Disruptive mood dysregulation disorder (DMDD): causes, symptoms, and treatments
Table of content
- What is disruptive mood dysregulation disorder?
- What are the causes of disruptive mood dysregulation disorder?
- What are the symptoms of disruptive mood dysregulation disorder?
- 1. Severe recurrent temper tantrums
- 2. Temper tantrums that are inconsistent with the child’s age
- 3. Outbursts occur frequently
- 4. The mood between outbursts is persistently irritable or angry
- What can I expect from disruptive mood dysregulation disorder?
- What are the available treatments for disruptive mood dysregulation disorder in children?
Disruptive Mood Dysregulation Disorder (DMDD) is a mental health condition that primarily affects children and adolescents. It is recognized by severe, recurrent temper tantrums that are extremely excessive to the situation and inconsistent with developmental level.
The causes of DMDD include neurological disability, brain chemistry, family history, recent family divorce, death, or relocation, lack of adequate nutrition or vitamin deficiency, and a woman’s pregnancy and postpartum experience. Children who’ve had trauma, neglect, or stress in their early life are more susceptible to developing disruptive mood dysregulation disorder.
Symptoms of DMDD include chronic irritability, anger, and frequent outbursts. These symptoms are severe and can be physical or verbal in nature. As a result, patients with DMDD experience significant impairment in their daily functioning and social environment.
Treatment of DMDD includes talk therapy. Depending on the symptoms and the cause of the problem, a combination of talk therapy and medication is also suggested. Talk therapy can help patients learn how to regulate their emotions and develop new, more practical coping skills. Medicines curb the symptoms and control other co-occurring mental disorders.
What is disruptive mood dysregulation disorder?
Disruptive Mood Dysregulation Disorder (DMDD) is a mental disorder that impacts the youth, mostly children and teenagers. This condition causes intense and ongoing irritability, temper outbursts, anger, and negative mood.
DMDD is a relatively new diagnosis in the field of mental health. It was first introduced in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) in 2013 as a new disorder. A paper by Jun Chen et al. published in the October 2016 issue of Shanghai Archives of Psychiatry explains that before the introduction of DMDD, children who showed symptoms of severe and chronic irritability were often diagnosed with Bipolar Disorder. However, many experts saw this diagnosis as controversial. Mainly because the symptoms did not fit the criteria for bipolar disorder. Thus, children were being overmedicated and overdiagnosed.
Another study by Raman Baweja et al. published in the August 2016 issue of Neuropsychiatric Disease and Treatment discussed the diagnostic criteria and epidemiology of DMDD. In the mid-1990s, there was a debate about how mania (extreme mood swings) in younger patients was different from adults. Adults tend to have clear episodes of mania that can last a week or more. In children and teenagers, these phases may be less clear.
It was believed that children with mania would have long periods of rapid mood changes within a day. This led to an increase in bipolar disorder diagnoses in the U.S. But, some experts worried that the medications children received could lead to potential side effects. So, more research was necessary to find a better way to diagnose and treat these patients.
When DMDD was introduced as a separate disorder, patients could get a more accurate diagnosis and better treatment. Because this disorder is relatively new, more research and studies are necessary to understand its causes and the most effective treatments.
How common is disruptive mood dysregulation disorder?
Current research indicates that DMDD is a relatively rare condition and it affects only a small portion of children and teenagers.
According to a study by William E. Copeland, PhD, et al. published in the February 2013 issue of The American Journal of Psychiatry, the prevalence of DMDD among patients aged 2 to 17 was estimated to vary from 0.8% to 3.3%, with the highest rate in preschoolers. This study included more than 3,200 patients and involved over 7,800 observations.
DMDD often co-occurs with other common mental disorders such as anxiety, depression, or attention deficit hyperactivity disorder. Psychology Today estimates that the condition is more common in boys than in girls.
Another study by Mary A. Fristad, PhD, and her team published in the March 2016 issue of the Journal of Child and Adolescent Psychopharmacology examined the rates of DMDD in 82 children. Experts found that among children with severe irritability, only a small percentage met the criteria for DMDD. Data shows that by parental report, 31% of patients met the DMDD diagnosis criteria. But, after inpatient observation, only 16% were actually diagnosed with the condition.
The paper titled Disruptive Mood Dysregulation Disorder among Children and Adolescents by Gabrielle A. Carlson and Caroly Pataki published in the Winter 2016 issue of the Focus (American Psychiatric Publishing), indicates that a DMDD diagnosis decreases over time. Clinically ill patients with DMDD or severe mood dysregulation (age 11 years) were evaluated 2 and 4 years later. At this point, the rates dropped from 100% to 49% and 40%, respectively. This doesn’t mean that the children were healthy, just that they no longer met the full DMDD criteria.
Similar findings were noted in a LAMS study (Longitudinal Assessment of Manic Symptoms), published in 2012 in the Journal of Clinical Psychiatry. In this study, 52% of the sample met DMDD diagnostic criteria at one assessment, 29% at two assessments, and 19% at all three follow-up assessments. The rates went down from 9.3% to 5.9% from childhood to adolescence.
