Disruptive Mood Dysregulation Disorder (DMDD): Symptoms, Causes, & Treatments

What Is DMDD?

Disruptive mood dysregulation disorder (DMDD) is a childhood mental health condition characterized by persistent irritability, anger, and frequent, intense temper outbursts.¹ Children commonly experience periods of moodiness, but those with DMDD exhibit severe symptoms that significantly impact their daily lives. DMDD in children is more than “bad moods” and often requires professional support.

DMDD Vs. Bipolar Disorder

DMDD and bipolar disorder share overlapping symptoms but are two distinct mental health conditions. DMDD primarily manifests as chronic irritability and severe mood dysregulation in children and adolescents. Children with DMDD often experience frequent and intense temper outbursts disproportionate to the situation.

On the other hand, bipolar disorder typically emerges later in adolescence or adulthood and includes alternating episodes of mania and depression. These episodes can last for days or even weeks, with stable periods in between. Irritability and mood disturbances are present in both conditions, but the main difference lies in the absence or presence of manic or depressive episodes.

ODD Vs. DMDD

Some may see the tantrums and outbursts of DMDD as defiance, confusing these symptoms as oppositional defiant disorder (ODD). ODD and DMDD may appear alike, but ODD reflects a disregard for rules, structure, and boundaries rather than the irritability associated with DMDD.¹ Instead, many children with ODD appear disinterested and indifferent.

DMDD Vs. ADHD

Attention/deficit hyperactivity disorder (ADHD) often triggers symptoms akin to DMDD, like irritability and temper outbursts. However, disruptive mood dysregulation disorder and ADHD differ in that children with ADHD can also struggle with concentration, motivation for non-engaging tasks, and impulsivity.¹

DMDD Symptoms

Disruptive mood dysregulation disorder symptoms primarily involve chronic irritability and mood dysregulation. Children with DMDD often exhibit severe temper outbursts accompanied by verbal or physical aggression directed toward people or objects. They may also have a persistently irritable or angry mood nearly every day.

Symptoms of DMDD cause difficulty functioning in various settings, including at home, school, or social environments, due to the intensity and frequency of irritability and anger. During calmer periods, children may experience a sense of sadness or hopelessness.

Symptoms of disruptive mood dysregulation disorder include:²

• A history of repeated, severe outbursts of anger more intense than the situation warrants
• Outbursts that do not match the child’s age or developmental level
• Outbursts that occur more than three times each week
• Anger or irritability without reason

What Causes DMDD?

Disruptive mood dysregulation causes vary and are not fully understood. However, research suggests that multiple factors may contribute, including brain abnormalities in areas responsible for regulating aggression and inhibition. Studies have shown increased activation in the frontal gyrus and anterior cortex.³

Other potential factors include genetic predisposition and environmental influences. While genetics may make some more susceptible to developing the disorder, environmental factors, like dysfunctional family dynamics or exposure to stressful situations, may also play a role.³ Future research to fully understand the causes of DMDD may help explain the complex interplay between biological and psychosocial factors.

Risk factors commonly seen in children with DMDD include:

• Anxiousness
• Irritability
• Difficult temperament
• Moodiness
• Lack of parental support
• Parental mental health struggles or substance use
• Dysfunctional family dynamics
• Difficulties at school or with authority

Obtaining a DMDD Diagnosis

Receiving a comprehensive evaluation 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 parents to learn more about their symptoms, history, and impacts on quality of life.

The professional may order lab tests or communicate with school staff to gather more information and rule out another medical condition.⁴ With this data, the professional will refer to the disruptive mood dysregulation DSM-5 criteria to determine a diagnosis.

Treatment For DMDD

As with depression treatment, disruptive mood dysregulation disorder treatment will focus on therapy and medication interventions that benefit the entire family system. The most effective strategies must address symptoms of DMDD and co-occurring conditions comprehensively.⁵

Therapy

Therapy techniques are a central intervention for addressing symptoms of DMDD and related disorders. These strategies aim to limit symptoms and improve functioning across all settings. Fortunately, people do not need to choose just one therapeutic intervention, and many treatment teams can employ multiple types simultaneously for the best results.

