Disruptive mood dysregulation disorder (DMDD) is a fairly new diagnosis, first appearing in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. It’s a childhood condition characterized by severe irritability, anger, and frequent temper outbursts. ¹

While it’s common for children to experience moodiness, DMDD goes beyond what we normally see in a moody child. Throughout this article, we’ll take a deeper look at DMDD and how to properly treat it.

Signs and Symptoms

DMDD begins before the age of ten but isn’t prevalent in children under six and adolescents over 18. The most common symptoms of this condition include: ²

• Angry mood or irritability most of the day
• Difficulty functioning due to irritability (i.e. at home, in school, with peers)
• Intense temper outbursts (both verbal and behavioral) occurring three or more times per week

DMDD can debilitate a child’s development as it may keep them out of specific situations. For example, a child with DMDD will be unable to participate in after-school activities with their peers as irritability is too big an issue.

Furthermore, to be diagnosed, a child must struggle with these symptoms steadily for 12 months or more.

Risk Factors

Since DMDD is such a new disorder, the risk factors for this condition remain unknown.

However, researchers have noticed it’s more common in children who visit pediatric mental health clinics than the general population. This means other mental disorders, such as anxiety and depression, may lead to DMDD.

Other studies have revealed the following may also lead to DMDD: ³

• Low maternal level of education
• Maternal depression during the first years after childbirth
• Maternal mood symptoms during pregnancy

However, we still don’t know exactly what causes the condition. Current research seeks brain mechanisms and genetic/environmental risk factors for DMDD.

How to Treat

As of this time, medical professionals haven’t developed a DMDD treatment for those newly diagnosed. Instead, DMDD is treated similarly to other disorders that have symptoms of irritability and temper tantrums. These include:

• Anxiety disorders
• Attention deficit/hyperactivity disorder (ADHD)
• Major depressive disorder
• Oppositional defiant disorder

If you believe your child struggles with DMDD, it’s important to seek out treatment as soon as possible. Untreated DMDD can diminish a child’s quality of life, school performance, and inhibit their relationship with peers.

Furthermore, DMDD may increase the risk of a child developing other mental health conditions later in life, such as anxiety disorders or depression. ⁴

To treat DMDD, your child will be given both of the following treatment methods:

Medication

The U.S. Food and Drug Administration (FDA) has not approved any medications for DMDD in children or adolescents. However, some may be beneficial. These include:

• Antidepressants – Used for a variety of mental health conditions, antidepressants can help relieve irritability and other mood problems. ⁵ However, their use in children and adolescents should be closely monitored as it can bring about suicidal thoughts and behaviors. ⁶

• Atypical Antipsychotics – May be useful in children who struggle with irritability as a result of autism. ⁷

• Stimulants – Common among those with ADHD, stimulants can help to decrease irritability in children. ⁸ However, those with heart problems should avoid stimulants as they can change the heart rate and blood pressure. ⁹

Since researchers are still observing how medication affects those with DMDD, there’s no clear indication as to which is most beneficial for your child.

Furthermore, all these medications come with the risk of serious side effects. You should consult your doctor about these side effects before administering these medications to your child.

Psychological Treatments

Before medication, parents should see if the psychological treatments for DMDD help to relieve symptoms. The most common include:

• Psychotherapy – Such as cognitive behavioral therapy (CBT) can help children identify their thoughts and feelings while allowing them to develop coping skills for frustration. ¹⁰

• Parent Training – This may help how you interact and work with your child to reduce irritable behavior and aggression. This training can help you identify predictable natures, how to be consistent with a child, and how to reward positive behaviors. ¹¹

• Computer-Based Training – Studies have found that children with DMDD may misperceive certain facial expressions as anger. ¹² Therefore, some preliminary evidence suggests that computer-based training can help identify this problem. ¹³

Final Word

While we still have a lot to learn about DMDD, what we do know can help identify and treat this condition early in childhood. The earlier treatment occurs, the better chance they have of overcoming symptoms.

Currently, lots of research is being done to better understand this disorder. If you’re interested in participating in a study, you can learn more here:

• NIMH’s Clinical Trials webpage is for those looking for more information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on DMDD for a list of clinical trials funded by the National Institutes of Health (NIH)
• Join a Study: Children – DMDD for a list of studies taking place on the NIH Campus in Bethesda, MD

References

¹ Bruno A, Celebre L, Torre G, Pandolfo G, Mento C, Cedro C, Zoccali RA, Muscatello MRA. Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry Res. 2019 Sep;279:323-330. doi: 10.1016/j.psychres.2019.05.043. Epub 2019 Jun 1. PMID: 31164249.

