Disruptive Mood Dysregulation Disorder (DMDD)
DMDD was introduced in DSM-5. It describes children who have severe recurrent temper outbursts on top of persistent irritable mood. These are not kids who can be sunny and pleasant when things are going well but who blow up when frustrated, redirected, or disappointed. These are kids who are almost never happy, and then are incredibly reactive to negative stimuli.
DMDD: Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation.
- The temper outbursts are inconsistent with developmental level.
- They occur on average 3 or more times weekly.
- Mood between outbursts is persistently irritable or angry most of the day, nearly every day, as observed by others.
The time criteria are complicated, but DMDD emerges between ages 6 and 10 years, and can be initially diagnosed only up to age 18. Emerging between ages 6 and 10 years, it excludes the early temper tantrum years, and cannot have onset after age 10, when adolescent moodiness may emerge. The symptoms must be present for at least a year, and not just at home or just at school but in more than 1 setting.
DMDD arose out of a long controversy about how to treat persistently irritable, explosive kids. Many of these children were diagnosed with "pediatric bipolar disorder" in part because the atypical antipsychotics, which are indicated for bipolar disorder, relieved some of the irritability and explosiveness. Longitudinal studies, however, suggest that these children do not go on to meet criteria for bipolar disorder. Instead, they are more likely to develop depression as adults.
Because it is a relatively new diagnostic classification, epidemiology and treatment are not well established. Best recommendations are to treat comorbidities, most commonly ADHD or depression and refer to behavioral therapy and/or parent management training.
DSM-5 Criteria for Disruptive Mood Dysregulation Disorder
Severe recurrent temper outbursts 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.
The temper outbursts are inconsistent with developmental level.
The temper outbursts occur, on average, three or more times per week.
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).
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.
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.
The diagnosis should not be made for the first time before age 6 years or after age 18 years.
By history or observation, the age at onset of Criteria A–E is before 10 years.
There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
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.
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]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
The symptoms are not attributable to the physiological effects of a substance or another medical or neurological condition.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC