Symptoms of Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a relatively new diagnosis that was added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a way to diagnose children whose symptoms might have been previously misdiagnosed as childhood bipolar disorder.

The signs and symptoms of DMDD include:

• severe, chronic irritability
• severe verbal or behavioral tantrums, several times weekly for at least a year
• reactions out of proportion to the situation
• difficulty functioning because of outbursts and tantrums
• aggressive behavior
• frequently breaking rules

If your child has DMDD, they may have trouble socializing and forming friendships and relationships. They may be physically aggressive with friends and family and have difficulty playing team sports.

Children with DMDD don’t experience the episodic mania that a child with bipolar disorder would. They are also not at greater risk of developing bipolar disorder. However, a child diagnosed with DMDD does have a higher risk of developing anxiety as an adult.

Your child’s healthcare professional can evaluate your child’s symptoms and refer you to a mental health professional experienced in working with children and adolescents with DMDD.

DMDD is specifically a childhood diagnosis.

To be diagnosed with DMDD, your child must be at least 6 years old. Most children will be diagnosed by age 10.

It is also believed that more boys than girls experience the symptoms of DMDD.

When diagnosing DMDD, your child will have experienced these tantrums at least 3 times weekly for at least a year. Their symptoms are severe, and between tantrums, they are also chronically irritable. Overall, symptoms affect your child’s relationships at home, school, and with friends.

The top diagnostic criterion for DMDD is severe, chronic irritability. Your child will have had tantrums and outbursts several times a week for at least a year at home, at school, and among friends.

In other words, if your child has outbursts in only one setting, like being irritable during the school day but calm after they are at home, your child isn’t likely to have DMDD.

DMDD share similar symptoms, like severe tantrums and chronic irritability, that are seen in other mental health disorders, like childhood bipolar disorder, autism, or oppositional defiant disorder.

What differentiates DMDD from other mood disorders is the duration of symptoms, the relatively short nature of the outbursts, and a child’s overall irritability, even when they are not having a tantrum.

There is no clear cause of DMDD, though research shows that environmental influences are risk factors and may play a more significant role in predicting if a child will be diagnosed with DMDD.

That same research also found that factors like childhood abuse and a history of family psychiatric illness were contributing influences as well.

A child’s DMDD diagnosis may also co-occur alongside other disorders like oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD).

Because DMDD is still a relatively new diagnosis, there is no gold standard treatment for it just yet. However, the treatments that are used most often for DMDD are ones that have been proven successful for conditions that share irritability and tantrums as symptoms.

Following diagnosis, it’s recommended that DMDD treatment begins with therapy (psychotherapy and parent training) and with medications being prescribed later in treatment or starting at the same time with therapy.

Psychotherapy

Cognitive behavioral therapy (CBT) can be very helpful for children with DMDD. With CBT, a therapist works with your child to discuss why they are reacting negatively and to help them better understand how it impacts their mood.

CBT would also help your child develop coping skills that can help them avoid elevated responses at home and school.

Parental management training

Therapy for your child is a solid first step, but parents also play a role in the child’s treatment, too.

For parents of children with DMDD, parental management training teaches specific strategies to avoid reinforcing the negative behaviors associated with your child’s DMDD and to reward their positive behaviors.

Medication

Just like with DMDD psychotherapy treatment, there isn’t an official medication for treating DMDD either.

However, there are several medications for similar conditions that a doctor can prescribe “off-label” — meaning the medication is safe and Food and Drug Administration approved but is being used for a condition outside of FDA approval — that can benefit children with DMDD.

Stimulants, like those used to treat ADHD, can be given to some children with DMDD to help with irritability symptoms.

Antidepressants may also help decrease irritability and help improve your child’s mood. Again, while not an official medication for DMDD, the off-label benefits of antidepressants (like selective serotonin reuptake inhibitors) are currently being studied.

However, it is worth noting that some children may experience suicidal behaviors and thoughts while on antidepressants. A mental health professional can offer guidance if your child starts taking this type of medication.

Seeking additional resources and support can help parents learn how to manage a child with DMDD. The more you can anticipate your child’s needs and understand what they are experiencing, the better you can support them during treatment.

Your child’s healthcare team will be able to answer any questions you may have. If your child’s mood changes, or if you notice other behavioral changes, a mental healthcare professional will be able to offer guidance.

Your child’s teachers and school staff can help support you during your child’s treatment, so it’s a good idea to keep them informed about your child’s therapy and medications and if there are any changes.

Being a parent can be stressful, and a new DMDD diagnosis can increase your stress level, so you’ll want to tend to your self-care and mental well-being.

If your child’s symptoms and treatment are stressful for you, consider seeking someone to talk with or explore calming activities such as yoga or meditation.

If you’re a parent who has a child with DMDD, effective treatments can ease your child’s DMDD symptoms. You’re not alone in this.