Therapy for disruptive mood dysregulation disorder may include:⁵

• Cognitive-Behavioral Therapy (CBT): CBT for kids can help show youth how thoughts, feelings, and behaviors are interconnected. Children learn to regulate their moods and increase their tolerance.
• Parent training: Clients in parent training meet with a therapist to explore how to change themselves rather than their child. This strategy can help reduce anger, aggression, and frustration in children.
• 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 behavior.

Medication

Medication can be part of a treatment plan for disruptive mood dysregulation disorder but is not always the first line of treatment. While treating DMDD often includes a multimodal approach of psychotherapy, behavioral interventions, and support from authority figures, professionals may prescribe medication to manage aggressive or depressive symptoms.

Only a qualified healthcare professional can prescribe and monitor medication. Parents or caregivers should consult healthcare providers or pediatricians to consider the severity of symptoms and the potential risks and benefits of medication for their child.

Possible medications for DMDD include:

• Antidepressants: Antidepressants may be good for the irritability and mood issues associated with DMDD. For children, a physician may prescribe an SSRI antidepressant such as fluoxetine (Prozac), escitalopram (Lexapro), or sertraline (Zoloft).*
• Atypical antipsychotics: Medications like risperidone and aripiprazole are approved for treating irritability connected to autism spectrum disorder (ASD) and may have an off-label use with DMDD.⁶
• Stimulants: Medications commonly used to treat poor concentration and impulsivity in people with 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.⁷

* This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

**This medication has a black box warning, the most serious kind of warning from the FDA for a risk of medication misuse or abuse.

Can DMDD Be Prevented?

Preventive strategies may not necessarily stop the development of DMDD but can help foster emotional regulation and adaptive coping skills. Parents should closely work with mental health professionals to develop individualized strategies and interventions. These techniques may contribute to better overall outcomes for children with DMDD.

Helping a Child With DMDD

Helping a child with disruptive mood dysregulation disorder includes a comprehensive and multidimensional collaboration between parents, teachers, mental health professionals, and caregivers. For instance, consider creating a structured and predictable environment, establishing consistent routines and rules, and providing clear expectations and consequences.

Help your child develop emotional regulation skills by teaching them coping mechanisms, problem-solving strategies, and relaxation techniques. Work with your child’s teachers to maintain consistency at home and school. Early intervention and ongoing support are crucial for helping children with DMDD thrive and develop appropriate social and emotional skills.

Below are ways to support a child with DMDD:

• Stick to their treatment plan: Stick to their treatment plan, which may involve a combination of therapy, medication, and support from healthcare professionals. Consistency is crucial when managing symptoms of DMDD.
• Encourage regular exercise and healthy nutrition: Physical activity and healthy diets can also be beneficial. Exercise has numerous mental health benefits and can help decrease irritability in children with DMDD.
• Work on improving your relationship: Foster the relationship with your child by showing empathy, patience, and understanding to create a supportive and nurturing environment that promotes emotional regulation.
• Focus on communication: Open and effective communication allows you to understand your child’s needs, emotions, and triggers. Actively listening can help them feel heard and validated.
• Maintain consistent routines: Children with DMDD thrive in predictable environments because they provide structure, security, and stability.
• Teach them healthy coping skills: Healthy coping skills like breathwork can empower your child to manage their emotions more adaptively.
• Work with their school counselors: Collaborating with school counselors and educators can ensure your child receives consistent preventive and supportive strategies across different environments.
• Educate yourself about DMDD: Support your child by learning more about DMDD through reliable sources, workshops, or parent groups. Doing so means you can better understand the condition and effective strategies.
• Take care of yourself, too: Self-care as a parent or caregiver is crucial. Prioritize your needs, seek support from others, and engage in activities to recharge. Taking care of your own well-being allows you to support your child with DMDD.
• Don’t blame yourself: Don’t blame yourself for your child’s behavior because this is not productive or healthy. Discuss with a therapist or social worker about reducing the environmental effects on your child’s behavior.

Final Thoughts

Parents and professionals may not consider disruptive mood dysregulation disorder when reviewing childhood problematic behavior. However, understanding the condition can lead to the best treatments. Treating DMDD can lower current symptoms and help prevent more serious depressive symptoms.