What is Disruptive Mood Dysregulation Disorder?

ByStacy Garcia, MA, LPC, NCC

What is Disruptive Mood Dysregulation Disorder?

Have you heard of DMDD, or disruptive mood dysregulation disorder in children? Unless you work in the mental health field, are a pediatrician, or a parent of a child who struggles with DMDD, it’s quite possible that you haven’t heard of this relatively new diagnosis.

13 Facts About Disruptive Mood Dysregulation Disorder (DMDD)

  1. Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnosis (newly found in the  DSM-5, published in 2013) that describes children who have frequent explosive outbursts that seem grossly out of proportion to the situation and inconsistent with a child’s developmental level; in between the outbursts, these children are chronically irritable. The angry or irritable mood should be observed by parents, teachers, and peers (in more than one place, in other words). So if a child only exhibits such behaviors at home, but not at school, then it’s not DMDD. If a child shows symptoms only at school, but nowhere else, then it’s not DMDD.
  2. The DMDD diagnosis was created to more accurately categorize some children who had previously been diagnosed with pediatric bipolar disorder but do not experience the episodic mania or hypomania symptoms of bipolar disorder, and they don’t typically develop adult bipolar disorder. Years ago, many children were diagnosed with bipolar disorder because there really wasn’t a better descriptor of what was going on with the child, but not all of these kids had true pediatric bipolar disorder.
  3. A clinician considering a DMDD diagnosis for a child would look for severe temper outbursts that occur, on average, three or more times per week. Additionally, the child’s mood between outbursts must be consistently and observably angry or irritable. The child must experience this pattern of frequent outbursts, plus conistent anger or irritability between outbursts, for 12 or more months. During this 12-month period, the child must show symptoms consistently, meaning that he doesn’t experience a break of three or more months without DMDD symptoms.
  4. Outbursts, or elevated or expansive moods that last for longer than a few hours or for days on end, are more likely to be signs of mania, which would rule out disruptive mood dysregulation disorder.
  5. The diagnosis of DMDD cannot be made before age 6 or after age 18. The onset of symptoms typically takes place before age 10.
  6. Parents should work closely with their child’s doctor to learn what works best for their child, but in general, medication or psychological treatments (e.g., psychotherapy, parent training, computer based training) are primarily used to treat DMDD. The National Institute of Mental Health (NIH) recommends that psychological treatments be considered first, with medication added later if necessary, or psychological treatments can be provided with medication from the beginning.
  7. The diagnostic criteria for disruptive mood dysregulation disorder are meant to separate children who have chronic trouble regulating their moods from children who are afflicted with other mental disorders that may also express themselves in intermittent outbursts, irritability and anger, including bipolar disorder, autism, intermittent explosive disorder, or oppositional defiant disorder. But DMDD can occur alongside ADHD, a depressive disorder, conduct disorder, an anxiety disorder, posttraumatic stress disorder (PTSD) or substance use disorder.
  8. Children with DMDD may find it hard to participate in activities or make friends. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his family and peers.
  9. Having DMDD increases the risk of developing depression or anxiety disorders in adulthood.
  10. DMDD has a prevalence of 2%-5% and occurs mostly in boys; bipolar disorder affects boys and girls equally and affects less than 1% prior to adolescence.
  11. Before diagnosing DMDD, it is important for the clinician to assess for a history of psychological trauma. Trauma affects many aspects of a child’s life; in the case of outbursts, it is emotional resilience that is impaired.
  12. It is important to recognize that the child is not “just angry,” but very distressed.
  13. Hugging and verbally consoling the child’s distress is sometimes effective and does not reinforce the behavior unless the parent also yields to demands. But once outbursts begin, you can liken them to a bomb going off – there really isn’t a good intervention at that point. Instead, the task of the family, and over time that of the child, is to recognize and better manage the triggers.

About the author

Stacy Garcia, MA, LPC, NCC administrator

I am a Licensed Professional Counselor and National Certified Counselor in the state of West Virginia, who is also currently working toward the Registered Play Therapist (RPT) certification. I graduated with a Master of Arts degree in Counseling from West Virginia University in 2004 after attainment of a Bachelor of Science degree in Psychology from Campbellsville University in Campbellsville, Kentucky. I have nearly fifteen years of experience in the mental health field, most of which has been spent counseling primarily children and adolescents and their families. I specialize in the treatment of trauma-related issues and concerns, parent-child conflict, and mood and anxiety disorders in children. I have a great deal of experience and training as a counselor, but my biggest and most important job is that of a mom of two wonderful boys, ages 12 and 5. They are my world and my heart, and each and every day they are my best trainers in child development and parent-child relationships. Every day is an adventure.

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