What are the causes of disruptive mood dysregulation disorder?
The causes of disruptive mood dysregulation disorder are still unclear because this is a relatively new diagnosis. A combination of different causes plays a role in the development of this condition. The causes of disruptive mood dysregulation disorder are listed below:
- Neurological disability
- Brain chemistry
- Family history
- Recent family divorce, death, or relocation
- Lack of adequate nutrition or vitamin deficiency
- Woman’s pregnancy and postpartum experience
1. Neurological disability
Neurological disability is a term that refers to deficits or impairments resulting from brain injury that begins during the developmental process or sustained brain damage. The brain plays a key role in regulating emotions and behavior. When a child experiences any disruptions in normal brain function, then it can make it harder to control the mood. Children with neurological disabilities, such as migraines, autism, hyperactivity disorder, and learning and developmental disorders, may be more susceptible to developing DMDD.
Neurological disability becomes a cause of disruptive mood dysregulation disorder because it can lead to changes in behavior and impulse control. For example, children with migraines can regularly experience mood swings, Dr. Parisa Gazerani from Oslo Metropolitan University in Oslo, Norway explains in a study published in the April 2021 issue of Behavioral Sciences. Their mood mostly changes when the headaches occur. They often have trouble thinking, experience irritability, confusion, poor concentration, lower or higher energy, and depression. If the migraine symptoms are severe and regular, then children might develop persistent aggressive behavior and irritability. This could lead to a diagnosis of DMDD.
Children with autism can struggle with socializing, understanding, and regulating their emotions. Based on a recent report titled Psychiatric Comorbidities in Children with ASD: Autism Centre Experience by Iva Ivanović in the June 2021 issue of Frontiers in Psychiatry, roughly 40% to 80% of people with autism spectrum disorder also have problems with sleep. Insomnia, however, is 10 times more prevalent in children with autism compared to those without. When combined, all of these problems can lead to persistent irritability and anger, making them more prone to DMDD.
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly recorded neurodevelopmental disorders of childhood. Children with ADHD may have trouble with impulse control, which could lead to aggression and outbursts of anger. ADHD can make a child more irritable and prone to mood swings. According to the Medical Home Portal, DMDD might be comorbid with ADHD in younger patients. Children with ADHD and mood disorders may have severe and more difficult symptoms to treat. Around 16% to 26% of children with ADHD struggle with depression when younger. Of the children with both DMDD and ADHD, 41% had anxiety, and 89.7% experienced comorbid oppositional-defiant disorder (ODD).
Traumatic brain injury (TBI) could be another contributing factor to DMDD, explains Sophie Robert in a paper Traumatic Brain Injury and Mood Disorders from the November 2020 issue of Mental Health Clinician. TBI is a serious health problem that can happen from a range of causes, such as a serious blow to the head. TBI can damage the brain, causing various emotional, cognitive, and physical symptoms. Some of which can include irritability, aggression, and emotional dysregulation. These symptoms are very similar to DMDD, meaning that TBI could increase the odds of DMDD.
Neurological disability is one of the causes of disruptive mood dysregulation disorder because the affected children may face challenges on an emotional and social level. For example, it can be very difficult to communicate and interact with peers. This can lead to feelings of low self-esteem, frustration, and isolation. Such difficulties can also manifest in persistent anger, irritability, and temper outburst. Moreover, children with any of these disorders can be prone to stress due to social and academic pressures, which can further worsen their behavior and emotional control.
2. Brain chemistry
Brain chemistry is the sum of the chemical messaging that occurs in the brain and regulates moods, emotions, and daily functions. The changes in brain chemistry, particularly the neurotransmitters that regulate mood and behavior, can cause DMDD. Neurotransmitters are chemicals in the brain capable of transmitting signals between neurons. With their help, different regions of the brain can communicate with one another. Serotonin, dopamine, and norepinephrine are three key neurotransmitters that can regulate mood, behavior, and emotions, based on a post last updated in May 2022 on the website of the National Library of Medicine by Sandeep Sekhon from Delhi University in New Delhi, India and Vikas Gupta from South Carolina Department of Mental Health.
Brain chemistry becomes a cause of disruptive mood dysregulation disorder because changes in levels of neurotransmitters can influence behavior and impulsivity. For example, a child with low serotonin can show impulsive aggression and find it difficult to control their emotions. These are often classic symptoms of DMDD. Similarly, an imbalance in norepinephrine and dopamine could trigger impulsivity and problems with emotional regulation. These are other common features of DMDD. Disruptions in the stress response system can also lead to changes in brain chemistry and increase the odds of DMDD. For example, a child that’s been exposed to chronic stress or some form of trauma can have high cortisol levels. Cortisol is a hormone that affects mood, behavior, and cognitive function. If the cortisol level is too high, then the child might be more aggressive and irritable. They could also struggle with impulse control and emotional regulation.
