What Is Disruptive Mood Dysregulation Disorder (DMDD)?

Many children experience “temper tantrums” and periods of irritability. However, for some children and adolescents, it goes beyond that and becomes a condition that can greatly impact their lives. Disruptive mood dysregulation disorder (DMDD) is a mental health condition diagnosed in childhood and adolescence that is characterized by ongoing irritability and frequent temper outbursts. Learn more about this disorder in this overview.

What Is Disruptive Mood Dysregulation Disorder?

DMDD is a mental health diagnosis made in childhood and adolescence. It involves persistent anger, irritability, and many severe temper outbursts. While it may initially sound like something that could be a “phase,” it is much more severe and can cause significant problems for the child at home, at school, and with peers. 

DMDD is a newer diagnosis, first classified in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), which was published in 2013. The DSM-5 contains the formal guidelines used by healthcare professionals to diagnose mental health disorders.

The diagnosis of DMDD was developed to be more accurate when assessing youth who previously might have been diagnosed with pediatric bipolar disorder. Studies have shown that children with DMDD typically do not go on to have bipolar disorder as adults but have a greater risk of experiencing depression and anxiety instead.

Symptoms

Children and adolescents with DMDD display the following symptoms: 

• Severe temper outbursts (either verbal or behavioral) about three or more times per week 
• Irritable or angry mood most of the day, almost every day 
• Symptoms that are present in at least two of three settings (at home, at school, with peers) and are severe in at least one of three

Symptoms must be present for at least 12 months, and the child needs to be at least 6 years old for DMDD to be diagnosed. If the child is older than age 10, the symptoms need to have begun before the age of 10. After 18 years of age, DMDD can no longer be diagnosed.

Diagnosis

It might be difficult to tell initially if a child’s behavior is more than just a developmental phase. However, it is important to speak with a healthcare professional if the behavioral pattern lasts longer than a few weeks, causes distress, or interferes with their ability to function at school, at home, or with peers. 

When speaking with the parents and caregivers, the doctor will ask for a thorough history. Parents and caregiver interviews are important to help the healthcare team understand what is happening and how it is affecting the child’s life. They might also request information from the child’s school and teachers, and they may interview the child. 

The next steps may include a referral to a mental health professional, like a psychiatrist or psychologist, especially those trained in child and adolescent mental health. This is important for an accurate diagnosis because DMDD can occur with other disorders like attention-deficit/hyperactivity disorder (ADHD, a condition in which children have trouble paying attention, controlling impulsive behaviors, or settling down) and anxiety disorders. 

Treatment

Treatment is always based on the individual child and their needs. Since DMDD is a newer diagnosis, there have not been many research studies on specific treatments, so most options are based on research about other related conditions associated with irritability, like mood disorders, ADHD, and anxiety. Fortunately, many of these treatments seem to also work for DMDD, but there is still research ongoing to look for DMDD-specific treatments. 

DMDD treatment usually includes psychotherapy (talk therapy) and sometimes medications. Psychotherapy often is started first, with medications being added later, but sometimes they are both started at the same time.

Psychotherapy

There are a few different types of therapy being used for DMDD. Cognitive behavioral therapy (CBT) can help show children and adolescents how to cope with their feelings and emotions. Another method being studied is dialectical behavior therapy for children (DBT-C). It could help children with regulating their emotions and preventing extreme outbursts. 

While it is important for the child to receive therapy, parent training might also be helpful in teaching the parents or caregivers how to effectively respond to and manage the child’s behavior, as well as how to spot potential triggers. It can also teach them the ideas of predictability and consistency, as well as rewarding positive behaviors.

Medications

There are no medications approved by the Food and Drug Administration (FDA) specifically for DMDD at this time. However, medications are still used for the DMDD symptoms of irritability and aggression, since other diagnoses exhibit these symptoms too and often appear with DMDD. 

Some medications used in DMDD include:

• Stimulants: This class of medications increases energy, attention, and alertness, and treats children and adults with ADHD. These drugs have been shown to decrease aggression in children who also have ADHD.  
• Antidepressants: Antidepressants are used to treat depression, as well as anxiety, pain, and insomnia. Sometimes these are used to help with the irritability and mood problems a child may experience. One study has shown that Celexa (citalopram), which is a selective serotonin reuptake inhibitor (SSRI), combined with Ritalin (methylphenidate), a stimulant, could decrease irritability in youth with DMDD. 
• Atypical antipsychotics: While atypical antipsychotics, which are newer, are used primarily to treat psychosis, they are also used for many other conditions as well. Two medications, Abilify (aripiprazole) and Risperdal (risperidone) are FDA approved for children with autism and/or intellectual disabilities to treat irritability and aggression, respectively. These are sometimes used for DMDD, but due to the potential side effects, they are often used when other options have not improved the symptoms. 

All medications have the potential for side effects, so it is important for the parents and caregivers to discuss these with the child’s healthcare provider and to monitor and report any observed side effects.

Coping

Caring for a child can be challenging, especially when they have more specific needs like DMDD. It can cause stress and be overwhelming for both the caregiver and the child. As such, it is important for caregivers to take care of both the child and themselves. 

Some ways for parents and caregivers to help themselves and the child include: 

• Learn about and research the disorder.
• Talk to the child’s teacher and school counselor or psychologist about strategies, plans, and accommodations. 
• Find ways to manage stress. 
• Look for additional support and help from professional organizations. 
• Stay in regular communication with the child’s healthcare provider.
  

A Word from Verywell

Childhood and adolescence are filled with many developmental changes, which are characterized by a variety of behaviors and emotions. This can make the job of a parent or caregiver difficult at baseline. However, the behaviors and emotions associated with DMDD can cause additional stress for both you and your child. It is important to take care of your child by talking with their healthcare provider but also to take care of yourself and seek extra support when needed. 

Speaking with your child’s pediatrician or a mental health professional who has experience working with children and adolescents will help get your child the right treatment and will direct you to other resources and support solutions.