Disruptive mood dysregulation disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. DMDD symptoms go beyond a being a “moody” child—children with DMDD experience severe impairment that requires clinical attention.
a new diagnosis in children 18 years or younger with persistent irritability and an average of at least three episodes per week of extreme behavioral dyscontrol (e.g., severe rages). It has been established as an alternative to the diagnosis of bipolar disorder in children.
A father with a nine-year-old girl we will call Betsy went for evaluation for severe anxiety. The father described a situation in which Betsy. Although a very bright child from an upper middle class family who had done well in school, was continually irritable and increasingly unable to get along at home, engaging in intense arguments, particularly with her mother, at the slightest provocation.
Her mood would then deteriorate into a full-blown aggressive temper tantrum and she would run to her room and on occasion begin throwing things. She began refusing to eat meals with the family, since bitter arguments would often arise and it just became easier to allow her to eat in her room.
Since nothing else seemed to work to calm her down, her father resorted to something he used to do when she was a baby, take her for a long ride in the family car. After a while Betsy would begin to relax but during one long ride turned to her father and said “Daddy, please help me feel better because if I keep feeling like this I just want to die”.
Diagnostic Criteria for Disruptive Mood Dysregulation Disorder.
A. Severe recurrent temper outburst manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A-E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, met a manic or hypomanic episode.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.
Trauma in early childhood (such as emotional, physical, or sexual abuse) can lead to the development of disruptive mood dysregulation disorder in children and adolescents. Other possible environmental causes and risk factors associated with DMDD include: Recent family divorce, death, or relocation.
They are likely caused by an imbalance of brain chemicals. Life events (such as stressful life changes) may also contribute to a depressed mood. Mood disorders also tend to run in families. Family history of anxiety, depressive, or substance use disorders. Possessing a history of having an irritable temperament before the age of 10.
A very important objective for the immediate future will be developing and evaluating treatments for this difficult condition both psychological and drug. For example, it is very possible that new psychological treatments under development for severe emotional dysregulation in children may be useful with this condition.