Disruptive Mood Dysregulation Disorder (DMDD)

What is disruptive mood dysregulation disorder (DMDD)?

Disruptive mood dysregulation disorder (DMDD) is a mental health condition that causes chronic, intense irritability and frequent anger outbursts in children.

While it’s normal for children to go through periods of moodiness, DMDD is more severe and longer lasting. The temper outbursts are greatly out of proportion in intensity and/or duration to the situation. The condition disrupts your child’s daily life. Symptoms need to begin before the age of 10 to meet diagnostic criteria.

What is the difference between disruptive mood dysregulation, oppositional defiant disorder (ODD) and bipolar disorder?

Oppositional defiant disorder (ODD) is a behavioral condition in which your child displays a continuing pattern of uncooperative, defiant and sometimes hostile behavior toward people in authority. While some of its symptoms overlap with ODD, DMDD is considered a more severe condition with a significant mood component.

Children who meet the criteria for both ODD and DMDD are only diagnosed with DMDD.

Bipolar disorder (BD) is a lifelong mood disorder that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for days, weeks or months and interrupt your ability to carry out day-to-day tasks.

While similar behaviors may overlap between bipolar disorder and DMDD, the symptoms of BD are contained within episodes. The symptoms of DMDD are ongoing. Additionally, bipolar is less common in children and adolescents. BD is usually a lifelong condition, whereas DMDD is more likely to “change” into major depressive disorder or generalized anxiety disorder later in life.

Before DMDD became an official diagnosis in 2013, most children with DMDD were misdiagnosed with bipolar disorder.

Who does DMDD affect?

DMDD symptoms typically begin before the age of 10. Healthcare providers don’t diagnose DMDD in children under 6 or adolescents over 18.

How common is DMDD?

Disruptive mood dysregulation disorder is a relatively new diagnosis, so research is lacking to determine just how common it is. Early research shows that it may affect around 2% to 5% of children in the U.S.

What are the signs and symptoms of disruptive mood dysregulation disorder (DMDD)?

DMDD symptoms usually begin before the age of 10. A child with DMDD experiences:

• An irritable or angry mood most of the day, almost every day.
• Severe temper outbursts (verbal or behavioral) that are out of proportion to the situation. These usually happen three or more times per week.
• Issues with daily functioning due to irritability in more than one environment, such as at home, in school or with their peers.

If you think your child has DMDD, they should see a mental health professional and receive treatment. DMDD can impair your child’s quality of life and school performance. It can also negatively affect relationships with family members and friends.

What causes disruptive mood dysregulation disorder?

As DMDD is a relatively new diagnosis, researchers don’t have much insight into what causes it. Like oppositional defiant disorder (ODD) and bipolar disorder (BD), DMDD likely develops from a complex combination of biological, genetic and environmental factors.

How is DMDD diagnosed?

Mental health professionals diagnose disruptive mood dysregulation disorder if your child meets the condition’s criteria as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for at least 12 months. The DSM-5, published by the American Psychiatric Association, is the standard reference book for recognized mental illnesses.

Your child will likely need to see a child and adolescent psychologist or psychiatrist if they’re showing signs of DMDD. These mental health professionals use specially designed interview and assessment tools to evaluate your child for a mental health condition.

Psychiatrists and psychologists often rely on reports from the child’s parents, siblings, friends and teachers to get a full understanding of their behavior.

DMDD can occur at the same time as other conditions associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety disorders. Your child’s psychologist or psychiatrist will carefully assess your child to develop an accurate diagnosis.

What is the treatment for disruptive mood dysregulation disorder?

As DMDD is a newly recognized condition, there haven’t been many research studies on its treatment. Current treatments are mainly based on research focused on other childhood conditions associated with irritability, such as anxiety and ADHD. The good news is that many of these treatments also work for DMDD.

The two main treatment options for DMDD are psychotherapy (talk therapy) and medications. In many cases, healthcare providers recommend psychotherapy first before trying medications.

