An Overview of Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive mood dysregulation disorder (DMDD) is a childhood condition that is characterized by severe anger, irritability, and frequent temper outbursts. While temper tantrums tend to be quite common in kids, DMDD is more than just normal childhood moodiness. The angry outbursts that kids experience with DMDD are extreme, intense, and can lead to significant disruption in many areas of a child's life. 

This condition is a fairly new diagnosis, first appearing in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), which was published in 2013. This condition was added to the DSM-5 to help address concerns about possible over-diagnosis and treatment of bipolar disorder in children. 

However, some controversy exists about the addition of this condition due to the lack of empirical data on DMDD. 

Symptoms 

In order to be diagnosed with disruptive mood dysregulation disorder, a child must be between the ages of six and 18.

The symptoms of DMDD include:

• Severe, recurrent temper tantrums: Such outbursts can involve yelling, pushing, hitting, or destruction of property.
• Outbursts occurring three or more times a week: A child may still be diagnosed with DMDD if they don’t always have this many outbursts a week. Kids may have more tantrums one week, and fewer the next. On average, tantrums three or more times a week are required for the diagnosis.
• Tantrums that are out of proportion to the situation: For example, you might expect a child to get angry when they don’t get a toy they want, but a child with DMDD might act out with physical aggression and verbal outbursts that are excessive and intense.
• Tantrums that are inappropriate for the child's age level: For example, while you might not be surprised if a very young child has a tantrum that involves falling to the floor crying and screaming, it is not something you would expect from a 12-year-old.
• Irritable and angry moods between tantrums: In between bouts of intense emotional outbursts, kids with DMDD have moods that are consistently angry and extremely irritable. Such moods are present most of the time and are noticed by others.
• Symptoms happen in multiple settings: This means that temper outbursts don’t just occur in a single setting, such as at school. DMDD is characterized by having tantrums in at least two settings such as at school, at home, or with peers.

In addition to the above criteria, these symptoms must be present for at least 12 months with no more than three consecutive months where the diagnostic criteria are not met. In addition to meeting these criteria, psychiatrists will also rule out other causes such as substance use and developmental disability.

Causes

The exact causes of DMDD are not clear, although there are a number of factors that are believed to play a role. Such factors may include genetics, temperament, co-occurring mental conditions, and childhood experiences. 

The disorder appears to be more common during early childhood and is likely to co-occur with other psychiatric conditions, most commonly depressive disorders and oppositional defiant disorder.

A child's temperament may be a risk factor for developing DMDD. Some traits that are more commonly seen in kids with this condition include:

• Moodiness
• Anxiousness
• Irritability
• Difficult behavior

Other risk factors associated with DMDD include:

• Low parental support
• Parental hostility and substance use
• Family conflicts
• Disciplinary problems at school

Diagnosis

If your child is experiencing symptoms of DMDD, start by making an appointment with a pediatrician. The doctor will evaluate your child and make a diagnosis or refer you to a psychiatrist for further evaluation and treatment.

The first step of diagnosis involves assessing a child's health, ruling out other health conditions, and then evaluating the child's symptoms. A doctor or psychiatrist may also interview the child, parents, other caregivers, and teachers to get a clearer view of a child's behaviors.

DMDD vs. Bipolar Disorder

During the 1990s, there was a dramatic increase in the diagnosis of bipolar disorder in children. Concerns over this and the effectiveness and long-term safety of atypical antipsychotics and mood-stabilizing drugs used to treat bipolar disorder in children were some factors that led to the creation of the diagnosis of disruptive mood dysregulation disorder.

One way disruptive mood dysregulation disorder is differentiated from bipolar disorder is by chronic irritability. Where bipolar disorder is generally characterized by episodic changes in mood, children with DMDD have moods that are persistently angry or irritable.

Treatment

Because DMDD is a new diagnosis, there is not a great deal of research on which treatments are the most effective. Treatments are usually based on what has been helpful for conditions that share some of the same symptoms, including oppositional defiant disorder and attention deficit hyperactivity disorder (ADHD).

Because the symptoms of DMDD can create such significant impairments in a child's life, it is important that parents obtain treatment for their child as soon as possible. The symptoms of irritability, anger, and outbursts that characterize this condition can damage a child's relationships with classmates and family members.

Therapy

Psychotherapy is usually considered a first-line treatment and may include cognitive behavioral therapy (CBT) and parent training. CBT helps kids learn to recognize the thoughts that contribute to feelings of anger and learn new ways of responding to different situations. Therapists may also work with parents to help them learn new ways of responding to their child's anger and outbursts.

Medication

While more research is needed to help determine which types of medication may be the most effective for treating this condition, psychiatrists may prescribe stimulants, antipsychotics, mood stabilizers, or antidepressants to treat symptoms of DMDD. 

Doctors may sometimes avoid treating the condition with stimulants and antidepressants out of fear of worsening symptoms of irritability or inducing symptoms of mania. However, researchers suggest that using these agents can be effective and don't tend to lead to mania in children with DMDD.

Coping

Coping with disruptive mood dysregulation disorder can present challenges for both children and caregivers. The disorder can make it difficult for kids to function at home and at school, and parents and other adults may find it tough to handle children's intense temper outbursts. There are some coping strategies that may help.

Understand Your Child's Triggers

If your child is likely to have a tantrum in certain settings or situations, try to have a plan in place. Briefly removing your child from the situation can sometimes help. 

Keep Your Child Safe

If your child is prone to acting out physically, try to keep any potentially dangerous objects out of reach. For example, make sure that all of the furniture in your home is safely secured and keep heavy, sharp, throwable objects out of reach.

Teach Coping Skills

In one case study, a child with DMDD was taught to mentally recite song lyrics whenever she found herself becoming angry. This was also combined with using deep breathing and reciting verbal reminders to help interrupt angry outbursts before they began.

Encourage Positive Behaviors

Reward appropriate behaviors with attention, praise, and privileges. In multi-child households, kids sometimes go unnoticed when they are behaving well, but are able to get one-on-one attention when they misbehave.

This tends to reinforce misbehavior and discourage good behavior. Break this pattern by making sure that you notice and reward your child's positive actions.

A Word From Verywell

DMDD can be a challenging condition that can result in significant problems in a child’s life. It can also increase a child’s risk of experiencing depression and anxiety as an adult, so it is important to seek treatment if you suspect that your child may have this condition.

While these temper outbursts can be upsetting, appropriate treatment can help your child manage their symptoms and improve relationships in school, home, and social settings.