Depressive disorders often trigger sadness, low energy levels, and decreased motivation, but disruptive mood dysregulation disorder (DMDD) is a depressive condition marked by intense, chronic irritability. People with DMDD experience angry moods and outbursts regularly. DMDD is a challenging childhood condition, but when parents, schools, and mental health experts work towards a helpful treatment plan, symptoms can resolve.
Disruptive Mood Dysregulation Disorder in Different Populations
Disruptive mood dysregulation disorder is a depressive condition of childhood and affects somewhere between 2% and 5% of children and adolescents (FN1). DMDD is a new condition (added to DSM-V in 2013), and because of its novelty, experts have completed fewer studies on the topic, especially when compared to a disorder like major depressive disorder (MDD).
Despite the limited research, it seems that boys might be more likely than girls to have symptoms of DMDD and receive the diagnosis (FN1). More studies are needed to conclude precisely how widespread DMDD is in a general population and which groups more commonly experience the condition (FN2).
What Disruptive Mood Dysregulation Looks Like
Most children with disruptive mood dysregulation disorder will share a similar clinical presentation marked by intense anger and frustration.
A youth 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
DMDD has specific rules for diagnosis compared to other mental health conditions. 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 APA, if a child began expressing severe irritability and anger at age 12, the child would not qualify for a DMDD diagnosis (FN1).
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 (FN3):
- 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
These children will create constant disruptions in the classroom and may fall behind academically and socially as they struggle to begin new or maintain old friendships. 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 in parents and poor interactions with siblings (FN1).
With other depressive disorders 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 person will feel the adverse influence of the condition as well.
Symptoms of Disruptive Mood Dysregulation Disorder
When mental health experts consider making the diagnosis, they refer to the symptoms of disruptive mood dysregulation disorder.
Symptoms of DMDD include(FN1):
- 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 above symptoms must continue for 12 months and present in several settings like home, school, and in the community (FN1). Again, if the child has ever experienced symptoms of a manic episode, they cannot have DMDD.
Treatment of Disruptive Mood Dysregulation Disorder
As a condition that affects the whole family and all aspects of the person’s life, 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 since the diagnosis is new (FN3).
DMDD is a mental health condition that frequently co-occurs with other disorders, so all treatments must address all current symptoms (FN3). Only addressing the symptoms of DMDD will permit the other conditions to worsen, which will decrease the person’s well-being.
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.
With a condition like DMDD, therapy may take place in just one or a variety of settings including:
- An office
- The home
- In the community
- A hospital
- A residential treatment center
The location of therapy can change as well as the type of therapy a child completes. Based on the therapist’s goals, the person with DMDD may engage in (FN4):
- Individual therapy that involves meeting one-on-one with the therapist,
- Group therapy involving meeting with at least one therapist and other group members with similar symptoms
- Family therapy that involves at least one therapist and family members. In family therapy, friends and other loved ones may be included.
With DMDD symptoms affecting so many parts of a child’s life, it is reasonable to expect multiple treatment options to occur simultaneously. For example, a child could attend individual and group or individual and family therapy to target their symptoms.
Common Types of Therapy
DMDD does not have a specific form of therapy designed for it, so professionals will utilize treatments proven effective for conditions with similar symptoms. Therapists will specialize in certain therapeutic styles based on their education, training, and experience.
Possible therapy types of disruptive mood dysregulation disorder include:
Known as CBT, cognitive-behavioral therapy helps show teens and children 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, so minor issues do not trigger major frustrations.
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. Parent training can help prevent outbursts and improve the parent response once an outburst begins to shorten the duration and reduce the intensity. Throughout parent training, the parents will learn ways to stay consistent and predictable while rewarding the child’s desired behaviors.
Children with DMDD may inaccurately perceive the facial reactions of other people, leading to anger and hostility. 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.
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 seekings and towards more desired outcomes. By engaging the child with creative play based on metaphors, instead of talk, the therapist creates change (FN3).
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.
Intended Treatment Outcome & Timeline
Treatment for DMDD is intended to reduce and manage symptoms of irritability and outbursts so that daily functioning is not affected. Though this is the desired result, achieving this may be difficult.
Experts report that about half of the children with chronic irritability linked to DMDD will see symptoms resolve within a year. The other half will observe symptoms that persist (FN1). Due to limited research targeting this new condition, establishing the treatment timeline is problematic.
The children with DMDD who do not see their symptoms resolve may see their symptoms shift over time. Symptoms of DMDD usually diminish as they approach adulthood. They may experience no symptoms, or they could see other depressive or anxious symptoms emerge (FN1).
