Disruptive mood dysregulation disorder (DMDD) is a childhood condition marked by intense, chronic irritability. Beyond regular levels of “moodiness,” children with DMDD experience angry moods and outbursts regularly. DMDD is a challenging condition that affects 2-5% of children and adolescents, but when parents, schools, and mental health experts work towards a helpful treatment plan, symptoms can resolve.1
What Is DMDD?
Disruptive mood dysregulation disorder is different from other depressive disorders because it creates more irritability than low moods. A person with DMDD will display outbursts, rages, and tantrums that are not usually associated with depression.
With other types of depression like major depressive disorder or persistent depressive disorder, the person with the condition may experience severe symptoms without affecting others. With DMDD, though, the family, teachers, and friends of the child will feel the adverse influence of the condition as well.
How Is DMDD Diagnosed?
Getting a comprehensive evaluation for a child from a mental health professional is the only way to ensure a DMDD diagnosis. To complete this assessment, the evaluator will meet with the child and the parents to learn more about the symptoms, their history, and the impact on the child’s life.
At times, the professional may order lab tests or communicate with teachers and school staff to gather more information and rule out another medical condition,7 but at this time there are no lab tests or imaging studies (like a CT or MRI) that make the diagnosis of DMDD. With all of the data gathered, the professional will refer to the DSM-5 to determine if this child’s experience meets the criteria for DMDD.
A person cannot receive a DMDD diagnosis if they are under the age of six or over the age of 18. Additionally, symptoms of DMDD must begin before age 10, so according to the American Psychological Association, if a child began expressing severe irritability and anger at age 12, the child would not qualify for a DMDD diagnosis.1
DMDD Symptoms
Symptoms of DMDD include:1
- A history of repeated, severe outbursts of anger, which are more intense than the situation warrants
- Outbursts that do not match the child’s age or developmental level with older children behaving like a much younger child would
- Outbursts that occur more than three times each week
- Moods that are angry or irritable, even when there is not a reason to be angry or irritated
The symptoms above must continue for 12 months and present in several settings like home, school, and in the community.1 If the child has ever experienced symptoms of a manic episode, they cannot have DMDD.
What Disruptive Mood Dysregulation Looks Like
The children and adolescents with disruptive mood dysregulation disorder will appear to have an overriding sense of anger and frustration. They will seem annoyed, full of rage, irritable, and out of control. Although these symptoms can be very intense at times, the disorder is fueling these symptoms, which means addressing the condition can help limit the unwanted effects.
A child with DMDD will show:
- An irritable or angry mood that remains consistent
- Outbursts that are severe in intensity and occur at least three times each week
- Poor functioning at home, school, or with social relationships
Tantrums
Typical children will engage in tantrums occasionally, but those with DMDD will have tantrums and outbursts that do not match their age group. During these incidents, the child will behave in ways inconsistent with their age and maturity levels.
Amid an outburst, a child with DMDD will:3
- Engage in verbal rages
- Display physical aggression towards people or property
- Struggle with emotional regulation
- Become irritated often
- Show a level of frustration that far exceeds the situation
- Fail to control and regulate their behavior
- Outbursts of anger
- Physically aggressive towards people or property
- Cannot control emotions
- Easily irritated
- Gets frustrated when it does not fit the situation
- Cannot control their behavior
Academic, Social, & Family Issues
These children will create constant disruptions in the classroom and may fall behind academically and socially as they struggle to make friends. In the community, they will fail to find enjoyment in the same sports and activities as peers. At home, the powerful symptoms of DMDD may result in increased tension and frustration with parents and poor interactions with siblings.1 Many families feel that they have little idea what will lead to an outburst and describe the other family members as “walking on eggshells” to avoid being a trigger for a blow-up.
Treatment of Disruptive Mood Dysregulation Disorder
Similar to any depression treatment, treatment for disruptive mood dysregulation disorder will focus on therapy and medication interventions that benefit the entire family system. The most effective treatment strategies are still under investigation because the diagnosis is new, but since DMDD is a mental health condition that frequently co-occurs with other disorders, treatments must address all symptoms comprehensively.3
Therapy
Therapy techniques are a central intervention used to address symptoms of DMDD and related disorders. Also called psychotherapy, talk therapy, or behavioral therapy, these strategies will aim to limit the symptoms of DMDD and improve the person’s functioning across all settings.
