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Chapter 47: Disruptive Mood Dysregulation Disorder

Argyris Stringaris; Pablo Vidal-Ribas Belil

ESSENTIALS OF DIAGNOSIS

Disruptive mood dysregulation disorder (DMDD) is one of the new categories in DSM-5 and is classified under the section of Depressive Disorders. This disorder is characterized by persistent irritable mood, and severe (i.e., out of proportion in intensity or duration) and frequent (i.e., three or more times per week) temper outbursts. These features should have been present for at least 1 year and began before age 10, although the diagnosis should not be made before age 6 or after age 18.

Little research has been done on DMDD itself. Most of what we know about severe irritability as a category comes from the research done on severe mood dysregulation (SMD; see Table 47–1). This is a category of severe irritability created by Leibenluft and colleagues (Leibenluft et al, 2003) as a means of empirically scrutinizing the notion that chronically irritable children may be suffering from bipolar disorder. SMD and DMDD overlap considerably with two main differences. One is that in SMD, the requirement is for persistent negative mood (Criterion 2), which may be either irritability or sadness, whereas in DMDD only irritability or anger qualifies. The other difference is that DMDD does not include a hyperarousal criterion (Criterion 3 in SMD).

Table 47–1Research Diagnostic Criteria for Severe Mood Dysregulation (SMD)
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Table 47–1 Research Diagnostic Criteria for Severe Mood Dysregulation (SMD)

Inclusion criteria

  1. Compared to his/her peers, the child exhibits markedly increased reactivity to negative emotional stimuli that is manifest verbally or behaviorally. For example, the child responds to frustration with extended temper tantrums (inappropriate for age and/or precipitating event), verbal rages, and/or aggression toward people or property. Such events occur, on average, at least three times a week.

  2. Abnormal mood (specifically anger or sadness), present at least half of the day most days, and of sufficient severity to be noticeable by people in the child's environment (e.g., parents, teachers, peers).

  3. Hyperarousal, as defined by at least three of the following symptoms: insomnia, agitation, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness.

  4. The symptoms in 1, 2, and 3 are currently present and have been present for at least 12 months without any symptom-free periods exceeding 2 months.

  5. Aged 7–17, with the onset of symptoms before age 12.

  6. The symptoms are severe in at least one setting (i.e., violent outbursts, assaultiveness at home, school, or with peers). In addition, there are at least mild symptoms (distractibility, intrusiveness) in a second setting.

Exclusion criteria

  1. Exhibits any of these cardinal manic symptoms:

    • Elevated or expansive mood.

    • Grandiosity or inflated self-esteem.

    • Episodically decreased need for sleep.

  2. The symptoms occur in distinct periods lasting more than 1 day.

  3. Meets criteria for schizophrenia, schizoaffective disorder, pervasive development disorder, or posttraumatic stress disorder.

  4. Meets criteria for substance abuse disorder in the past 3 months.

  5. IQ <70.

  6. The symptoms are due to the direct physiological effects of a ...

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