Brain chemistry is one of the causes of disruptive mood dysregulation disorder because impaired reward processing could lead to problematic behavior and inability to feel pleasure. According to a study by Samuel W. Hawes, PhD, et al. published in the April 2021 issue of The American Journal of Psychiatry, disruptions in the reward system can contribute to the development of DMDD. The reward system regulates feelings of motivation and pleasure. Children with disruptive behavior disorders often have disrupted reward processing.
3. Family history
Family history is the record of information regarding medical history that involves direct blood relatives of an individual. It includes current and past illnesses. Family history is important because both physical and mental conditions can affect blood relatives or a person could be at a higher risk of an illness if their family member also had it. It can lead to DMDD too.
Family history becomes a cause of disruptive mood dysregulation disorder because the condition may involve a genetic component. The study by Garrett M Sparks et al. in the April 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry suggests that children and teenagers with a family history of bipolar disorder are more prone to DMDD, Classic DMDD symptoms such as severe temper tantrums and chronic irritability are often associated with behavioral and childhood mood disorders in youth at risk for bipolar disorder.
Another report from Lukas Propper and his team from the 2017 issue of The British Journal of Psychiatry suggests that children with a family history of major depressive disorder may be at risk of DMDD. If a person has a parent or a sibling with major depression, they can have a 2- or 3-times bigger risk of developing depression, compared to an average individual. The situation may be different if the sibling or parent has recurrent depression that began in early childhood or adolescence. Someone with this type of family history of depression, could be more prone to experiencing depression, explains Douglas F. Levinson, MD, for Stanford Medicine. Several genes could be linked to depression and children with DMDD are more likely to experience problems with depression or anxiety.
Family history is one of the causes of disruptive mood dysregulation disorder because parents can pass on certain genes and genetic mutations to their children. The paper by Maria Shadrina et al. in the July 2018 issue of Frontiers in Psychiatry suggests that mutations in the genes CLOCK, PER3, PER2, and CKie, can increase the odds of depressive symptoms. Therefore, people with a history of depression have a more increased expression of the circadian system genes BMAL1, PER1, and CLOCK compared to healthy individuals.
It’s important to point out that having a genetic predisposition to DMDD doesn’t necessarily mean that the child will develop the disorder. Environmental factors, like abuse or trauma, can also play a role.
4. Recent family divorce, death, or relocation
Recent family divorce, death, or relocation refers to major life changes that affect every family member. These life changes can be a source of stress and may affect family dynamics. Problems with family dynamics can contribute to DMDD. For example, children who grow up in chaotic, abusive, or stressful environments may be at risk of this disorder. Recent family divorce, loss of a loved one, or relocation can be serious life stressors that can cause or worsen DMDD symptoms.
Recent family divorce, death, or relocation becomes a cause of disruptive mood dysregulation disorder because these events can lead to feelings of abandonment, loss, confusion, and insecurity. These feelings can also progress to irritability, frustration, and emotional instability.
Family divorce can cause a lot of hostility, criticism, and neglect. The emotional turmoil of the entire process can be very stressful for the child, especially if that child is caught between custody battles and changing family dynamics.
Based on the June 2021 research paper by Rosa Willems from Tilburg University, adolescent boys of divorced parents tend to be more aggressive than girls while girls often experience problems with intimate relationships and self-esteem later in life.
Overall, divorce can significantly affect a child’s psychological functioning, which may also lead to DMDD in certain cases. Children that exhibit aggressive and disruptive behavior, including severe temper tantrums, impulsivity, and irritability may struggle with DMDD.
The death of a family member, sibling, or parent might also trigger disruptive mood dysregulation disorder. Children might have a hard time dealing with grief, sadness, and confusion. This can lead to emotional dysregulation and irritability. If the child was close to that particular family member, then they can feel a powerful sense of abandonment, which could worsen their symptoms.
Recent family divorce, death, or relocation is one of the causes of disruptive mood dysregulation disorder because it can lead to stress, irritability, and bullying. For instance, when a child or a teenager relocates to a completely different environment, such as a new school or city, they can experience significant stress. Not only can a child feel insecure, confused, or lonely in this new environment, but they could also be the subject of bullying or other types of conflict (i.e. domestic violence), which could lead to behavioral changes such as aggression, irritability, and temper outbursts. This can happen because the negative interactions or experiences have led to changes in the child’s brain chemistry.
5. Lack of adequate nutrition or vitamin deficiency
Lack of adequate nutrition or vitamin deficiency refers to consumption of an unhealthy diet that fails to deliver much-needed nutrients necessary for physical and mental health and wellbeing.
A balanced diet packed with vitamins and nutrients is essential for proper physical and mental development. A systematic review by Adrienne O’Neil et al. published in the October 2014 issue of the American Journal of Public Health suggests there is a significant relationship between unhealthy dietary habits and poor mental health in children and teenagers. Unhealthy diet can cause health problems and may even contribute to DMDD.
