Dec 07, 2022

If you're a parent, you know that dealing with temper tantrums can be a normal part of raising children. It's likely you know what will upset your child and how they'll react. However, frequent emotional outbursts, difficult to control, violent, or out of proportion are not normal and could indicate a condition called disruptive mood dysregulation disorder (DMDD).

DMDD can significantly affect a child's well-being and ability to function at home, in the classroom, and in society. However, understanding the signs and symptoms of DMDD can help you effectively identify and manage your child's outbursts.

What is disruptive mood dysregulation disorder (DMDD)?

Disruptive mood dysregulation disorder (DMDD) is a mental health condition characterized by severe irritability and frequent temper tantrums in children.

While children may experience periods of moodiness and have outbursts from time to time, those with DMDD experience prolonged symptoms that are more severe. Temper tantrums are typically intense and out of proportion to the situation. Having DMDD can significantly disrupt several aspects of a child's everyday life. To be diagnosed with DMDD, symptoms typically must begin before the age of 10.

Officially established as a mental health disorder in 2013, DMDD is a relatively new diagnosis that is still being evaluated for appropriate treatment options. DMDD was included in the Diagnostic and Statistical Manual (DSM-5) to address concerns about overdiagnosis and overtreatment of bipolar disorder in children.

DMDD vs. Bipolar Disorder

The diagnosis of bipolar disorder in children increased dramatically during the 1990s. This and uncertainties about the long-term efficacy of antipsychotics and mood stabilizers used to treat bipolar disorder in children led to the diagnosis of disruptive mood dysregulation disorder.

Unlike bipolar disorder, disruptive mood dysregulation disorder is characterized by chronic irritability in children. As opposed to bipolar disorder, which has episodic mood changes, children with DMDD generally have persistent anger or irritable moods.

What are the signs and symptoms of disruptive mood dysregulation disorder (DMDD)?

DMDD can be diagnosed in children between the ages of 6 and 18. While symptoms can vary slightly, most children will exhibit similar behavior patterns.

Common symptoms of DMDD include:

• Frequent, severe temper tantrums: This can include screaming, hitting, pushing, or damaging property.
• Tantrums occur three or more times a week: Tantrums may be more frequent one week and fewer the next. However, an average of three or more per week is typically required for diagnosis.
• Tantrums are excessive for the situation: A child may get angry when having to share a toy at school, but a child with DMDD may exhibit aggression and verbal outbursts that are out of proportion to the event.
• Outbursts that are not appropriate for the child's age: It's normal for a toddler to have a tantrum from time to time, but it's not normal to see a 10-year-old on the ground kicking and screaming.
• Irritable and angry moods between tantrums: Children with DMDD consistently exhibit anger and irritable moods between bouts of intense emotional outbursts. Most of the time, these moods can be noticed by others.
• Symptoms happen in multiple settings: Temper outbursts don't just happen at home where they feel comfortable. Children with DMDD can have tantrums in public places, at school, or at friends' houses.

What causes disruptive mood dysregulation disorder?

While the exact cause of DMDD is not fully understood, a variety of factors are thought to play a role. These factors include a child's temperament, genetics, preexisting mental illnesses, and upbringing.

DMDD is more prevalent in early childhood and frequently occurs alongside other mental illnesses, such as oppositional defiant disorder.

A child's temperament may contribute to DMDD. Children with DMDD are more likely to show the following traits:

• Moodiness
• Anxiousness
• Irritability
• Difficult behavior

DMDD is also associated with the following risk factors:

• Being male
• Being of school-age
• Having a family history of anxiety, depression, or substance abuse
• Having a lack of parental support
• Having a family history of violence
• Frequent family conflicts
• Having problems with discipline at school

Effects of DMDD

If left untreated, disruptive mood dysregulation disorder can lead to several negative outcomes for children. Some effects can be temporary, while others can cause long-term repercussions. Getting your child into effective and comprehensive treatment will prevent the following:

• Poor school performance
• Family conflict
• Disrupted peer relationships
• Lack of involvement in extracurricular activities that promote social development
• Self-harm
• Suicidal thinking
• Suicide attempts
• Hospitalization

How is DMDD diagnosed?

