Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder (DMDD) is a new addition to the DSM-5 characterized by behavioral and emotional problems in children.

Acting out or misbehaving during childhood is a normal part of development. Children are continually learning new information and navigating new situations, and it is normal for them to occasionally behave poorly or have a hard time controlling their emotions. However, extreme behavioral or emotional problems might signal a less typical problem. 

Disruptive mood dysregulation disorder (DMDD) is a condition seen in children and adolescents. Young people with the disorder are often irritable or moody. Disruptive mood dysregulation disorder is a new addition to the most recent Diagnostic and Statistical Manual, Version 5. This article will explain some of the facts related to DMDD.

What Is Disruptive Mood Dysregulation Disorder?

Disruptive mood dysregulation disorder is a diagnosable psychiatric condition seen in children over 6 and under the age of 18. The condition is characterized by severe and frequent temper tantrums that are not considered typical for a child’s age. Children with DMDD are considered moody and may have dramatic mood swings that are extreme for a given situation.

Although most parents experience stages where their children have outbursts and tantrums, DMDD is extreme and distressing to both parent and child. In some cases, symptoms of DMDD can resemble bipolar disorder, and parents may be unsure whether DMDD or bipolar disorder is a more appropriate diagnosis.  

DMDD vs. Bipolar Disorder

Although still a rare diagnosis, bipolar disorder rates have been increasing in children. Bipolar diagnoses in children have been somewhat controversial, and many suggest that including DMDD in the DSM-5 can help reduce false diagnoses of bipolar in children.

There are important differences between disruptive mood dysregulation disorder and bipolar disorder. Mainly, mood disturbances in bipolar disorder occur in episodes, meaning that tantrums or outbursts might occur in brief phases. In contrast, DMDD symptoms are present on a regular daily or near-daily basis.

Symptoms of DMDD

Certain emotions and behaviors can be signs of DMDD in children. The condition is characterized by several key symptoms that are required for diagnosis. The signs and symptoms of DMDD include: 

• Anger or irritability for the majority of the day, on a daily or near-daily basis
• Verbal or behavioral outbursts three or more times per week (on average) that are unusual for a child’s age or developmental level
• Difficulty functioning in more than one situation, such as at school, at home or with friends

For a diagnosis of DMDD, a child must have been experiencing these symptoms for at least 12 months and must not go more than three months without any symptoms. Disruptive mood dysregulation disorder symptoms must not be better explained by another disorder, and negative mood symptoms should be noticeable to those around the child.

Causes of DMDD

As a relatively new clinically diagnosable disorder, it’s not entirely clear what causes DMDD. As with other mental health conditions, there are often multiple causes of psychiatric problems that interact with one another.

Disruptive mood dysregulation disorder causes have been linked to family, personality and mental health factors. For example, family factors like marriage satisfaction, parental support and substance use disorders in parents have been associated with DMDD. 

Whether or not genetics play a role in causing DMDD is not clear, and research suggests that children of parents who have bipolar disorder may be more likely to develop DMDD. In addition to family mental health, the environment a child is exposed to or aspects of their personality that make them feel uncertain or insecure can also contribute to DMDD.

Risk Factors

Similar to causes of DMDD, there are many risk factors that can contribute to whether or not a child develops DMDD. Risk factors for disruptive mood dysregulation disorder include individual characteristics, a child’s environment and the presence of co-occurring mental health problems.

There is evidence that DMDD is more common among boys and younger children. Parenting styles can also increase the risk of DMDD. For example, factors like inconsistent discipline and parental expression of negative emotions can increase the risk of developing DMDD. 

Perhaps surprisingly, children who experience higher levels of positive emotions and impulsivity might be at higher risk for DMDD. These children might be very motivated by rewards, and as a result can be particularly upset when their rewards or goals are blocked.

Diagnosing DMDD

The criteria for diagnosing disruptive mood dysregulation disorder are outlined in both the DSM-5 and International Classification of Disease, version 10 (ICD-10). However, the condition is defined and named differently in each text. 

While disruptive mood dysregulation disorder is included in the DSM-5, the same symptoms are categorized as a mixed disorder of emotion and conduct (MDEC) in the ICD-10. Both DMDD and MDEC are conditions in children that feature behavioral and emotional problems.

Although DMCC and MDEC involve similar symptoms, there is evidence that they represent slightly different conditions. MDEC in the ICD-10 requires that criteria for both conduct and emotional disorders are met for diagnosis. 

In general, diagnosing DMDD is done using the DSM criteria for disruptive mood dysregulation disorder criteria. Assessment and diagnosis of DMDD will be done by a registered psychiatrist using the DSM-5. 

DMDD and Related Conditions

Some of the mood and behavioral features of DMDD are shared with other mental health conditions. While these conditions are related and can occur at the same time, they are separate conditions from DMDD. 

• Attention-deficit hyperactivity disorder (ADHD): Disruptive mood dysregulation disorder and ADHD share similar symptoms, including irritability and behavior problems. Importantly, DMDD and ADHD often differ in the cause of behavioral problems. While behavior in children with ADHD can be linked with hyperactivity or inattention, disordered mood or problems with emotion regulation may cause behavior problems in DMDD.
• Oppositional defiant disorder (ODD): Oppositional defiant disorder often co-occurs with DMDD, as they share similar behavioral symptoms. While both DMDD and ODD include behavioral problems, a key difference between DMDD vs. ODD is that children with ODD have intent behind their behaviors. For example, children with ODD act out with the intention of making others fearful or angry.
• Autism: Children with autism often have a hard time regulating their emotions. Although outbursts and tantrums in children with autism appear similar to those in children with DMDD, these are likely driven by difficulties in processing information. DMDD and autism can co-occur, but emotional and behavioral problems in the two conditions are a result of different challenges.

Disruptive Mood Dysregulation Disorder Treatment

DMDD can be very stressful for parents, as well as their children. If it’s suspected that a child may have DMDD, it’s important to seek disruptive mood dysregulation disorder treatment. Symptoms of DMDD can prevent a child from participating in academic, social and recreational activities that are important to their development. 

Treatments for DMDD may include medication and therapy. Therapy, such as psychotherapy or parent training, should be considered before medication. If medication is necessary, therapy should still be used in combination with it.

Treating DMDD often includes identifying environmental stressors and teaching children coping skills to deal with stress or emotions. Treatments to improve functioning in a child with DMDD might also include working closely with schools or community resources.  

Appropriate treatment for DMDD can help a child participate in regular educational and social activities and improve quality of life for both the child and parent. If your child or someone you care about may be suffering from DMDD and co-occurring addiction, contact The Recovery Village today to discuss possible treatment options.

Related Topic: Disruptive behavior disorder treatment

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more