Disruptive Mood Dysregulation Disorder (DMDD)

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Disruptive Mood Dysregulation Disorder (DMDD)

THC Editorial Team January 20, 2021
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Photo by Jyotirmoy Gupta on Unsplash

Contents

What Is Disruptive Mood Dysregulation Disorder?

Disruptive mood dysregulation disorder (DMDD) is a mental condition that can affect children and adolescents and is characterized by excessive displays of irritability or anger or by temper outbursts. Although most children experience occasional frustration and anger, those with DMDD display excessive and situationally disproportionate tantrums. They may yell, hit people, or lash out in other ways. This type of excessive temper display may negatively affect people’s lives at home, at school, and in other social circumstances.1

DMDD is a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5).2 In the past, many children who had this condition were diagnosed with bipolar disorder even though their symptoms may not have completely fit that diagnosis. Currently, DMDD and bipolar disorder are two separate diagnoses. Children who are diagnosed with DMDD do not typically develop bipolar disorder later in life, but they are more likely to experience a mood disorder, such as depression or anxiety.3

What Are the Symptoms of Disruptive Mood Dysregulation Disorder?

The main symptoms associated with DMDD are as follows:2

  • severe temper outbursts (verbal or behavioral) that typically occur three or more times per week
  • persistent and long-term sadness, irritability, or anger that occurs most days and is experienced between outbursts of temper

However, these symptoms do not necessarily indicate that a person has DMDD. They are also associated with conditions such as persistent depressive disorder, separation anxiety disorder, posttraumatic stress disorder, and autism spectrum disorder.4 Additionally, children who have DMDD may have been diagnosed with bipolar disorder in the past, but they cannot be diagnosed with both disorders simultaneously under current DSM-5 rules.

Differences Between Disruptive Mood Dysregulation Disorder and Pediatric Bipolar Disorder

DMDD is a newly established disorder that helps distinguish children who do not meet the criteria for bipolar disorder (BD) but were often labeled as such because BD seemed to be the closest diagnosis based on their symptoms. BD involves distinct mood episodes, whereas DMDD involves chronic irritability.4 Another notable difference is that people who have BD experience periods of mania or hypomania that are absent among people who have DMDD. In addition, people with DMDD experience consistent irritability or bad moods, whereas those with BD typically experience such mood changes only during manic or hypomanic episodes.5

Causes and Risk Factors of Disruptive Mood Dysregulation Disorder

Although researchers have not yet discovered the exact cause of DMDD, some studies have revealed that certain physical factors may contribute to this condition among children.6 One longitudinal study investigated abnormalities in reward-processing systems in children with DMDD. The study’s results indicated that abnormalities involving neurons in the brain are likely the psychopathological cause of DMDD.7

The following physical factors may contribute to DMDD:

  • abnormal neural pattern activation
  • reduced activity in the reward center in the brain
  • genetic predisposition toward irritability

According to the results of some studies, males are more likely to experience DMDD than females.8 In addition, several other risk factors have been associated with DMDD:9,10

  • parental bipolar disorder
  • maternal mood dysregulation during and after pregnancy
  • poor family relationships
  • economic difficulties
  • behavioral problems in school or with peers

Children who live in single-parent households of low socioeconomic status may also experience increased risk for developing DMDD.9

How Is Disruptive Mood Dysregulation Disorder Diagnosed?

For a child or adolescent to be diagnosed with DMDD, associated symptoms must be present for 12 months or more. The symptoms must negatively affect the child in multiple settings and must be severely disproportionate to situational contexts or the child’s developmental level. Additionally, the child must be between the ages of 6 and 18 to receive this diagnosis.

For a child to receive a proper diagnosis, a therapist may need to first rule out other conditions that share some of the symptoms associated with DMDD.

Treatments for Disruptive Mood Dysregulation Disorder

Healthcare professionals use psychological therapies, medication, and at-home behavioral interventions to treat children and adolescents with DMDD. Healthcare providers will develop specific, individual treatment plans for people who have DMDD based on the severity and frequency of their symptoms and on the location in which their symptoms are most likely to occur.