The first step in diagnosing a child with DMDD is scheduling an appointment with a mental health provider. A mental health provider will typically interview the child and use different assessment tools to evaluate the child's symptoms and severity. They may talk to the child's parents, caregivers, and teachers to better understand their behavior.

For a child to be diagnosed with DMDD, they must exhibit the symptoms listed above for at least 12 months. Pediatricians may also be consulted to determine whether underlying medical disorders are present. As DMDD can co-occur with other conditions, the child will also be evaluated for conditions related to irritability, such as ADHD or anxiety disorders.

How is disruptive mood dysregulation disorder treated?

As DMDD has only been recognized recently, little research has been conducted on its treatment. The majority of treatments are based on research focusing on other childhood disorders related to irritability, such as ADHD. Fortunately, many of these treatments also work well for DMDD. Psychotherapy and medication are the two most common forms of treatment.

Psychotherapy

Psychotherapy, also called talk therapy, encompasses a variety of techniques used to help individuals identify and change unhealthy thoughts, emotions, and behaviors. In most cases, it is considered the first-line treatment for children with DMDD.

During treatment, children will work one on one with a licensed mental health professional. Mental health providers may implement a variety of techniques to help children regulate their emotions, improve their responses to specific situations, and enhance communication skills.

The most common techniques for treating DMDD include:

• Cognitive behavioral therapy (CBT): One of the most common forms of psychotherapy, CBT helps children examine their thoughts and emotions. With this form of therapy, children can shed negative thoughts and behaviors and develop new attitudes and behavior patterns, enabling them to handle anger without having a tantrum.
• Dialectical behavior therapy (DBT): This technique is typically best suited to children who experience their emotions very intensely. With DBT, children can develop emotional regulation skills and prevent extreme outbursts.
• Parent training: Mental health providers may recommend including parents in therapy sessions. This method helps parents and caregivers respond more effectively to irritable behavior. Parent training also emphasizes consistency with their child and utilizing positive reinforcement to encourage healthy behaviors.

Medication

While further research is needed to determine the most effective medications for DMDD, mental health professionals may choose to prescribe the following medications to help manage a child's symptoms.

Stimulants: Although stimulants are traditionally prescribed to treat ADHD, studies suggest they may also reduce irritability in children with DMDD.

Antidepressants: Antidepressants can sometimes be recommended to treat anger and low mood in children with DMDD.

Antipsychotics: These medications may be prescribed for children who are irritable, have severe outbursts, or exhibit aggression. In most cases, providers will only prescribe these medications if all other treatment options have failed.

How can I help my child with DMDD?

In addition to getting your child professional care, there are things you can do as a parent to help your child with DMDD and cope with their condition.

Consider the following tips:

Become familiar with DMDD: Talk to your child's mental health provider about DMDD. Get information on treatment options, home care, and new research on DMDD.

• Keep your child's mental health provider updated: Talk regularly with your child's therapist and inform them of any changes in your child. Working together helps you make decisions about treatments that are best for them.
• Partner with your child's teacher or school counselor: By working together, you can create a plan to help your child succeed in school.
• Take breaks: If a conflict with your child is going to escalate, walk away and take a break. Allow your child to do the same and reconnect when emotions have settled.
• Practice self-care: Having a child with DMDD can be stressful at times. Make time for activities that help reduce stress. Get plenty of rest and reach out for support when needed.

Comprehensive Care for Children

While you may not be able to prevent DMDD, recognizing and treating symptoms early can reduce stress for your child and family. If DMDD is treated effectively, your child may also avoid developing other disorders as an adult, such as depression and anxiety.

CHE Behavioral Health Services offers comprehensive care for children with DMDD and other mental health conditions. Our experienced and compassionate mental health providers can help children regulate their emotional responses and develop healthy thought and behavior patterns to move forward with ease.

For more information about disruptive mood dysregulation disorder (DMDD) and treatment options offered by CHE Behavioral Health Services, please call 888-515-3834. We are ready to talk, and ready to listen.