Lack of adequate nutrition or vitamin deficiency becomes a cause of disruptive mood dysregulation disorder because it may cause mental health problems including lack of emotional stability, which may lead to changes in behavior. What may be overlooked when it comes to DMDD disorder is that inadequate nutrition and vitamin deficiencies can increase the risk of mood disorders in youth. Unhealthy diets can put a child at risk of anxiety and depression. When paired with other causes of DMDD, like trauma, abuse, or genes, children may be more prone to developing DMDD.
Deficiencies in other vitamins and minerals, such as zinc, magnesium, and iron, might lead to mood disorders. For example, a deficiency in zinc can lead to irritability, emotional instability, depression, and anxiety, according to a book by Anna Rafalo and a team of experts, titled Nutritional Deficiency.
A study by Jeanette A. Maier and colleagues, published in the September 2020 issue of the journal Nutrients suggests that a deficiency in magnesium can cause headaches, and irritability. Iron deficiency might cause fatigue, weakness, and irritability. All of these factors might contribute to the development of DMDD. Another newer study by Gisèle Pickering et al. published in the December 2020 issue of Nutrients supports the impact of magnesium on mental health.
Lack of adequate nutrition or vitamin deficiency is one of the causes of disruptive mood dysregulation disorder because poor nutrition can also affect brain development, explains Marina Roberts et al. in a study from the February 2022 issue of Nutrients. Cognitive development in infants and children depends on adequate nutrition. When a child doesn’t consume the necessary nutrients and vitamins, it puts them at risk of having impaired cognitive skills. Problems such as these could lead to long-term mood disorders, such as DMDD.
Eating whole foods and an anti-inflammatory diet high in veggies and omega-3 fatty acids might prove useful for preventing mental health disorders like DMDD. Focusing on foods low in sugar, salt, and processed products may even help recovery. But, more research is necessary to study the full effect of nutrition and vitamin deficiencies in patients with DMDD disorder.
6. Woman’s pregnancy and postpartum experience
Woman’s pregnancy and postpartum experience refers to emotional and mental health that women experience during pregnancy and after childbirth. What happens during pregnancy and following the birth of the baby can have a major impact on the child’s development. For that reason, the mother’s experience during pregnancy and postpartum can contribute to development of DMDD.
Woman’s pregnancy and postpartum experience becomes a cause of disruptive mood dysregulation disorder because it can cause mood disturbances and anxiety. Hormonal changes in estrogen and progesterone levels can cause fatigue, physical stress, and change in the metabolism. Serious changes in hormone levels can also affect the neurotransmitters, which can regulate mood.
Women who experience complications during pregnancy and delivery may develop postpartum depression. About 1 in 7 women can experience postpartum depression (PPD). This is a severe mood disorder that can affect the mother’s ability to bond with her child or care for herself. Although women who experience baby blues can quickly recover, PPD often lasts longer and severely affects the woman’s ability to return to normal function, explains Saba Mughal et al. in the post last updated in October 2022, published on the website of the National Library of Medicine.
Children of depressed mothers are more likely to struggle with behavioral and emotional problems. These can include mood swings, aggression, and irritability. These symptoms could manifest in early infancy and last throughout their childhood and teenage years. According to a study by Tiago N. Munhoz et al. from the June 2017 issue of the Journal of Affective Disorders, effective prenatal and postnatal mental health care can prevent mental disorders in newborns.
Woman’s pregnancy and postpartum experience is one of the causes of disruptive mood dysregulation disorder because it can affect development of the baby’s brain and thereby influence the child’s mood and behavior. Factors such as low birth weight, and exposure to drugs or toxins during pregnancy can contribute to the formation of DMDD. For example, babies exposed to drugs in the womb might experience developmental consequences, such as impaired growth, changed brain development, and birth defects. These factors can have a negative impact on the developing brain and make the child more prone to mood disorders.
What are the symptoms of disruptive mood dysregulation disorder?
The symptoms of disruptive mood dysregulation disorder are present in patients between the ages of six and 18, stated Anna Smith Haghighi for Medical News Today. The DMDD symptoms are listed below:
- Severe recurrent temper tantrums
- Temper tantrums that are inconsistent with the child’s age
- Outbursts occur frequently
- The mood between outbursts is persistently irritable or angry
1. Severe recurrent temper tantrums
Severe recurrent temper tantrums are unplanned outbursts of anger and frustration by children that can be physical, verbal, or both. Severe temper tantrums are temper tantrums that last longer than 15 minutes. The lengthy temper tantrums are a sign of a serious problem such as DMDD.
Severe recurrent temper tantrums become a symptom of disruptive mood dysregulation disorder because children with this mental illness struggle to regulate their moods, emotions, and behaviors. For that reason, the children may respond to stressful situations or negative stimuli with extremely emotional and physical outbursts. The symptoms of temper tantrums can frequently occur, often daily, and last for a very long time, sometimes a couple of hours whereas temper tantrums in healthy children are brief episodes of vocal or physical outbursts. They can last longer than 15 minutes whereas “regular” temper tantrums last from two to 15 minutes.