² Baweja R, Mayes SD, Hameed U, Waxmonsky JG. Disruptive mood dysregulation disorder: current insights. Neuropsychiatr Dis Treat. 2016 Aug 24;12:2115-24. doi: 10.2147/NDT.S100312. PMID: 27601906; PMCID: PMC5003560.

³ Munhoz TN, Santos IS, Barros AJD, Anselmi L, Barros FC, Matijasevich A. Perinatal and postnatal risk factors for disruptive mood dysregulation disorder at age 11: 2004 Pelotas Birth Cohort Study. J Affect Disord. 2017 Jun;215:263-268. doi: 10.1016/j.jad.2017.03.040. Epub 2017 Mar 19. PMID: 28347949; PMCID: PMC5408904.

⁴ Copeland WE, Angold A, Costello EJ, Egger H. Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. Am J Psychiatry. 2013 Feb;170(2):173-9. doi: 10.1176/appi.ajp.2012.12010132. PMID: 23377638; PMCID: PMC3573525.

⁵ Kim S, Boylan K. Effectiveness of Antidepressant Medications for Symptoms of Irritability and Disruptive Behaviors in Children and Adolescents. J Child Adolesc Psychopharmacol. 2016 Oct;26(8):694-704. doi: 10.1089/cap.2015.0127. Epub 2016 Aug 2. PMID: 27482998.

⁶ Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006 Mar;63(3):332-9. doi: 10.1001/archpsyc.63.3.332. PMID: 16520440.

⁷ Fallah MS, Shaikh MR, Neupane B, Rusiecki D, Bennett TA, Beyene J. Atypical Antipsychotics for Irritability in Pediatric Autism: A Systematic Review and Network Meta-Analysis. J Child Adolesc Psychopharmacol. 2019 Apr;29(3):168-180. doi: 10.1089/cap.2018.0115. Epub 2019 Feb 1. PMID: 30707602.

⁸ Posner J, Kass E, Hulvershorn L. Using stimulants to treat ADHD-related emotional lability. Curr Psychiatry Rep. 2014 Oct;16(10):478. doi: 10.1007/s11920-014-0478-4. PMID: 25135778; PMCID: PMC4243526.

⁹ Martinez-Raga J, Knecht C, Szerman N, Martinez MI. Risk of serious cardiovascular problems with medications for attention-deficit hyperactivity disorder. CNS Drugs. 2013 Jan;27(1):15-30. doi: 10.1007/s40263-012-0019-9. PMID: 23160939.

¹⁰ Kircanski K, Clayton ME, Leibenluft E, Brotman MA. Psychosocial Treatment of Irritability in Youth. Curr Treat Options Psychiatry. 2018 Mar;5(1):129-140. doi: 10.1007/s40501-018-0141-5. Epub 2018 Feb 9. PMID: 30319935; PMCID: PMC6181450.

¹¹ Bearss K, Johnson C, Smith T, Lecavalier L, Swiezy N, Aman M, McAdam DB, Butter E, Stillitano C, Minshawi N, Sukhodolsky DG, Mruzek DW, Turner K, Neal T, Hallett V, Mulick JA, Green B, Handen B, Deng Y, Dziura J, Scahill L. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. JAMA. 2015 Apr 21;313(15):1524-33. doi: 10.1001/jama.2015.3150. Erratum in: JAMA. 2016 Jul 19;316(3):350. doi: 10.1001/jama.2016.9050. Erratum in: JAMA. 2016 Jul 19;316(3):350. doi: 10.1001/jama.2016.9558. PMID: 25898050; PMCID: PMC9078140.

¹² Vidal-Ribas P, Brotman MA, Salum GA, Kaiser A, Meffert L, Pine DS, Leibenluft E, Stringaris A. Deficits in emotion recognition are associated with depressive symptoms in youth with disruptive mood dysregulation disorder. Depress Anxiety. 2018 Dec;35(12):1207-1217. doi: 10.1002/da.22810. Epub 2018 Jul 13. PMID: 30004611; PMCID: PMC9719110.

¹³ Stoddard J, Sharif-Askary B, Harkins EA, Frank HR, Brotman MA, Penton-Voak IS, Maoz K, Bar-Haim Y, Munafò M, Pine DS, Leibenluft E. An Open Pilot Study of Training Hostile Interpretation Bias to Treat Disruptive Mood Dysregulation Disorder. J Child Adolesc Psychopharmacol. 2016 Feb;26(1):49-57. doi: 10.1089/cap.2015.0100. Epub 2016 Jan 8. PMID: 26745832; PMCID: PMC4779288.