Disruptive mood dysregulation disorder, or DMDD, is a relatively new diagnosis. It first appeared in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published in 2013. As noted in the DSM-5, DMDD was developed to address concerns that bipolar disorder was being diagnosed excessively in children.
DMDD is a mental health concern that typically affects children age 12 and younger. The DSM-5 advises that a young person should not be diagnosed with DMDD before age 6 or after age 18. Also, for a teen to be diagnosed with DMDD, there must be evidence that they experienced the onset of symptoms before age 10.
The defining characteristic of disruptive mood dysregulation disorder is chronic and severe irritability. Children and adolescents who have DMDD will display this irritability through a persistently angry mood and frequent outbursts of temper.
Although disruptive mood dysregulation disorder was created as an alternative diagnosis to bipolar disorder, the DSM-5 includes it in the Depressive Disorders section. This decision was made, the authors of that section note, because children who exhibit the signs and symptoms of disruptive mood dysregulation disorder are more likely to develop depressive disorders or anxiety disorders, but not bipolar disorder, as they age into adolescence and adulthood.
Signs & Symptoms of Disruptive Mood Dysregulation Disorder
Children who exhibit the following signs and symptoms may have disruptive mood dysregulation disorder:
- They may have outbursts of verbal rage that are wildly disproportionate to the incident that provoked the anger.
- They may act physically aggressive toward other people or their property.
- These physical or verbal temper outbursts will not be consistent with the child’s developmental level.
- These physical or verbal temper outbursts will occur three or more times each week, on average.
- When the child is not in the midst of a physical or verbal temper outburst, they will exhibit an irritable or angry mood, most of the day, just about every day.
- This irritable or angry mood will be observable by other people in the child’s environment, such as their peers, parents, or teachers.
To be accurately diagnosed with disruptive mood dysregulation disorder, a child or adolescent must exhibit the symptoms listed above for at least one year. During that year, there should never be a period of three months or longer during which they do not exhibit any signs or symptoms of disruptive mood dysregulation disorder.
Also, at no point should the child meet the full symptom criteria for a manic or hypomanic episode, both of which are associated with bipolar disorder. This reinforces the intention of the DSM-5 to establish DMDD as a distinct disorder that is clearly differentiated from pediatric bipolar disorder.
What Causes DMDD?
Several temperamental, genetic, and psychological factors can influence a person’s risk for developing DMDD. The following are examples of potential risk factors for this disorder:
- History of chronic irritability, to the point that the individual may have been diagnosed with oppositional defiant disorder (ODD) or major depressive disorder before receiving a diagnosis of disruptive mood dysregulation disorder
- Symptoms of attention-deficit/hyperactivity disorder (ADHD) or an anxiety disorder from a young age
- Face-emotion labeling deficits
- Family history of anxiety disorders, depressive disorders, and substance use
- Being male
Disruptive Mood Dysregulation Disorder Statistics
According to the DSM-5, the past-year prevalence of disruptive mood dysregulation disorder is 2%-5% of children within the relevant age range.
In December 2020, the journal Neurology, Psychiatry and Brain Research published a DMDD study that included the following statistics about disruptive mood dysregulation disorder:
- About 22% of children who were referred to outpatient treatment for a depressive disorder had a diagnosis of DMDD.
- Between 15.9% and 30.5% of children who received mental health treatment on an inpatient basis met the criteria for a diagnosis of DMDD.
- Among a sample group of 706 children who were referred to treatment for possible symptoms of bipolar disorder, 26% actually had disruptive mood dysregulation disorder.
Potential Effects of Untreated DMDD
A young person who needs but does not receive professional treatment for disruptive mood dysregulation disorder may be at risk for myriad negative outcomes. The following are examples of the many potential effects of untreated disruptive mood dysregulation disorder:
- Poor relationships with family members and peers
- Frequent conflicts with others
- Substandard performance in school
- Academic failure
- Social withdrawal or isolation
- Inability to engage in age-appropriate activities that are important for healthy development
- Lack of meaningful friendships
- Physical injuries due to frequent acts of aggression
- Suicidal ideation
- Suicidal behaviors
Levels of Care for DMDD Treatment
When you are seeking treatment for a young person who has disruptive mood dysregulation disorder, it is important to understand the scope of the options that are available to you. This includes the level or levels of care that may be best for your child.
