What Is Disruptive Mood Dysregulation Disorder (DMDD)?

Disruptive mood dysregulation disorder is a fairly new diagnosis assigned to children who have frequent anger outbursts and ongoing irritability.  While disruptive mood dysregulation disorder presents some difficult symptoms, it is treatable.

What is DMDD?

Disruptive Mood Dysregulation Disorder (DMDD) is a condition marked by extreme anger, irritability, and emotional outbursts in children.  Although every child experiences moodiness from time to time, DMDD symptoms go far beyond the typical ups and downs of children’s moods.  Children diagnosed with DMDD have severe temper tantrums that are hugely out of proportion to the trigger or situations.  

The DMDD diagnosis was created in response to many children being inappropriately diagnosed with pediatric bipolar disorder.  Pediatric bipolar disorder was often assigned to children who did not actually experience the mania characteristic associated with bipolar and thus were given an inaccurate diagnosis (DMDD vs. Bipolar Disorder: What’s the Difference?).

Research indicates somewhere between 1-3% of children display symptoms of DMDD, and this diagnosis is more frequently given to males.  

Symptoms of Disruptive Mood Dysregulation Disorder

Children with DMDD typically begin to show signs before the age of 10.  DMDD can look different depending on the child, but there are some common symptoms experienced by most children.

• Angry mood nearly every day, for most of the day
• Increased irritability that interferes with functioning in more than one setting (home, school, socially, etc.)
• Severe temper tantrums (can be verbal and/or behavioral) three or more times per week

In addition to the symptoms, in order to be diagnosed with DMDD, a child must display these symptoms for 12 months or more, be between the ages of 6 to 17, and have experienced the symptoms before the age of 10.

Risk Factors for DMDD

Risk factors for disruptive mood dysregulation disorder include:

• Having a family member with a psychiatric condition and/or history of substance abuse
• Family conflict
• Difficulty in peer/social relationships
• Acting out in school
• Low socioeconomic status

Treatment of DMDD

As with many mental health diagnoses, disruptive mood dysregulation disorder is often treated with therapy, medication, or a combination of both.  

Psychological Treatments

• Psychotherapy, specifically cognitive behavioral therapy (CBT), is the most frequently used treatment approach for children with DMDD.  CBT centers on teaching children techniques to manage their moods and increase tolerance for difficult emotions.  Through CBT, the child learns how their thoughts can contribute to intensifying emotions, and thus behaviors.
• Parent training and support – support for parents is aimed at helping increase the effectiveness of interacting with children with disruptive mood dysregulation disorder.  The goal is to find ways to communicate that will help reduce irritability and aggressive behavior and to improve the parent-child relationship.

Medication for DMDD

• Stimulants – typically used in the treatment of ADHD, have also proven to be effective in decreasing irritability in children.
• Antidepressants –have been shown to help manage the mood swings and irritability associated with disruptive mood dysregulation disorder.
• Atypical Antipsychotics – prescribed in the more severe cases of DMDD, can be helpful in children whose anger outbursts have become physical (towards property or people).  Unfortunately, there are some significant side effects of atypical antipsychotics including weight gain, suicidal thoughts and/or behaviors, sedation, the onset of movement disorders, hormone changes, and others.

As with any prescribed medication, a child with DMDD should be monitored and regularly assessed by a medical professional for effectiveness and any undesirable side-effects.

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