DMDD does not have a specific form of therapy designed for it, so professionals will utilize treatments proven effective for conditions with similar symptoms like:3
- Cognitive-Behavioral Therapy (CBT): CBT can help show children and teens how thoughts, feelings, and behaviors are interconnected. By teaching children to change their thoughts and actions, they can regulate their mood and increase their tolerance.
- Parent Training: Rather than focusing on the child changing, parent training involves the therapist meeting with parents and other family members to explore ways to change their behaviors in order to reduce anger, aggression, and frustration in the child.
- Computer-Based Training: Using computer-based training, children and teens learn to shift their views to see facial expressions in more positive ways, resulting in less frustration and fewer outbursts.
- Play Therapy: Younger children with DMDD may respond well to elements of play therapy that help them shift their attitudes, perceptions, and behaviors away from rule-breaking, aggression, and negative attention seeking and towards more desired outcomes.
Fortunately, people do not need to choose just one therapeutic intervention to help with DMDD. Often, the treatment team can employ multiple types of therapy simultaneously for the best results.
Medication
There are no medications specifically designed to address DMDD, so prescribers will offer medicines that are effective in limiting similar symptoms in other conditions.
Some possible medication interventions include:
- Antidepressants: For the irritability and mood issues linked to DMDD, antidepressants may be a good option. Some studies have shown that antidepressants can help reduce irritability in a variety of conditions. Usually in children, a physician would first prescribe an SSRI antidepressant such as fluoxetine (Prozac), escitalopram (Lexapro), or sertraline (Zoloft).
- Atypical antipsychotics: Medications like risperidone and aripiprazole are approved for the treatment of irritability connected to autism spectrum disorder (ASD) and may have an off-label use with DMDD also.5
- Stimulants: Medications commonly used to treat poor concentration and impulsivity in people with attention-deficit/ hyperactivity disorder (ADHD) may have an off-label use in managing DMDD. Medications like methylphenidate (Concerta, Ritalin, Daytrana) and amphetamine-based stimulants (Adderall) can reduce the degree of irritability a child experiences.6
Some people may not respond to any of these medications, while others will do well with a combination approach. By addressing the symptoms of DMDD through medications, the overall condition can improve. Patients who are prescribed medications for DMDD should also be working with a therapist on handling their emotions and behaviors.
Additional DMDD Treatments
Children with DMDD will encounter frequent issues in school, so effective interventions will include some level of communication between the treatment team and the school officials.5 By having the teacher and other school staff aware of the behavioral plan in place, the same rewards and unwanted consequences can be applied in multiple settings.
These behavioral modifications can be incorporated into formal education plans or charts employed in the classroom. With increased consistency and structure, the child with disruptive mood dysregulation disorder can find more success in school.
Lifestyle Changes
For DMDD, professional therapy and medication management will be essential for improving symptoms, but the addition of at-home lifestyle changes can boost the effectiveness of the other treatments.
Lifestyle changes for DMDD include:
- Sticking to the treatment plan by attending therapy and using the medications as prescribed
- Getting regular exercise to stay active
- Eating healthy foods and getting plenty of rest
- Shifting thought patterns to become more positive and hopeful
- Working on improving relationships with peers and family members to gain extra support
- Remaining calm and patient to allow treatments the needed time to become effective
Some helpful lifestyle changes for parents of kids with DMDD include:
- Reminding yourself that many children have DMDD, and many parents face the struggles each day
- Trying to build clear and consistent routines and schedules
- Staying consistent with rewards and consequences
- Finding healthy coping skills to reduce stress
- Seeking support groups for people in the same situation to gain insights and encouragement
People should make lifestyle changes one at a time. Having too many changes at once can make it impossible to know which modification is producing the best result.
How to Get Help for Disruptive Mood Dysregulation Disorder
If the symptoms and signs of disruptive mood dysregulation disorder are causing issues for your child and your family, you should seek an evaluation from a mental health professional as soon as possible. Early and effective treatment can produce the best results.
Since DMDD affects children between the ages of 6 and 18, parents and other loved ones will be taking the most active role in getting help. Because DMDD is a serious mental health condition that adversely affects the life of the person with the condition as well as their family, professional treatment is a must.
Parents seeking treatment for their child with DMDD can:
- Contact the child’s primary care doctor or pediatrician for an evaluation or referral to another specialist
- Speak to the school’s guidance counselor or psychologist for an evaluation—this step could be especially important if the child is experiencing disruptive behaviors, academic problems, or social issues at school
- Phone a trusted and experienced mental health therapist or psychiatrist in the area to begin treatment
- Inquire with friends and family with experience in the field of mental health for assistance navigating the process
- Contact their insurance company to locate providers in the area who treat DMDD
Disruptive Mood Dysregulation Disorder Statistics
DMDD statistics illustrate how the condition is similar to and different from other conditions. With limited data compiled since DMDD became an official diagnosis, many of the statistics involve a proposed condition called severe mood dysregulation, which later transformed into DMDD.
