalopram being the most studied for this condition), stimulants (e.g., methylphenidate), and atypical antipsychotics (e.g., aripiprazole, risperidone) are the most common medications used for DMDD. Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or teen taking one of these medications should see their child-adolescent psychiatrist regularly, especially if their dosage has recently changed.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Brænden, A., Zeiner, P., Coldevin, M., Stubberud, J., & Melinder, A. (2022). Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria. JCPP Advances, 2(1). _https://doi.org/10.1002/jcv2.12060_

– Child Mind Institute. (2021, September 7). Quick guide to disruptive mood dysregulation disorder. _https://childmind.org/guide/disruptive-mood-dysregulation-disorder-a-quick-guide/_

– Miller, C. (2022, July 14). DMDD: Extreme tantrums and irritability. _https://childmind.org/article/dmdd-extreme-tantrums-irritability/_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. American Journal of Psychiatry, 170(2), 173–179. _https://doi.org/10.1176/appi.ajp.2012.12010132_

– Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145(4), 390–409. _https://doi.org/10.1037/bul0000183_

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington. Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. _https://doi.org/10.1038/s41380-021-01161-7_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. _https://doi.org/10.1038/mp.2013.50_

– Munhoz, T. N., Santos, I. S., Barros, A. J. D., Anselmi, L., Barros, F. C., & Matijasevich, A. (2017). Perinatal and postnatal risk factors for disruptive mood dysregulation disorder at age 11: 2004 Pelotas Birth Cohort Study. Journal of Affective Disorders, 215, 263–268. _https://doi.org/10.1016/j.jad.2017.03.040_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Brænden, A., Zeiner, P., Coldevin, M., Stubberud, J., & Melinder, A. (2022). Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria. JCPP Advances, 2(1). _https://doi.org/10.1002/jcv2.12060_

– Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. American Journal of Psychiatry, 170(2), 173–179. _https://doi.org/10.1176/appi.ajp.2012.12010132_

Interventions

– Breaux, R., Baweja, R., Eadeh, H. M., et al. (2022). Systematic review and meta-analysis: Pharmacological and non-pharmacological interventions for persistent non-episodic irritability. Journal of the American Academy of Child & Adolescent Psychiatry. Published online June 2022: S0890856722003033. _https://doi.org/10.1016/j.jaac.2022.05.012_

– Epstein, R. A., Fonnesbeck, C., Potter, S., Rizzone, K. H., & McPheeters, M. (2015). Psychosocial interventions for child disruptive behaviors: A meta-analysis. Pediatrics, 136(5), 947-960. _https://doi.org/10.1542/peds.2015-2577_

– National Institute of Mental Health, U.S. Department of Health and Human Services. Disruptive Mood Dysregulation Disorder: The Basics (NIH Publication No. 20-MH-8119). National Institute of Mental Health. _https://www.nimh.nih.gov/health/publications/disruptive-mood-dysregulation-disorder_

– Tourian, L., LeBoeuf, A., Breton, J.-J., Cohen, D., Gignac, M., Labelle, R., Guile, J.-M., & Renaud, J. (2015). Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder. Journal of Child and Adolescent Psychopharmacology, 25(7), 547-556. _https://doi.org/10.1089/cap.2015.0043_