At CenterPointe Hospital, we provide adolescent mental health treatment at the following levels:
- Inpatient treatment: The general goal of inpatient treatment is to help adolescents achieve stabilization. At this level of care, young people ages 12-17 take part in full days of structured treatment while also benefiting from round-the-clock care and support. Typical length of stay at this level is seven to 10 days. However, the exact amount of time any specific patient remains in our care is determined by their needs and progress.
- Intensive outpatient program (IOP): Adolescents ages 13-17 who have DMDD may also receive treatment for this disorder through one of our IOPs. At the IOP level, adolescents participate in treatment three days per week, three hours per day. Some adolescents transfer to one of our IOPs for step-down support after completing inpatient treatment. Others enter treatment directly at the IOP level. Typical length of stay in our IOPs is four to six weeks.
- Partial hospitalization program (PHP): Adolescents ages 13-17 who are struggling with DMDD may also find the care that is right for them at the PHP level. The typical length of stay in our adolescent PHP, offered at our Maryville, Illinois, location, is five to seven days, with daily treatment offered for four to five hours each day.
How to Select a DMDD Treatment Center
Your child has received a diagnosis of disruptive mood dysregulation disorder. You know that they need comprehensive professional treatment, but you’re not sure how to find the optimal source of that care. What’s the best way to select the right DMDD treatment center for your child?
First, it is important to remember that there is no such thing as one perfect DMDD treatment center, or even treatment approach. A facility or service that is ideal for one young person who has DMDD may not be right for another who has the same disorder.
You will want to focus on identifying the hospital or other DMDD treatment center whose services align most closely with your child’s history and needs, as well as with your preferences and expectations. When you are speaking with the representatives of any DMDD treatment center you’ve been considering, here are some questions that can help you find the right place for your child and your family:
- What type or types of assessments will my child complete before they begin treatment? Who will conduct these assessments?
- What levels of care does your facility offer?
- How will you determine which level or levels of care are right for my child?
- Can you describe your facility’s approach to treatment for young people who have DMDD?
- What types of therapies or other services do you typically include in treatment for disruptive mood dysregulation disorder?
- How will you determine which of these therapies and services are (or are not) right for my child?
- Can you briefly discuss the qualifications and experience of the professionals who will work with my child?
- How do you incorporate parents into treatment?
- What is the typical length of stay at your facility for a young person who has DMDD?
- How will you determine how long my child will need to remain in treatment?
- Once my child has completed their time at your DMDD treatment center, what types of discharge planning or aftercare support do you provide?
- Does your facility accept my insurance?
Benefits of Receiving Treatment for Disruptive Mood Dysregulation Disorder
The signs and symptoms of disruptive mood dysregulation disorder first occur during a developmentally significant period of a child’s life. If the child progresses into adolescence without receiving proper professional treatment for DMDD, they remain at elevated risk for considerable harm.
But when a child or adolescent who has DMDD gets the type and level of care they need, they can experience a wide range of benefits, including the following:
- Learning to regulate their emotions and respond to perceived conflicts in an appropriate manner
- Replacing self-defeating thought and behavior patterns with healthier ways of thinking and acting
- Discovering proper ways of managing stress, reacting to disappointments, and responding to conflicts
- Being able to interact with peers without conflict, which can lead to the establishment of meaningful friendships
- Taking greater responsibility for their behaviors, which can empower them to have more success in the classroom
- Interacting with parents, teachers, and other authority figures in a less adversarial manner
- Becoming a contributing, productive member of their family and classroom
This content was written on behalf of and reviewed by the clinical staff at CenterPointe Hospital.