Psychotherapy

Psychotherapy, also called talk therapy, is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors.

Psychotherapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to your child and/or your family to help them with DMDD.

Different types of psychotherapy that may help with DMDD include:

• Cognitive behavioral therapy (CBT): CBT is one of the most common forms of psychotherapy. During CBT for DMDD, a mental health professional helps your child take a close look at their thoughts and emotions. Your child will come to understand how their thoughts affect their actions. Through CBT, your child can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits. The mental health professional can help your child increase their ability to tolerate frustration without having an outburst.
• Dialectical behavior therapy (DBT): DBT is based on CBT, but it’s specially adapted for people who experience emotions very intensely. DBT may help your child learn to regulate their emotions and avoid extreme or prolonged outbursts.
• Parent training: Your child’s provider may recommend combining therapy for your child with parent training. This therapy teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead their child to have an outburst and attempting to prevent it. Training also focuses on the importance of being consistent with your child and using positive reinforcement to decrease unwanted behaviors and promote healthy behaviors.

Medication

Currently, the U.S. Food and Drug Administration (FDA) hasn’t approved any medications specifically for treating DMDD. However, healthcare providers may prescribe certain medications to help manage DMDD symptoms, including:

• Stimulants: Providers traditionally prescribe stimulants for the treatment of ADHD. Research suggests that stimulant medications may also decrease irritability in children with DMDD.
• Antidepressants: Providers sometimes prescribe antidepressants to treat irritability and mood issues that children with DMDD may experience. One study suggests that citalopram, when combined with methylphenidate (a stimulant), can decrease irritability in children with DMDD.
• Certain atypical antipsychotic (neuroleptic) medications: Providers sometimes prescribe these medications to treat children with irritability, severe outbursts or aggression. Providers typically only prescribe these medications for DMDD if all other treatment approaches have been unsuccessful.

All medications have side effects. It’s important to monitor your child for any side effects and talk to their provider if side effects develop.

Can DMDD be prevented?

Although it might not be possible to prevent DMDD, recognizing and acting on symptoms when they first appear can minimize distress to your child and family. It can also help prevent many of the problems associated with the condition.

What is the prognosis for disruptive mood dysregulation disorder?

Children with DMDD can experience significant issues in school, at home and in social relationships.

If left untreated, children with DMDD are at high risk of developing depression and/or anxiety disorders in adulthood. Because of this, it’s important to seek help for your child as soon as possible if they’re showing signs of DMDD.

How can I help my child with disruptive mood dysregulation disorder?

If your child has disruptive mood dysregulation disorder, aside from getting them professional care, you can help them and yourself in the following ways:

• Learn as much as you can about DMDD: Talk to your child’s healthcare provider or mental health professional. Ask questions about treatment options and new research on DMDD.
• Communicate regularly with your child’s healthcare provider: It’s important to work closely with your child’s provider to make treatment decisions that are best for them.
• Work with your child’s teacher or school counselor: Together, you can develop strategies and accommodations that can help your child thrive in school.
• Take a time-out or break when needed: If you’re about to make the conflict with your child worse instead of better, take a break and step away. This also sets a good example for your child. Support your child if they decide to take a break to prevent escalating a negative situation.
• Take care of yourself: Maintain interests and hobbies that you enjoy and manage stress. Try to work with and gain support from the other adults who are interacting with your child.

When should my child see their healthcare provider?

If your child has been diagnosed with disruptive mood dysregulation disorder (DMDD), and their behavior becomes more severe or further disrupts family or school life, talk to their provider.

A note from Cleveland Clinic

Children and teens who are constantly irritable can be very challenging for parents. While it’s normal for young children and teens to show moodiness from time to time, frequent and disruptive behavior may indicate disruptive mood dysregulation disorder (DMDD).

Starting treatment early for DMDD is important, and the first step to treatment is to talk with a healthcare or a mental health provider. Don’t be afraid to ask your child’s provider questions. They’re available to help.