Because this disorder is a new diagnosis in the DSM-5, researchers and practitioners have not yet identified which therapies treat this condition most effectively.10 However, since DMDD symptoms overlap with those of other mental health conditions, treatment models for other conditions have been shown to effectively treat DMDD.1,11

Psychological Treatments and Therapies

Different forms of counseling, such as individual or family therapy, may be used to treat DMDD. Counseling efforts may also involve some school personnel if a child’s behavior affects their education.

Psychological therapies such as the following should be the first line of treatment for DMDD:1,11,12

Medication

Currently, the United States Food and Drug Administration has not approved any medication for the treatment of DMDD. In certain cases, however, psychiatrists may prescribe certain off-label medications to treat DMDD. These include the following:1,4,10

  • mood stabilizers
  • antidepressants
  • atypical antipsychotics
  • stimulants

Medication should only be used to treat DMDD in cases where patients have already tried psychological therapies. If such interventions do not work in isolation, healthcare providers may prescribe medication in conjunction with continued therapy.

At-Home Coping and Behavioral Intervention

Caregivers can help children with DMDD cope with temper outbursts by using certain at-home behavioral change techniques. Some effective measures include the following:

  • offering positive reinforcement
  • knowing and avoiding outburst triggers
  • giving clear verbal instructions
  • redirecting
  • using time-outs

As a caregiver, if you pay attention to specific triggers that facilitate outbursts as well as the child’s behavior patterns, you may be able to recognize signs and redirect the child’s response. By doing so, you are better able to prevent an outburst and help the child handle their emotions more effectively.13

References

  1. National Institute of Mental Health. (n.d.). Disruptive mood dysregulation disorder: The basics.U.S. Department of Health and Human Services, National Institutes of Health.
    https://www.nimh.nih.gov/health/publications/disruptive-mood-dysregulation-disorder/index.shtml
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
    https://doi.org/10.1176/appi.books.9780890425596
  3. American Academy of Child & Adolescent Psychiatry. (2019). Disruptive mood dysregulation disorder (DMDD).
    https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Disruptive-Mood-Dysregulation-Disorder-_DMDD_-110.aspx
  4. Roy, A. K., Lopes, V., & Klein, R. G. (2014). Disruptive mood dysregulation disorder: A new diagnostic approach to chronic irritability in youth. American Journal of Psychiatry, 171(9), 918–924.
    https://doi.org/10.1176/appi.ajp.2014.13101301
  5. Noller, D. T. (2016). Distinguishing disruptive mood dysregulation disorder from pediatric bipolar disorder. Journal of the American Academy of Physician Assistants,29(6), 25–28.
    https://doi.org/10.1097/01.JAA.0000483092.35899.a7
  6. Tapia, V., &John, R. M. (2018). Disruptive mood dysregulation disorder. Journal for Nurse Practitioners, 14(8), 573–578.
    https://doi.org/10.1016/j.nurpra.2018.07.007
  7. Kessel, E. M., Dougherty, L. R., Kujawa, A., Hajcak, G., Carlson, G. A., & Klein, D. N. (2016). Longitudinal associations between preschool disruptive mood dysregulation disorder symptoms and neural reactivity to monetary reward during preadolescence. Journal of Child and Adolescent Psychopharmacology,26(2), 131–137.
    https://doi.org/10.1089/cap.2015.0071
  8. Mayes, S. D., Calhoun, S. L., Waxmonsky, J. G., Kokotovich, C., Baweja, R., Lockridge, R., & Bixler, E. O. (2019). Demographic differences in disruptive mood dysregulation disorder symptoms in ADHD, autism, and general population samples. Journal of Attention Disorders, 23(8), 849–858.
    https://doi.org/10.1177/1087054716664409
  9. Munhoz, T. N., Santos, I. S., Barros, A., 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
  10. 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 the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 41–54.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357333/
  11. Child Mind Institute. (n.d.). DMDD: Treatment.
    https://childmind.org/guide/guide-to-disruptive-mood-dysregulation-disorder/treatment/
  12. GoodTherapy. (2017, June 12). Disruptive mood dysregulation (DMDD).
    https://www.goodtherapy.org/learn-about-therapy/issues/disruptive-mood-dysregulation
  13. Evolve. (n.d.). Disruptive mood dysregulation disorder in teens.
    https://evolvetreatment.com/for-parents/parent-guides/disruptive-mood-dysregulation-disorder/

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