An Overview of Disruptive Mood Dysregulation Disorder (DMDD)

Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping

Table of ContentsView All

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Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Coping

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This condition is a fairly new diagnosis, first appearing in the fifth edition of theDiagnostic 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 ofbipolar disorder in children.

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

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:

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 anddevelopmentaldisability.

How Common Is DMDD?Because this condition is so new, there is not a great deal of data available on prevalence rates. The results of one study suggest that between 0.8% and 3.3% (depending on how strictly exclusion criteria were applied) of more than 3,200 participants between the ages of two and 17 met the diagnostic criteria for DMDD over a three-month period.

How Common Is DMDD?

Because this condition is so new, there is not a great deal of data available on prevalence rates. The results of one study suggest that between 0.8% and 3.3% (depending on how strictly exclusion criteria were applied) of more than 3,200 participants between the ages of two and 17 met the diagnostic criteria for DMDD over a three-month period.

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 includegenetics, temperament, co-occurringmental 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 andoppositional 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:

Other risk factors associated with DMDD include:

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.

While there are no validated scales for assessing DMDD, health professionals may use different questionnaires, assessments, and caregiver ratings to measure irritability and tantrums in children.

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 ofatypical antipsychoticsandmood-stabilizing drugs used to treat bipolar disorderin children were some factors that led to the creation of the diagnosis of disruptive mood dysregulation disorder.

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 andattention 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.

There is no specific treatment for disruptive mood dysregulation disorder, but the condition is often treated with psychotherapy, medication, or a combination of both.

Therapy

Psychotherapy is usually considered a first-line treatment and may includecognitive 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 prescribestimulants, antipsychotics, mood stabilizers, orantidepressantsto 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.

Understanding Mania and Manic Episodes

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.

What Does It Mean to Be ‘Triggered’

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 usingdeep breathingand reciting verbal reminders to help interrupt angry outbursts before they began.

Healthy Coping Skills for Uncomfortable Emotions

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.

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 experiencingdepressionandanxietyas 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.

What to Know About Depressive Disorders in Children

5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Copeland WE, Angold A, Costello EJ, Egger H.Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder.Am J Psychiatry. 2013;170(2):173-9. doi:10.1176/appi.ajp.2012.12010132Dougherty LR, Smith VC, Bufferd SJ, et al.DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.Psychol Med. 2014;44(11):2339-50. doi:10.1017/S0033291713003115Baweja R, Mayes SD, Hameed U, Waxmonsky JG.Disruptive mood dysregulation disorder: current insights.Neuropsychiatr Dis Treat. 2016;12:2115-24. doi:10.2147/NDT.S100312Tudor ME, Ibrahim K, Bertschinger E, Piasecka J, Sukhodolsky DG.Cognitive-behavioral therapy for a 9-year-old girl with disruptive mood dysregulation disorder.Clin Case Stud. 2016;15(6):459-475. doi:10.1177/1534650116669431Additional ReadingRao U.DSM-5: disruptive mood dysregulation disorder.Asian J Psychiatr. 2014;11:119-23. doi:10.1016/j.ajp.2014.03.002Roy AK, Lopes V, Klein RG.Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.Am J Psychiatry. 2014;171(9):918-24. doi:10.1176/appi.ajp.2014.13101301

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Copeland WE, Angold A, Costello EJ, Egger H.Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder.Am J Psychiatry. 2013;170(2):173-9. doi:10.1176/appi.ajp.2012.12010132Dougherty LR, Smith VC, Bufferd SJ, et al.DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.Psychol Med. 2014;44(11):2339-50. doi:10.1017/S0033291713003115Baweja R, Mayes SD, Hameed U, Waxmonsky JG.Disruptive mood dysregulation disorder: current insights.Neuropsychiatr Dis Treat. 2016;12:2115-24. doi:10.2147/NDT.S100312Tudor ME, Ibrahim K, Bertschinger E, Piasecka J, Sukhodolsky DG.Cognitive-behavioral therapy for a 9-year-old girl with disruptive mood dysregulation disorder.Clin Case Stud. 2016;15(6):459-475. doi:10.1177/1534650116669431Additional ReadingRao U.DSM-5: disruptive mood dysregulation disorder.Asian J Psychiatr. 2014;11:119-23. doi:10.1016/j.ajp.2014.03.002Roy AK, Lopes V, Klein RG.Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.Am J Psychiatry. 2014;171(9):918-24. doi:10.1176/appi.ajp.2014.13101301

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Copeland WE, Angold A, Costello EJ, Egger H.Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder.Am J Psychiatry. 2013;170(2):173-9. doi:10.1176/appi.ajp.2012.12010132Dougherty LR, Smith VC, Bufferd SJ, et al.DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.Psychol Med. 2014;44(11):2339-50. doi:10.1017/S0033291713003115Baweja R, Mayes SD, Hameed U, Waxmonsky JG.Disruptive mood dysregulation disorder: current insights.Neuropsychiatr Dis Treat. 2016;12:2115-24. doi:10.2147/NDT.S100312Tudor ME, Ibrahim K, Bertschinger E, Piasecka J, Sukhodolsky DG.Cognitive-behavioral therapy for a 9-year-old girl with disruptive mood dysregulation disorder.Clin Case Stud. 2016;15(6):459-475. doi:10.1177/1534650116669431

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.

Copeland WE, Angold A, Costello EJ, Egger H.Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder.Am J Psychiatry. 2013;170(2):173-9. doi:10.1176/appi.ajp.2012.12010132

Dougherty LR, Smith VC, Bufferd SJ, et al.DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.Psychol Med. 2014;44(11):2339-50. doi:10.1017/S0033291713003115

Baweja R, Mayes SD, Hameed U, Waxmonsky JG.Disruptive mood dysregulation disorder: current insights.Neuropsychiatr Dis Treat. 2016;12:2115-24. doi:10.2147/NDT.S100312

Tudor ME, Ibrahim K, Bertschinger E, Piasecka J, Sukhodolsky DG.Cognitive-behavioral therapy for a 9-year-old girl with disruptive mood dysregulation disorder.Clin Case Stud. 2016;15(6):459-475. doi:10.1177/1534650116669431

Rao U.DSM-5: disruptive mood dysregulation disorder.Asian J Psychiatr. 2014;11:119-23. doi:10.1016/j.ajp.2014.03.002Roy AK, Lopes V, Klein RG.Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.Am J Psychiatry. 2014;171(9):918-24. doi:10.1176/appi.ajp.2014.13101301

Rao U.DSM-5: disruptive mood dysregulation disorder.Asian J Psychiatr. 2014;11:119-23. doi:10.1016/j.ajp.2014.03.002

Roy AK, Lopes V, Klein RG.Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.Am J Psychiatry. 2014;171(9):918-24. doi:10.1176/appi.ajp.2014.13101301

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