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:
For the irritability and mood issues linked to DMDD, antidepressants may be a good option. One notable risk of using antidepressants with adolescents is the possible increased risk of suicidal thoughts and actions in some. A few specific antidepressant drugs that may be used off-label forDMDD are duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil,), and sertraline (Zoloft) (FN2).
If a person with DMDD has temper outbursts severe enough to end with physical aggression, violence, and destruction to property, an atypical antipsychotic could be prescribed. 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. The downside is the list of side effects from these drugs like suicidal thoughts, weight gain, and sedation (FN5).
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 (Adderall) can reduce the degree of irritability a child experiences. The side effects of stimulant medications involve cardiac changes, so someone starting these medications should receive monitoring for their blood pressure and heart rate (FN6).
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.
Additional DMDD Treatments
Children withDMDD will encounter frequent issues in school, so effective interventions will include some level of communication between the treatment team and the school officials (FN5). 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 causal charts employed in the classroom. With increased consistency and structure, the child with disruptive mood dysregulation disorder can find more success in school.
For DMDD, professional therapy and medication management will be essential towards improving symptoms, but the addition of at-home lifestyle changes can boost the effectiveness of the other treatments.
Children with DMDD should:
- Stick to their treatment plan by attending therapy and using the medications as prescribed
- Try to get regular exercise to stay active
- Eat healthy foods and get plenty of rest
- Shift their thinking to become more positive and hopeful
- Work on improving relationships with peers and family members to gain extra support
- Remain 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 in your life, you should seek an evaluation from a mental health professional as soon as possible. Early and effective treatment can produce the best results.
How to Get Help for a Child
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 to assess treatment options can:
- Contact the child’s primary care doctor/ 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 the 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:
- Before the introduction of DMDD, loose diagnosing resulted in a 40-fold increase in childhood bipolar disorder
- About 75% of children with DMDD symptoms also had ADHD symptoms and oppositional defiant disorder symptoms
- 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
Living with DMDD: Coping & Managing Symptoms
Living in a household affected by DMDD may be challenging, so parents should practice patience, consistency, and self-care to produce the best results.
Coping skills parents can use to benefit the child with DMDD include:
- Offering support and encouragement to the child
- Establishing a team approach where the family is working with each other, instead of against each other
- Finding ways to have fun together and engage in pleasurable activities
- Setting the child up for success by structuring time at home, offering rewards for wanted behaviors, and working towards goals
- Maintaining medication and therapy appointments
Parents should always avoid negative coping skills when managing DMDD. Some may feel so overwhelmed by the stress and frustration of managing their child that abusing alcohol or drugs becomes appealing. This practice must be avoided as it only makes the stress increase over time.
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.
Disruptive Mood Dysregulation Disorder vs. Other Depressive Disorders
Even though the DMDD is categorized as a depressive disorder, it shares few similarities with conditions 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 (FN1).
Disruptive Mood Dysregulation Disorder 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. 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 (FN1).
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 (FN1).
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 (FN1). 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.
Disruptive Mood Dysregulation Disorder 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 (FN1).
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.
Disruptive Mood Dysregulation Disorder vs. ADHD and 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 (FN1).
Taking the time to understand and differentiate these conditions will lead to a refined treatment plan and more effective services.
DMDD and 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 ODD, anxiety, depression, and even autism (FN1).
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.
Disruptive Mood Dysregulation Disorder Diagnosis History
Disruptive mood dysregulation disorder is a mental health condition that was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 (FN1). Previous versions of the DSM did not offer a diagnosis that was appropriate for children with severe irritability. Because of this gap, many professionals were assigning a bipolar diagnosis to children with these symptoms, even if the classic bipolar disorder symptoms were not present.
The additional numbers of bipolar disorder diagnoses resulted in The American Psychiatric Association (APA) adding DMDD and refining the criteria for bipolar disorder to help children receive the most accurate diagnosis possible. Now, bipolar disorder is reserved for people with major mood episodes, and DMDD offers a diagnostic option for children who previously had an incorrect bipolar diagnosis (FN1). With the best diagnosis in place, treatment can focus on symptoms of anger and irritability of DMDD, rather than the episodes of depression and mania in bipolar disorder.
Depression Tests, Quizzes, and Self-Diagnosis Tools
Parents and teachers interested in learning more about DMDD should avoid online tests, quizzes, and self-diagnosis tools and focus on scheduling a consultation with a mental health expert.
Mental Health Evaluation
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 medical conditions (FN7).
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.
Online Quizzes and Self-Diagnosis
No online quiz or self-diagnosis tools can accurately identify disruptive mood dysregulation disorder. Only mental health experts can differentiate between typical and atypical levels of irritability and outbursts. No one should make mental health decisions based on online quizzes.
Additional Resources for Depressive Disorders
For more information about DMDD and other depressive disorders, please refer to these organizations: