Disruptive Mood Dysregulation Disorder (DMDD) is a proposed disorder for the DSM-5 and was created as an alternative diagnosis to pediatric bipolar disorder. DMDD (formerly known as temper dysregulation disorder with dysphoria) shouldn’t be diagnosed for the first time before 6 or after 18 and is characterized by severe, chronic irritability for at least a year. DMDD is also not accounted for by any other mental disorder, neurological interference, or substance abuse.
Symptoms Of DMDD
- Recurring, severe outbursts that are out of proportion to the incident
- Outbursts manifested in the form of verbal rages or physical aggression at people or property
- Outbursts that are inconsistent with developmental level, averaging three times a week
- A mood disorder is almost constantly irritable or angry between outbursts
- The onset of the above symptoms occurs before age 12
Causes Of DMDD
While there is no consensus as to the causes of DMDD, theories for dysregulation include early psychological trauma and abuse. Some causes identified include family structure (recent death in the family, divorce, relocation); poor diet (lack of nutrition or vitamin deficiencies, underlying medical conditions); and a neurological disability that causes poor behavior, such as migraine headaches. If any of these problems are occurring, they should be addressed before a diagnosis is made.
Treatment And Prevention
There is no set way to treat DMDD; however, studies have found certain treatments to be effective at lessening the outbursts and decreasing the effects. These include:
- Behavior Modification Therapy
- Behavioral Psychotherapy
- Stimulant medication, such as Ritalin
- Educating family and teachers about DMDD and how to deal with the outbursts instead of punishment
- Observing the children for their individual triggers
- Timeout strategies
- Preventative measures, such as assigning children a safe place to alleviate their outbursts
- Giving children a person they can confide in when on the verge of an outbreak
- Giving children unlimited drinking fountain breaks to alleviate the tension they are experiencing
- Counseling from school psychologists
- Prescribing Risperidone, an antipsychotic
- Classroom support
- Modified time allotted for tests and homework
- Addressing family dysfunction
- Modifying the child’s diet
Risk Factors Of DMDD
Children with DMDD are thought to be prone to suicidal ideation as well as substance abuse. Family members should be aware of these dangers which are being faced by their children.
DMDD vs Bipolar Disorder
There are mood-stabilizing drugs and atypical antipsychotics used to treat bipolar disorder in children that help to diagnose the DMDD. It is differentiated from bipolar disorder by chronic irritability because it brings changes in mood and children with DMDD to have mood swings that are angry or irritable.
Measurement For Diagnosis
Disruptive Mood Dysregulation Disorder is made between 7 and 17 years of age, and the onset of the disorder generally begins at age 12 or younger. The abnormal mood is present at least half of the day on most days and is noticeable to people around the child. The symptoms should impair at least one setting in the child’s life.
Hyperarousal must be prevalent and is defined by agitation, insomnia, intrusiveness, pressured speech, racing thoughts, and flight of ideas. The child exhibits increased reactivity to negative emotional stimuli that come out verbally or behaviorally. Such events should occur at least three times a week.