Severe recurrent temper tantrums are one of the symptoms of disruptive mood dysregulation disorder because they are triggered involuntarily or impulsively by a minor inconvenience. A minor event can trigger a tantrum, such as their favorite TV show getting canceled, or breaking their favorite toy. The tantrums can occur several times a week or even daily, and the child might find it difficult to recover from them. Therefore, the child may remain angry or upset for hours after the temper tantrum ends. It’s also possible that the child might engage in self-harm behaviors during a tantrum, such as banging their head against a wall or pulling their hair. The intensity and frequency of these temper tantrums can interfere with the child’s academic performance, daily functioning, and social relationships.
Severe recurrent temper tantrums, as a symptom of DMDD, are identified as a display of verbal aggression, such as swearing, yelling, and insulting others. During a tantrum, the child might throw things, kick or hit people, or destroy objects that are closest to them. Children with DMDD might start to bite or hit people, scream, and refuse to listen to any attempts at calming them down.
Parents and caregivers might find it difficult to manage these tantrums and may feel helpless or frustrated. It is critical to point out that these tantrums are not the child’s fault. They are a manifestation of an underlying neurological and emotional dysregulation associated with DMDD, or a range of other causes.
2. Temper tantrums that are inconsistent with the child’s age
Temper tantrums that are inconsistent with the child’s age are angry outbursts that are more intense than normal temper tantrums in children of the same age group. When a temper tantrum is inconsistent with a child’s age, it means that the duration, frequency, and intensity of the outburst are not appropriate for their developmental level. For example, a typical tantrum for a toddler may involve breath-holding spells, whining, crying, hitting, and kicking. But, a child that is older and more emotionally mature, shouldn’t engage in such behavior.
Temper tantrums that are inconsistent with the child’s age become a symptom of disruptive mood dysregulation disorder because they are extreme emotional reactions to minor problems.
The inconsistency of temper tantrums in children with DMDD is worrying because it can interfere with the child’s ability to adapt to their environment. It can cause emotional distress for both the child and their parents or caregivers.
A study published by Amy Krain Roy, Ph.D. et al. in the September 2014 issue of The American Journal of Psychiatry talks about an 8-year-old boy who got diagnosed with a disruptive mood disorder. According to his parents, the boy had always been a difficult child. As a baby, he experienced severe pain in the abdomen due to intestinal or wind obstruction. So, he cried constantly for a couple of hours every day. As a toddler, the boy threw tantrums a couple of times per day. Unfortunately, as the boy got older, the outbursts became worse. By the time the boy turned five, his temper tantrums caused him to kick and hit his parents. He would also throw breakable objects. These behavioral and emotional problems were also present outside the home, which caused him to be expelled from Pre-K. When the boy started school, his tantrums increased. Homework made him feel frustrated and he showed strong opposition to finishing his homework when asked. He was fidgeting, constantly restless, and hard to control.
The boy also threw tantrums regularly to avoid doing daily chores, such as brushing his teeth or picking up his clothes. During this period the irritability also got worse. In first grade, he seemed to be constantly “on edge” and easily bothered by little things e.g. when someone sat down too close to him. Many of his causes for anger were over exaggerated. He also believed that he didn’t have any friends, no one liked him, and his parents didn’t love him.
Temper tantrums that are inconsistent with the child’s age are one of the symptoms of disruptive mood dysregulation disorder because it can be difficult for a child to control their thoughts, especially negative ones, which can affect their mood and behavior. Good example is the case of the boy described above. Sometimes, the thoughts he had were so difficult to control that they would send him into a “mind spiral”. The boy would then bring up events that made him angry out of nowhere and start yelling. These events happened a couple of days before.
Temper tantrums that are inconsistent with the child’s age, as a symptom of DMDD, are identified as a child becoming easily provoked, which is not appropriate for the child’s developmental level. They are overly sensitive to rejection, criticism, or taking ‘no’ for an answer.
3. Outbursts occur frequently
Outbursts occuring frequently refers to the increased frequency of the temper tantrums i.e. angry physical or verbal outbursts. Frequent outburst means that the child can have multiple outbursts per week or even a day. Outbursts in children can vary in intensity, duration, and frequency. Children with a disruptive mood disorder may struggle with frequent temper outbursts. These outbursts are very different from normal outbursts. A normal outburst can be triggered by something specific and short-lived. A DMDD outburst can occur suddenly, and even a long time after a triggering event has happened.
Outbursts occuring frequently become a symptom of disruptive mood dysregulation disorder because children with anger issues might find it difficult to calm down after an outburst, and their emotions could linger for a very long time. In contrast, children without DMDD or anger issues may experience outbursts that are less intense and occur less frequently. They are usually able to calm down soon after the outburst has ended. The outbursts may occur in two or three settings, such as at home, school, or when socializing with friends.
