Disruptive Mood Dysregulation Disorder (DMDD) is a condition defined by chronic anger and irritability and explosive, often violent tantrums that occur several times per week. DMDD is a somewhat new diagnosis; it appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. The condition was identified, in part, in response to clinicians’ concerns about the misdiagnosis and over-diagnosis of bipolar disorder (BD) in young children. Children with DMDD do not have the manic episodes that children with BD exhibit. In addition, therapies and medications used to treat BD and DMDD are different, making it paramount that the conditions not be confused.
The causes of DMDD are still being studied, but the condition is thought to be triggered by neurological abnormalities such as chronic migraines, nutritional deficiencies, abnormalities in brain chemistry, early childhood trauma, and/or parental history of mental illness.
DMDD is diagnosed in children as young as six and under the age of 18. Prior to age six, their explosive tantrums may be considered an aspect of their development. For diagnosis, the hostile interactions must occur with both peers and authority figures; in other words, the tension cannot be the result of a given relationship but must be a product of the child’s inability to regulate themselves in most settings. The symptoms must appear three or more times per week, for 12 months or longer.
Children with DMDD often confuse neutral expressions or other innocuous triggers as threats. This may be due to a malfunctioning of the brain’s amygdala, which regulates emotional behavior. When triggered by these feelings of danger, they may respond with far more intensity than required.
Children with DMDD also have poor executive function skills due to an immature prefrontal lobe in comparison to other children their age. This contributes to problems with planning, emotional regulation, and inhibition. DMDD makes children appear angry and irritable and have explosive outbursts in all environments - not just at home. Secondary characteristics of DMDD include poor working memory, poor visual-spatial reasoning, poor planning and organization skills, and a short attention span. Children with DMDD often are unable to understand the needs of others when they’re under distress, and they have a very low tolerance for frustration.
DMDD is often co-diagnosed with ADHD and anxiety disorder and depression, which makes treatment decisions complex. When dealing with comorbid conditions, DMDD is usually addressed by therapeutic interventions and while the symptoms of the other condition are addressed pharmacologically. As children with DMDD may be a risk to themselves and others, it is critical that they receive help as soon as possible.