Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. The symptoms of DMDD resemble those of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder.

Signs and Symptoms

DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. A child with DMDD experiences:

  • Irritable or angry mood most of the day, nearly every day
  • Mood changes can occure only at home or places the child is very comfortable at.
  • Severe temper outbursts (verbal or behavioral) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level
  • Trouble functioning due to irritability in more than one place (e.g., home, school, with peers)

DMDD was introduced as a diagnosis to address what psychiatrists and psychologists believed to be the overdiagnosis of pediatric bipolar disorder. The key feature of bipolar disorders is the presence of manic or hypomanic episodes.

A manic episode is defined as a period of elevated, expansive, or irritable mood. In addition, a person also has an increase in goal-directed activity or energy. Hypomanic episodes are less severe versions of manic episodes. A person with bipolar disorder doesn’t always experience manic episodes. They aren’t a normal part of their daily functioning.

DMDD and bipolar disorders may both lead to irritability. Children with DMDD tend to be persistently irritable and angry, even when full-blown tantrums aren’t present. Manic episodes tend to come and go. You may ask yourself if your child is persistently in a bad mood, or if their mood seems to be out of the ordinary. If it’s persistent, they may have DMDD. If it’s out of the ordinary, their doctor may consider a bipolar disorder diagnosis.

Treatment of DMDD

Helping children with DMDD may involve psychotherapy or behavioral interventions, medication, or a combination of both. Non-medication treatments should be explored first. Treatments aren’t necessarily specific for DMDD. There are a variety of approaches that are commonly used for various mental health difficulties in children.

Psychotherapy and behavioral interventions
During psychotherapy, parents and children meet with a therapist every week to work on developing better ways of relating to one another. Among older children, individual therapy, such as cognitive behavior therapy, can help children learn to more effectively think of and respond to situations that upset them. Additionally, there are approaches that focus on empowering parents to develop the most effective parenting strategies.

A variety of medications are used to treat emotional and behavioral problems in children. These should be discussed with a psychiatrist. Commonly used medications include antidepressants, stimulants, and atypical antipsychotics.

An important consideration for treatment
The most effective interventions for all emotional and behavioral problems in children involve parents and other caregivers. Because DMDD affects how children interact with family members, peers, and other adults, it’s critical to consider these factors in treatment.

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