Outbursts that occur frequently are one of the symptoms of disruptive mood dysregulation disorder because the condition causes impulsivity and behavioral problems which pave the way to exaggerated reactions. Children with DMDD can be more impulsive, and oppositional, and have trouble following directions or rules, especially from authority figures (i.e. parents, caregivers, or teachers).
As a symptom of disruptive mood dysregulation disorder, outbursts that occur frequently are identified as temper tantrums or angry outbursts that are persistent, frequent, and severe.
4. The mood between outbursts is persistently irritable or angry
The mood between outbursts is persistently irritable or angry refers to feelings of frustration and anger that may arise from the smallest things even when the temper tantrums are over. Persistent irritability or anger can be a symptom of behavioral problems and may occur due to DMDD.
The mood between outbursts being persistently irritable or angry becomes a symptom of disruptive mood dysregulation disorder because children with this condition have a lower threshold for emotional arousal, which could indicate they become easily irritated or angry. This irritability can last most of the day, almost every day, explains Susan D. Mayes, PhD et al. in their study from the March 2016 issue of the Journal of Child and Adolescent Psychopharmacology. They may also find it difficult to return to a baseline emotional state after becoming upset. This symptom can make it difficult for the child to form positive relationships with friends, teachers, and parents. It can lead to problems in social settings, school, and at home.
The mood between outbursts as persistently irritable or angry is one of the symptoms of disruptive mood dysregulation disorder because children with this disorder often have trouble regulating their emotions, which could lead to meltdowns. They can feel angry or frustrated about small things and find it difficult to let go of negative emotions.
As a symptom of disruptive mood dysregulation disorder, the mood between outbursts as persistently irritable or angry is identified as the persistent irritability or anger between outbursts that last most of the day, reported Caroline Miller for the Child Mind Institute. The children might have trouble sleeping, concentrating, and difficulty forming or maintaining interpersonal relationships.
What can I expect from disruptive mood dysregulation disorder?
From disruptive mood dysregulation disorder, it can be expected that symptoms often start before the age of 10. This mental health disorder doesn’t extend into adulthood. But, without treatment, it can have a significant impact on the child’s life. The frequent and severe temper outbursts, along with the persistent anger and irritability between outbursts, can disrupt the child’s daily routine and social interactions.
Children with DMDD can struggle to form and maintain relationships. They can easily get into conflicts, which can hinder their academic performance, and ability to learn and concentrate. The disorder can lead to feelings of sadness, anxiety, hopelessness, and low self-esteem. As a result, a child with DMDD might be at risk of developing other mental health conditions, such as anxiety or depression.
DMDD can also affect the family dynamic. The constant outbursts and irritability can cause stress and tension within the family. Family members may experience feelings of frustration, guilt, or helplessness, as they try to support their child and manage the disorder. Therefore, it is critical to identify and treat DMDD as soon as possible. Early treatment can minimize the impact on a child’s life and help the child improve their relationship with siblings, parents, and friends.
Who is at risk for disruptive mood dysregulation disorder?
There are several risk factors associated with DMDD. These include being male, having a family history of anxiety, depression, abuse, or trauma, and being ill-tempered before the age of 10.
According to CBC (Cognitive & Behavioral Consultants), males are more likely to develop DMDD than females. One reason could be that boys tend to repress their emotions. When they do get a chance to express themselves, they might become really angry. They can throw a tantrum or show aggression and irritability.
According to a review by Samiksha Sahu and colleagues in the July-December 2020 issue of the Industrial Psychiatry Journal, many children with DMDD came from families where there was marital conflict such as, their parents going through a divorce, being exposed to chronic stress, History of childhood sexual abuse was another risk factor.
Children were also found to be irritable due to neglect, like after the birth of a sibling. Parents of these children would notice that the outbursts, anger, and irritability would increase after a conflict with their sibling. In this study, it was found that 50% of cases had serious relationship problems with their siblings.
A family history of abuse and trauma increases the risk of DMDD. Children who experience emotional, physical, or psychological trauma, might find it difficult to regulate their emotions. This could cause severe and frequent outbursts. Also, children with a family history of anxiety or depression might be prone to more negative mood states. They could have trouble coping with stress, which could cause an outburst. Children with DMDD might have dysfunction of amygdala, which is a part of the brain that processes emotions, stated Ellen Leibenluft, M.D in her paper Pediatric Irritability: A Systems Neuroscience Approach from the April 2017 issue of Trends in Cognitive Sciences. A study by Andreas Bauer et al. in the March 2023 issue of the Lancet Psychiatry confirms that children and teens with a history of abuse and trauma could be more prone to developing DMDD.
Being ill-tempered before the age of 10 can be another risk factor for DMDD. Children with a low tolerance for frustration, who are easily frustrated, and are quick to anger, become more prone to DMDD. But, it is important to point out that just because a child has these risk factors, it doesn’t guarantee that they will develop DMDD. However, if the child does experience symptoms of DMDD, it is important to consider these risk factors and consult with a mental health specialist.
