Friday, February 12, 2016

What is Disruptive Mood Dysregulation Disorder?

DMDD is a new diagnosis for children who have extreme and frequent temper tantrums. Find out more about this disorder.

What is Disruptive Mood Dysregulation Disorder?


Today’s guest blogger is R. Rao Gogineni,M.D., head of the division of child & adolescent psychiatry, at Cooper University Hospital and associate professor of psychiatry at Cooper Medical School of Rowan University.

Occasional temper tantrums and bad moods are a normal part of growing up.  Many children are irritable, upset or moody from time to time. However, there may be a problem for children with severe and frequent temper tantrums that interfere with their ability to function at home, in school, or with their friends.

To address this condition, the American Psychiatric Association proposed a new diagnostic classification called Disruptive Mood Dysregulation Disorder in its new manual (DSM-5) released in May. A child must have rages that are "grossly out of proportion" three or more times per week on average to receive a DMDD diagnosis.

The symptoms of DMDD include:

  • Severe verbal and/or behavioral temper outbursts, on an average three times a week. These temper outbursts are inconsistent with the child’s developmental level.
  • Mood between outbursts is persistently irritable or angry almost every day.
  • The child has trouble functioning in more than one setting (e.g., home, school and/or with friends).
  • The child’s reaction is more magnified than expected.
  • The child must be at least six years old and symptoms must begin before age ten.
  • The symptoms are present for at least a year.
More coverage
Move over protein shakes! 5 power foods every teen athlete needs
Which milk alternative is best for your child?
You say yes, I say no: Parenting style may affect teens’ behaviors
The truth about whole grains

Exclusionary criteria include presence of mania, major depressive disorder, dysthymia, psychosis, post-traumatic stress disorder, pervasive developmental disorders, or separation anxiety.

Prevalence rates of DMDD are estimated to be 0.8 to 3.3 percent. Research demonstrated children with this disorder may later develop depression or anxiety, but not bipolar disorder.  

The major reason the APA proposed this diagnosis was a finding that between 1994-1995 and 2002-2003, the diagnosis of bipolar disorder grew by 40-fold in children and that many of these children had behaviors that were not consistent with a bipolar diagnosis. 

The new diagnosis isn’t without some controversy. Ellen Leibenluft, MD, of the National Institute of Mental Health, who is responsible for the research leading to the DMDD classification, and Gabrielle Carlson, MD, a leading authority on bipolar disorder from Stony Brook University, concurred with this finding. But some other leading authorities and some anti-psychiatry groups fear that the new DMDD diagnosis will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children.

What can be done?

The treatment for DMDD needs to be individualized and may include individual therapy, and working with the family and school. It may also include the use of medication to help address specific symptoms. Parents should learn about the disorder, the specific treatment options and feel free to get a second opinion. Having a child with DMDD can be a challenging experience. Appropriate treatment for the child is important.

Here’s a case example:                                                                                                                                               

A 6 year-old boy, living with his mother, step father and younger sister was brought to the clinic with history of severe temper outbursts, both verbal and behavioral (throwing things, stomping, hitting self and others) “when things don’t go his way”. This would last 10 minutes to 2 hours, or until he became tired.  This happened almost daily and sometimes several times a day. Often he was angry and irritable. Attention span for desired activities was not impaired. These tantrums started when he was 2 ½ yrs of age.  There was no known family history of bipolar disorder.  

The treatment prescribed included parent education, training, supportive child therapy and 1 mg of long acting Guanfacine (Intuniv) once a day with a plan to use for 3 to 6 months if needed. After three months, there was marked improvement in his behavior. If a child is symptom free for three months, we try to taper medication off and then stop. About a quarter of the time, a child may require medication longer term.

For more information about children with DMDD and other challenging behaviors:

The Balanced Mind Foundation

National Alliance on Mental Illness

Mental Health America

Read more from the Healthy Kids blog »

We encourage respectful comments but reserve the right to delete anything that doesn't contribute to an engaging dialogue.
Help us moderate this thread by flagging comments that violate our guidelines.

Comment policy: comments are intended to be civil, friendly conversations. Please treat other participants with respect and in a way that you would want to be treated. You are responsible for what you say. And please, stay on topic. If you see an objectionable post, please report it to us using the "Report Abuse" option.

Please note that comments are monitored by staff. We reserve the right at all times to remove any information or materials that are unlawful, threatening, abusive, libelous, defamatory, obscene, vulgar, pornographic, profane, indecent or otherwise objectionable. Personal attacks, especially on other participants, are not permitted. We reserve the right to permanently block any user who violates these terms and conditions.

Additionally comments that are long, have multiple paragraph breaks, include code, or include hyperlinks may not be posted.

Read 0 comments
comments powered by Disqus
About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
Latest Videos
Also on
letter icon Newsletter