Disruptive mood dysregulation disorder is a new DSM-5 diagnosis found in the depressive disorders section. The main reason for the creation of this diagnosis appears to be the fact that many children with frequent outbursts and persistent irritability get the (incorrect) diagnosis of bipolar disorder. In reality these children may be at higher risk for unipolar depression.(1)
- A child must be at least 6yo, with onset of symptoms by age 10.
- (S)he must have recurrent outbursts 3+ /week, and have persistently negative mood (irritable, angry, and/or sad) in-between the tantrums.
- The symptoms must persists for 12 months and occur in 2 or more settings.
- The child must not meet criteria for a mood disorder, psychosis, or substance use disorder (can coexist with ADHD and ODD).
While nearly 50% of school-age children have tantrums, applying the stringent criteria outlined above, the prevalence of DMDD appears to be only 1%. (2)
Comorbidity with other internalizing and externalizing disorders is high, particularly with ODD (25% overlap, odds ratio 53-103!).
Little is known about treatment of DMDD. A rational approach would be to treat most disabling/impairing symptoms first.
1. Stringaris A. et.al. Adult Outcomes of Youth Irritability: a 20-year Prospective Community-based Study. Am J Psychiatry 2009; 166:1048-54
2. Copeland et.al. Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. Am J Psychiatry 2013; 170:173-79