Disruptive Mood Dysregulation Disorder

Most children lose their temper. Fits of crying, anger, or irritability are a normal part of coping with frustration. As they age, they eventually master the skill of controlling their emotions. While all children are inclined to the occasional temper tantrum, frequent outbursts may indicate disruptive mood dysregulation disorder.

Disruptive Mood Dysregulation Disorder
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What Is Disruptive Mood Dysregulation Disorder?

Disruptive mood dysregulation disorder is a childhood mood disorder impacting children and adolescents ages 6 to 18. The disorder is characterized by irritability and severe outbursts of anger that interfere with daily functioning. Its symptoms are similar to that of bipolar disorder, but without episodes of mania.

The outbursts, or “temper tantrums,” are developmentally inappropriate for the child’s age and are often out of proportion to the situation. Between outbursts, disruptive mood dysregulation disorder causes consistently a low mood. Although signs and symptoms frequently manifest earlier, disruptive mood dysregulation is diagnosed after the age of 6 and before age 18.

Symptoms of Disruptive Mood Dysregulation Disorder

The symptoms of disruptive mood dysregulation revolve around a consistent irritable, angry mood with outbursts of anger. These severe moods disrupt functioning at home, in school, and with peers. Symptoms include:

  • Verbal or behavioral outbursts—The temper outbursts exceed typical “temper tantrums” common in children. They last about 30 minutes and must occur 3 or more times per week.
  • Irritable mood—Sadness, irritability, and anger are near-constant between outbursts.
  • Impaired relationships—Tantrums occur with parents, teachers, and peers. The child’s social skills suffer, which isolates them from peers.  
  • Easily frustrated—Children and adolescents with disruptive mood dysregulation disorder overreact with anger out of proportion to the situation.
  • Outbursts seem “immature”—The outbursts are unexpected for the child’s age and level of development.
  • Anxiety and depression—Those with the condition are prone to developing anxiety and depression, especially from how the disorder impacts their lives. They may struggle to make friends or do poorly in school.

Causes and Risk Factors For Disruptive Mood Dysregulation Disorder

The causes of disruptive mood dysregulation disorder are unknown. Males are diagnosed with the disorder more frequently than girls. Children with a history of losing their temper easily or who have a previous diagnosis of attention deficit hyperactivity disorder (ADHD) and anxiety have a higher chance of developing disruptive mood dysregulation disorder.

Researchers continue to search for genetic and environmental links. Having a family member diagnosed with a mental disorder, low parental support, family conflict, poverty, and poor behavior at school are risk factors that influence the traits of disruptive mood dysregulation disorder.

Brain Changes In Disruptive Mood Dysregulation Disorder

Experts have been researching specific brain changes associated with disruptive mood dysregulation disorder. fMRI imaging investigated children and adults with mood dysregulation. The brain did not respond with heightened activity triggered by tantrums, but instead with decreased brain activity in the amygdala.  

Bipolar Disorder and Dysruptive Mood Dysregulation Disorder

The diagnosis of disruptive mood dysregulation disorder intended to replace the overdiagnosis of children with bipolar disorders. Experts noticed that many of the children diagnosed with bipolar disorder who had severe, violent outbursts did not develop classic bipolar symptoms in adulthood.

Whereas mood changes fluctuate significantly in bipolar disorder, those with disruptive mood dysregulation disorder do not exhibit episodes of mania like in bipolar disorders. They consistently maintain an irritable, angry mood between outbursts. So, diagnostic criteria do not allow someone to have both diagnoses.

Comorbidities of Disruptive Mood Dysregulation Disorder

Diagnostic criteria does not allow someone to receive a diagnosis of disruptive mood dysregulation disorder with bipolar disorder, oppositional defiant disorder, or intermittent explosive disorder. Although signs and symptoms are similar, children with oppositional defiant disorder display vindictiveness—purposely acting vindictive towards others and defying figures of authority. Intermittent explosive disorder is even more similar to disruptive mood dysregulation disorder, yet without an angry mood between outbursts.

Still, other psychiatric disorders are frequently seen occurring along with disruptive mood dysregulation disorder. Attention deficit hyperactivity disorder (ADHD), depression, and anxiety disorders are the most common.

Disruptive Mood Dysregulation Disorder and Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a brain-based disorder characterized by inattention, impulsivity, and hyperactivity. The cases of ADHD are steadily increasing with approximately 6 million children in the United States suffering from the condition. According to the American Journal of Psychiatry, 30 percent of children and adolescents with disruptive mood dysregulation disorder also have an ADHD diagnosis and nearly 90 percent meet a portion of the criteria for ADHD. The main difference is that ADHD alone does not have chronic, severe anger and irritability. It is important to distinguish whether the patient has one or both disorders.