How is disruptive mood dysregulation disorder diagnosed in children?
To diagnose a child with DMDD, mental health experts need to do a thorough evaluation. Diagnosing DMDD in kids starts with a clinical interview with the child and their parents or caregivers. The clinical interview can help assess the child’s symptoms, mood, behavior, history, and functioning.
For a child to be diagnosed with a DMDD mental disorder, they must meet specific diagnostic criteria outlined by Cecil R. Reynolds, PhD and Randy W. Kamphaus, PhD in the BASC3 (Behavior Assessment System for Children, Third Edition). The child must have severe recurrent temper outbursts that manifest behaviorally (i.e. physical aggression toward people or things) and/or verbally (i.e. verbal rages). These outbursts must be severe and inconsistent with the child’s developmental level. They should occur 3 or more times per week. Even if the outburst ends, the negative mood persists. For someone to be diagnosed with the condition, the symptoms must be present for 12 months or more; with no more than 3 months in a row without symptoms. The symptoms should occur in at least two settings (e.g. home, school, when spending time with friends) and be severe in at least one setting, explains Uma Rao from Meharry Medical College in Nashville, Tennessee in a paper published in the October 2014 issue of Asian Journal of Psychiatry.
To get an accurate diagnosis of DMDD, mental health experts need input from other people about how the child handles social interaction, tasks, and other aspects of life in different settings. This can give the expert a complete picture of the child’s behavior. For example, the healthcare expert may ask teachers or caregivers to provide additional information about how the child has been acting, including whether or not the child has problems with academic performance and interpersonal relationships. If the healthcare expert suspects the child to have DMDD, then they may recommend different treatment methods to alleviate the symptoms.
It is important to mention that doctors don’t diagnose DMDD in children younger than 6 or adolescents older than 18, stated the Cleveland Clinic.
What are the available treatments for disruptive mood dysregulation disorder in children?
There are several available treatments for this dysregulation disorder. The two of the most commonly used treatments include:
- Cognitive-behavioral therapy (CBT)
In certain cases, combination therapy may be suggested. This can be a viable approach if the child doesn’t respond well to CBT alone. It is critical for parents and caregivers to work closely with mental health experts to get a personalized treatment plan that can work for their child with DMDD.
1. Cognitive-behavioral therapy (CBT)
Cognitive-behavioral therapy (CBT) is a widely used psychotherapy technique that helps change negative thoughts and behaviors that contribute to mental health disorders. This type of talk therapy is used for treatment of mental health disorders such as depression, anxiety, substance use disorder, and it can also help with DMDD.
Cognitive behavioral therapy helps to treat disruptive mood dysregulation disorder because it focuses on helping children develop healthy coping and problem-solving skills. It can help the child identify and challenge their negative thoughts, and improve communication, and social skills.
CBT can be done in individual or group sessions. The goal is to teach the child how to identify negative beliefs and thoughts that contribute to their irritability and anger e.g. how to replace negative self-talk with more positive and adaptive thinking.
Cognitive-behavioral therapy is one of the best treatments for disruptive mood dysregulation disorder because it helps patients adopt new skills that improve their functioning. The new skills that the child can learn during CBT can help them develop strategies to manage their emotions, such as relaxation techniques.
Cognitive-behavioral therapy is an effective treatment for disruptive mood dysregulation disorder and its effectiveness is scientifically proven. Good example is a report by Megan E. Tudor et al. in the October 2016 issue of Clinical Case Studies, which confirmed that CBT was an effective treatment approach in a 9-year-old girl with DMDD.
The girl struggled with anger and aggression and a co-occurring ADHD. During the evaluation, the girl had 3 to 4 temper outbursts and 2 to 3 episodes of aggressive behavior per week including prolonged displays of non-episodic irritability that lasted for hours or days at a time.
After 12 CBT sessions over 12 weeks and 5 follow-up sessions, the girl experienced a significant decrease in the target symptoms such as aggression, irritability, and anger. One of the main benefits of CBT for DMDD is that the treatment can be tailored to the patient’s needs. This means children can get individualized treatment that can target their specific problems.
Moreover, CBT can help the child develop long-term coping mechanisms that can prove useful later in life. Another benefit of CBT is that this is a relatively short-term treatment.
How long it takes for CBT to take effect depends on severity of the symptoms and co-occurring mental disorders. Typically, it lasts between 12 and 20 sessions. Duration of each session is 30 to 45 or 60 minutes.
Medication is pharmacotherapy or pills that doctors prescribe for management of physical or mental health conditions. Doctors may prescribe specific medications in combination with therapy to treat DMDD.
Medication helps to treat disruptive mood dysregulation disorder because it can decrease anger outbursts, aggressive behavior, irritability, and other mood problems. Different medications may be recommended based on whether the child has other comorbid disorders. The three most used categories of medicine for DMDD are antipsychotics, antidepressants such as selective serotonin reuptake inhibitors (SSRIs), and stimulants.
