Disruptive Mood Dysregulation

Nicole Genaw

Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder (DMDD), a new diagnosis in The Diagnostic and Statistical Manual of

Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013), is characterized by chronic,

severe persistent irritability in children and adolescents. DMDD was added to the DSM-5, in part, to address

concerns about potential over-diagnosis and overtreatment of bipolar disorder in children (APA, 2013). DMDD

characterizes behavior that is considered outside of the normal range of childhood behavior; the major features of

this disorder include 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 (APA, 2013).

Age rage of DMDD

Data were obtained from 706 children aged 6–12 years who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study (sample was accrued from November 2005 to November 2008). DSM-IV criteria were used, and assessments, which included diagnostic, symptomatic, and functional measures, were performed at intake and at 12 and 24 months of follow-up(Axelson et al., 2012)

Pros and Cons

Having a definition of this behavior is a positive thing. As a clinician who runs an inpatient service, who takes care of kids like this, it’s been extremely frustrating not being able to have something that captures the severity of these explosive outbursts. If we haven’t settled on a way of labeling something, we don’t have a way of really gathering a database to be able to address the important question of how to treat it.

But there’s also a danger with DMDD — it makes you think it’s one condition. The fact is, you get explosive outbursts with ADHD, with ODD, with mania, with depression, with autism, with anxiety, with schizophrenia, with intermittent explosive disorder.

Explosive behavior is like fever. If you have a fever of 105, you know the kid is sick, but you don’t know what the kid is sick with. And so, to me, those explosive outbursts mean this child is in deep trouble. But what he’s in trouble with really needs a diagnostic assessment. And my concern about disruptive mood dysregulation disorder is people are going to say, “That’s it.” Brain slammed shut. They’re not going to think diagnostically. Which has actually been the biggest problem with bipolar disorder. People say, “Oh! Bipolar disorder.” Brain slams shut. Nobody thinks further, diagnostically.

My suggestion to the DSM-5 committee was to say, “Let’s make it as a modifier. Let’s have attention deficit disorder with explosive outbursts. Let’s have autism with explosive outbursts.” That way you don’t overlook what might be the primary condition behind disruptive mood dysregulation disorder. About 75 to 80% of those kids have ADHD / ODD. I know that. People around for the birth of this condition may know that. But 10 or 15 years from now, people aren’t going to know that. They’re going to say, “Oh, look at this new condition.” And they may not be treating the ADHD that underpins it, and they may be missing a really important opportunity.("A New Diagnosis for Explosive Behavior | Child Mind Institute", 2016)

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References

Gilea, B. L., & O’Neill, R. M. Disruptive Mood Dysregulation Disorder


Axelson, D., Findling, R., Fristad, M., Kowatch, R., Youngstrom, E., & Horwitz, S. et al. (2012). Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study. J. Clin. Psychiatry, 73(10), 1342-1350. http://dx.doi.org/10.4088/jcp.12m07674


A New Diagnosis for Explosive Behavior | Child Mind Institute. (2016). Child Mind Institute. Retrieved 11 April 2016, from http://childmind.org/article/pros-cons-disruptive-mood-dysregulation-disorder/


Quick Facts on Disruptive Mood Dysregulation Disorder (DMDD) | Child Mind Institute. (2016). Child Mind Institute. Retrieved 11 April 2016, from http://childmind.org/article/quick-facts-on-disruptive-mood-dysregulation-disorder-dmdd/


  • A NEW DIAGNOSIS FOR EXPLOSIVE BEHAVIOR | CHILD MIND INSTITUTE



    In-text: ("A New Diagnosis for Explosive Behavior | Child Mind Institute", 2016)

    Your Bibliography:A New Diagnosis for Explosive Behavior | Child Mind Institute. (2016). Child Mind Institute. Retrieved 11 April 2016, from http://childmind.org/article/pros-cons-disruptive-mood-dysregulation-disorder/


  • Journal

    AXELSON, D., FINDLING, R. L., FRISTAD, M. A., KOWATCH, R. A., YOUNGSTROM, E. A., HORWITZ, S. M., ARNOLD, L. E., FRAZIER, T. W., RYAN, N., DEMETER, C., GILL, M. K., HAUSER-HARRINGTON, J. C., DEPEW, J., KENNEDY, S. M., GRON, B. A., ROWLES, B. M. AND BIRMAHER, B.

    Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study


    In-text:(Axelson et al., 2012)

    Your Bibliography:Axelson, D., Findling, R., Fristad, M., Kowatch, R., Youngstrom, E., & Horwitz, S. et al. (2012). Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study. J. Clin. Psychiatry,73(10), 1342-1350. http://dx.doi.org/10.4088/jcp.12m07674


  • Website

    JOHNSON, JOHNSON, JOHNSON AND JOHNSON, A.

    Alexis Johnson, Clinical Social Work/Therapist, Fort Gratiot, MI 48059 | Psychology Today


    In-text:(Johnson, Johnson, Johnson & Johnson, 2016)

    Your Bibliography:Johnson, Johnson, Johnson, & Johnson, A. (2016). Alexis Johnson, Clinical Social Work/Therapist, Fort Gratiot, MI 48059 | Psychology Today.Therapists.psychologytoday.com. Retrieved 11 April 2016, from https://therapists.psychologytoday.com/rms/prof_detail.php?profid=15416