The data on DMDD showed:1
- About 75% of children with DMDD symptoms also had symptoms of ADHD and oppositional defiant disorder
- About 58% of children with DMDD symptoms had an anxiety disorder
- The rate of people with DMDD transitioning into having bipolar disorder is very low – only about 1%
- Even though about 50% of school-aged children experience tantrums and outbursts, only around 3% of children have all the criteria for DMDD
- Nearly 93% of youth with DMDD will have another mental health disorder
DMDD vs. Other Conditions
DMDD shares many symptoms with other mental health conditions and may transition into other disorders over time. Because of this, people affected by the condition should be vigilant in identifying and tracking symptoms to get the best treatments available.
DMDD vs. Other Depressive Disorders
Even though the DMDD is categorized as a depressive disorder, it shares few similarities with other depressive disorders like major depressive disorder (MDD) and persistent depressive disorder. One of the commonalities is the condition’s ability to produce irritability, which is also a sign of other depressive disorders in adolescents. A mental health professional will review all symptoms, including energy levels, appetite changes, and sleep issues, to identify the presence of DMDD or another depressive disorder.1
DMDD vs. Bipolar Disorders
The issue of irritability as a symptom of bipolar disorder in children has been debated over the last few decades, which has resulted in many youths receiving an incorrect bipolar diagnosis. Many of these children did not show classic symptoms of bipolar disorder by the time they reached adulthood. As the criteria stand now, a person must display a manic or hypomanic episode to have a bipolar disorder. During this episode, the child must show worsening cognitive, behavioral, and physical symptoms.1
Manic and hypomanic episodes last for discrete periods with a clear beginning and end. If a person cannot identify these episodes, they do not have bipolar disorder, and the DMDD diagnosis should be considered.
DMDD vs. Oppositional Defiant Disorder
Some may see the tantrums and outbursts of DMDD as defiance and may confuse these symptoms as oppositional defiant disorder (ODD). ODD is a condition of childhood marked by a disregard for the rules, structure, and boundaries.1
The primary difference is the presence of an irritable mood in children with DMDD. Many with ODD will appear disinterested and indifferent rather than displaying constant irritability.1 In this situation, parents should do their best to accurately observe and report the symptoms they notice in their child to produce the proper diagnosis.
DMDD vs. Intermittent Explosive Disorder
Like with DMDD, children with intermittent explosive disorder will engage in significant temper outbursts. The difference is that people with DMDD will display the chronic irritability and moodiness between outbursts, while people with intermittent explosive disorder may report being in a good mood.1
To separate the two conditions, parents and the treatment team should investigate the duration, intensity, and frequency of outbursts as well as the calm periods in between.
DMDD vs. ADHD & Autism Spectrum Disorder
ADHD and autism trigger symptoms that correspond to DMDD like irritability, impulsivity, and temper outbursts. These conditions are very different, though.
Children with autism will present with a variety of symptoms like repetitive behaviors and an impaired ability to communicate effectively. Those with ADHD can struggle with concentration, motivation for non-engaging tasks, and impulsivity, but they will not display the mood symptoms linked to DMDD.1
Taking the time to understand and differentiate these conditions will lead to a refined treatment plan and more effective services.
DMDD & Co-Occurring Disorders
In the majority of DMDD cases, the condition will occur simultaneously with at least one other condition. DMDD frequently co-occurs with mental health disorders like ADHD, anxiety, depression, and even autism.1
One condition that cannot coexist with DMDD is bipolar disorder. In this situation, the mental health professional needs to decide if the symptoms are better explained by one condition over the other.
Because of the high rates of comorbidity, it can be challenging for parents and mental health professionals to sort through the symptoms to fully understand all of the issues and conditions affecting the child. Parents should always maintain an open dialogue with providers to report on symptoms and changes over time.
Final Thoughts on DMDD
Parents and professionals may not consider disruptive mood dysregulation disorder initially when reviewing a child’s problematic behavior, but understanding the condition and making the proper diagnosis can lead to the best treatments. Treating DMDD appropriately can lower current symptoms and help prevent more serious depressive symptoms in the future.