Antipsychotic medications were primarily designed to relieve the symptoms of psychotic disorders, such as schizophrenia. Newer products, such as risperidone (Risperdal) and aripiprazole (Abilify) can help treat irritability in autistic patients and decrease the symptoms of DMDD. These medications are often used to decrease anger outbursts and aggression. However, they can cause some side effects, including metabolic and hormonal changes, sedation and notable weight gain.
Antidepressant medications can help with anxiety and mood disorders by improving the balance of neurotransmitter serotonin. They are designed to decrease feelings of sadness, mood problems, and irritability in teenagers with DMDD. However, this medication can also cause side effects, such as restlessness, headaches, and insomnia.
Stimulant medications can treat ADHD symptoms. For patients with DMDD and ADHD, options like dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) may be recommended to decrease irritability. They too can cause side effects, such as sleep problems, reduced appetite, moodiness, and increased blood pressure.
Medication is one of the best treatments for disruptive mood dysregulation disorder because they help manage problems with brain chemistry such as improving balance of neurotransmitters. At the same time, medications can improve the effectiveness of CBT. According to a study that S.D. Hollon et al. published in the October 2014 issue of JAMA Psychiatry combination of antidepressants and therapy may lead to significant improvements and faster recovery from depressive symptoms.
Medications are an effective treatment approach for management of DMDD although more research is necessary focusing on this condition specifically. An article by Stephen P. Hinshaw from the 1991 issue of the Journal of Clinical Child Psychology found clinically significant reductions of aggressive behavior with stimulant medications. Additionally, F.V. Krieger et al. found in their study from the June 2011 issue of The Journal of Child and Adolescent Psychopharmacology that antipsychotic medication such as risperidone could be effective in reducing irritability.
It may take around six weeks for antipsychotics to work, but full effects may require several months. Antidepressants may need one to two weeks to take effect, but noticeable improvements require four to eight weeks. The stimulant medications take effect as soon as they cross the blood-brain barrier, which may take 45 to 60 minutes.
How to reduce disruptive mood dysregulation disorder?
Even though DMDD can be a difficult condition to manage, there are strategies that can help reduce the symptoms and improve the quality of life. Key points to reduce disruptive mood dysregulation disorder are listed below:
- Seek professional help: It is critical to consult with a mental health professional if you suspect a child has DMDD. Healthcare experts can provide a proper diagnosis and recommend the best type of treatment.
- Therapy: Psychotherapy, especially CBT, can help patients with DMDD develop coping mechanisms to deal with their mood swings and temper outbursts. CBT can also teach patients how to recognize and manage their emotions more effectively.
- Medications: If the DMDD symptoms are severe, a mental health expert might recommend medications. Antidepressants and antipsychotic medications are commonly used. But, the treatment will vary based on the severity of the DMDD and other co-occurring mental disorders.
- Parental support: Parents must offer their child the necessary support to control the DMDD symptoms. They should provide the child with a healthy diet, consistent routine, and exercise. The goal is to promote stability and decrease stress.
- Identify triggers: It’s important to know the triggers that cause mood swings and temper outbursts. Every child is different. So, it’s best to encourage the child to talk about their feelings and monitor their behavior.
- Create consistency: Children with DMDD benefit from a routine and consistency. Establishing a regular sleep schedule, mealtimes, and homework time might help the angry mood.
Is disruptive mood dysregulation disorder a mental illness?
Yes, disruptive mood dysregulation disorder is a mental illness. It is classified as a mood disorder in children under the DSM-5. DMDD is a mental illness because it significantly impairs a child’s ability to function at home, school, or with peers. Additionally, DMDD shares many similarities with other mental illnesses, such as bipolar disorder and major depressive disorder. Both DMDD and bipolar disorder cause chronic irritability. DMDD and major depressive disorder (MDD) also share some symptoms, such as persistent irritability, anger, and sadness. Both health problems can lead to feelings of hopelessness, guilt, and worthlessness.
What is the difference between DMDD and bipolar disorder?
The difference between DMDD and bipolar disorder is that irritability in patients with bipolar disorder only happens during manic episodes, which occur sporadically. On the flip side, in DMDD the irritable mood is severe and persistent or chronic. Between two manic episodes, a person with bipolar disorder feels a regular level of emotion, but a patient with DMDD experiences anger and irritation almost all the time. Additionally, when it comes to disruptive mood dysregulation disorder vs. bipolar disorder, it’s important to keep in mind that the children with DMDD don’t experience euphoria, goal-directed behavior, and sleeplessness all of which is associated with mania.
While the symptoms of bipolar disorder are contained within episodes, they are more ongoing in patients with DMDD. Most importantly, DMDD isn’t a lifelong condition and it is likely to change into anxiety or depression in adulthood, but bipolar is a lifelong condition.