What Is Disruptive Mood Dysregulation Disorder (DMDD)?

DMDD officially appeared as a diagnosable condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Prior to this recognition, “children were being diagnosed prematurely with bipolar disorder, but as they developed, they would not actually have bipolar disorder,” according to Matis Miller, a licensed clinical social worker in Lakewood, New Jersey, the founder and director of The Center for Cognitive and Behavioral Therapy and the author of The Uncontrollable Child.

DMDD “includes frequent and chronic moodiness [and] a lot of irritability,” says Boston-based clinical psychologist Alisha Pollastri, Ph.D., principal investigator of the Laboratory of Youth Behavior. But the symptoms go beyond the typical tantrum. “They are much more severe, much more frequent and inconsistent with the child’s developmental level,” she says.

For example, there may be a 10-year-old having tantrums that look like something you would expect from a 5-year-old or 6-year-old. “The frequency of the [temper tantrums] must be at least three times a week in order to meet the criteria for DMDD,” says Dr. Pollastri.

Causes of Disruptive Mood Dysregulation Disorder

If your child has DMDD, Dr. Pollastri says it’s important to know it doesn’t mean you failed as a parent or because your child is “bad.” They simply have difficulty managing their mood and need to learn the skills to cope.

Since DMDD has only been a diagnosis available in the DSM since 2013, there aren’t many studies pinpointing the exact causes. Dr. Pollastri says there may be a genetic component at play, showing that if a child’s parent struggles with mood regulation, they may be more likely to have DMDD. One study in the Journal of the American Academy of Child and Adolescent Psychiatry found that children of parents with bipolar disorder were more likely to be diagnosed with DMDD^[1]Sparks G, Axelson A, Yu H, Ha W, Ballester J, Diler R, Goldstein B, Goldstein T, Hickey MB, Ladouceur C, Monk K, Sakolsky D, Birmaher B. Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2014;53(4):408-416. .

However, as with most other mental health disorders, nature and nurture are factors. Both experts say if children witness regular emotional outbursts from their caregivers or their guardians struggle to control their moods, they may be more likely to have similar difficulties as well due to the influences of modeling and principles of learning theory.

In order for a child to be diagnosed by a clinician with DMDD, they must exhibit the following symptoms, according to the DSM-5:

• Must be between the ages of 6 years old and 18 years old. This is because tantrums are so common in younger children, according to Dr. Pollastri.
• Temper tantrums must be severe and out of proportion for the situation.
• Outbursts are inconsistent with the child’s age.
• Spurts of anger occur an average of three times or more a week.
• The child’s mood is primarily one of irritability or outrage.
• Symptoms occur for at least a year and not just at home but also at school or other public places.
• The child hasn’t been diagnosed with post-traumatic stress disorder (PTSD), autism, separation anxiety disorder, persistent depressive disorder or a neurological condition.

Who May Experience Disruptive Mood Dysregulation Disorder?

Since DMDD is a fairly new diagnosable condition, research is sparse compared to studies conducted on other disorders. “There isn’t strong evidence showing how DMDD may be connected to certain environmental factors,” says Miller, further emphasizing the need for more research. However, he reiterates, if a child grows up seeing their caregivers struggle to control their emotions, they may have more trouble learning how to manage their own.

Being on the receiving end of intense emotional outbursts can be challenging for any parent. The good news is that there are treatment options available, outlined below:

• Cognitive behavioral therapy (CBT). With CBT, Dr. Pollastri says the child is taught behaviors that will help them better manage their emotions. This can include techniques and skills for dealing with difficult thoughts and feelings when they arise, and learning the connection between thoughts, feelings and behaviors.

• Dialectical behavior therapy (DBT). A type of therapy that was derived from some principles of CBT, DBT was developed to help people with extreme or unstable feelings. A therapist or psychiatrist helps the child and parent discover reasons for outbursts and the child is taught behavioral techniques to better manage their emotions, tolerate distress, practice mindfulness and develop interpersonal effectiveness.

• Expressive arts therapy. This form of therapy combines visual arts, movement, drama, music, writing and other creative processes to promote personal growth and healing. Miller says it’s often used in conjunction with CBT or DBT as an adjunctive therapeutic modality. Expressive arts therapy can help children work through emotions in a healthy way.

• Parent training. “A parent can play a key role in helping [a child with DMDD] manage their emotions,” says Miller. With parent training, caregivers are taught evidence-based skills to help their children manage their emotions and behaviors. These skills are based on learning principles and use structured techniques such as rewards and consequences to promote positive behaviors.

• Medication. Miller says that while it’s a last resort, medication—specifically selective serotonin reuptake inhibitors (SSRIs) and CNS stimulants—can play a role in treatment if the child is causing harm to themselves or others.

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When to See a Mental Health Provider

As DMDD is a newer diagnosis, experts say it’s tough to know exactly how successful specific treatments over a longer course of time are. This also means that there isn’t ample evidence showing the long-term consequences of not receiving appropriate treatment. However, Miller says one possible outcome is that tantrums get worse over time. “The child may get more emotional until they get a response,” he says, which can reinforce the behavior.

Another possible outcome of not receiving care, he notes, is the child may shut down emotionally. “If a child isn’t taught how to manage their emotions, they may experience chronic feelings of emptiness or feeling misunderstood,” he says. “This can lead to depression, anxiety and other mental health issues.”

For many parents, an official diagnosis of DMDD can come as a relief, says Dr. Pollastri. “It’s a helpful piece of information for parents because it tells them that their child is not willfully being disobedient. In actuality, the child doesn’t have the self-regulation skills to respond adaptively.” This is why it’s important parents take their child to a mental health provider to be evaluated if they exhibit signs of DMDD.

“It’s important to find out exactly what symptoms the child has so the treatment plan focuses on managing those specific symptoms,” she adds. For example, the provider will assess whether the child has difficulty seeing others’ perspectives, struggles with flexibility or can’t manage difficult emotions. “No one should be to blame,” says Dr. Pollastri. “Parents and the child just need the skills for managing it.”