Disruptive Mood Dysregulation Disorder, Unipolar Depression, and Anxiety

Also known as major depression or major depression disorder, unipolar depression is unexplained sadness without episodic mania. It is not to be confused with bipolar disorder with mood patterns shifting from “high” to “low.” Children with disruptive mood dysregulation disorder are prone to this type of depression as they age. A 20 year study discussed in the American Journal of Psychiatry found that mood dysregulation in childhood predicted “adult major depressive disorder, generalized anxiety, and dysthymia.” Generalized anxiety disorder is another mental condition that those with disruptive mood dysregulation disorder present with.

Diagnosing Disruptive Mood Dysregulation Disorder

The symptoms of disruptive mood dysregulation disorder must be present for at least 12 months for a child to receive a diagnosis. Children often experience symptoms before the age of 10. The official diagnosis cannot be confirmed if the child is under 6 years old or over 18.

If a child or adolescent is suspected to have disruptive mood dysregulation disorder, a mental health professional follows a strict set of diagnostic criteria proposed in The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5):

  1. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
  2. The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum).
  3. The temper outbursts occur, on average, three or more times per week.
  4. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends).
  5. The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings.
  6. The diagnosis should not be made for the first time before age 6 years or after age 18. The age of onset of these symptoms must be before 10 years old.
  7. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
  8. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.

Treatment For Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder currently has no cure. It is a newly discovered disorder and experts are still researching the best treatments and outcomes. The interventions that exist at this time are treatments used in other mental conditions such as attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety, and bipolar disorder.

Psychotherapy

The main type of psychotherapy, or talk therapy, applied in the treatment of disruptive mood dysregulation disorder is cognitive-behavioral therapy (CBT). Cognitive be therapy seeks to identify the child’s beliefs, emotions, and cognitive distortions contributing to negative behavior and then altering those cognitions with problem solving strategies to reduce unwanted behavior. The children learn better coping methods instead of resorting to anger outbursts. Cognitive behavioral therapy (CBT) is also effective for anxiety.

Computer Based Training

Technology is central in our culture today, so it only makes sense that computers are incorporated into symptom management. Computer-based training is most helpful for children and adolescents who struggle with social cues. For example, perceiving another’s facial expression or gestures as angry. Research regarding its effectiveness comes from the National Institute of Mental Health during their study implementing interpretation bias training (IBT). Symptomatic individuals viewed a series of 15 faces on a computer screen until they eventually interpreted the faces as “happy.”

Family and Caregiver Intervention

Growing up with a newly diagnosed disorder requires the support of family for treatment success. Having parents and/or caregivers involved in care increases the success rates. With the help of those closest to the child, the physician can decide on a treatment plan.

Disruptive Mood Dysregulation Disorder
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The greatest benefit of family interventions is parent training. Parent training is essential, as it teaches parents how to respond to their child’s behavior. Through coaching by a professional therapist, the parents of children with disruptive mood dysregulation disorder learn to accurately pick up on their child’s quest that predicts an outburst. Once they recognize the behaviors proceeding outbursts, the parents can prevent it from occurring or decrease its severity.

Medications

While not the first line treatment for disruptive mood dysregulation disorder, medications are occasionally beneficial. Stimulants, a class of drug used for those with attention deficit hyperactivity disorder, has been known to decreases irritability. Along with a stimulant, antidepressants treat fluctuating moods. Research shows that atypical antipsychotic medications may improve outbursts. Any medication prescribed to children should be taken with caution for side effects like suicidal tendencies.

Prognosis of Disruptive Mood Dysregulation Disorder

While there is no cure, disruptive mood dysregulation disorder is a treatable condition. Children and adolescents diagnosed with the disorder can lead fulfilling lives with minimal complications into adulthood. Without intervention, however, they are prone to developing comorbid disorders. Depressive disorders are the most common. They are also at risk for risky behaviors, dysfunctional relationships, and social problems.

References

Copeland, W. E., Shanahan, L., Egger, H., Angold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. The American journal of psychiatry171(6), 668–674. https://doi.org/10.1176/appi.ajp.2014.13091213

Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders. Wiggins JL, Brotman MA, Adleman NE, Kim P, Oakes AH, Reynolds RC, Chen G, Pine DS, Leibenluft E. Am J Psychiatry. 2016 Feb 19:appiajp201515060833. [Epub ahead of print]PMID: 26892942

3 Roy KR, et al. Disruptive mood dysregulation disorder (DMDD): A new diagnostic approach to chronic irritability in youth. American Journal of Psychiatry. September 2014. 171(9): 918-924. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390118/