Disruptive Mood Dysregulation Disorder (DMDD) is a new diagnosis that is used in place of what used to be diagnosed as Bipolar Disorder in children. The intensity of mood swings in children diagnosed with Bipolar Disorder was not always an appropriate diagnostic measure but allowed them to get the treatment necessary for such a severely disruptive condition.
Causes
Although the diagnosis name is new, the behaviors are well known by those who have a loved one with the symptoms, and by mental health professionals who are familiar with the disorder. Those with DMDD are often seen as uncontrollable, dangerous, and troubled youth. A diagnosis of this disorder happens between the ages of 6 and 18, with symptoms beginning before the age of 10. DMDD can be attributed to a chemical imbalance in the brain with some cases having environmental factors as well. The likelihood of a child being diagnosed with DMDD is higher if the child has a parent who suffers from a mental illness. It is also more likely that a child with this disorder will go on to develop a chronic depressive or anxiety disorder
Symptoms
The symptoms of DMDD have many features in common with Oppositional Defiant Disorder and Bipolar Disorder, with DMDD being more severe and consistent than both. To be diagnosed with DMDD, the symptoms need to be present for at least 12 months with no more than a 3 month period without symptoms. DMDD is marked with a constant irritable or angry mood that develops into explosive outbursts of rage at least 3 times per week. The behavior must be present in more than one environment which could include home, school, and community locations. Outbursts are often connected to situations that could be upsetting but the rage is more intense than the situation requires. At times the outbursts might occur when there is seemingly no cause for upset. The rage could include behaviors that are self-directed or directed at others and objects. It may seem as though the child is no longer aware of their surroundings which can create dangerous circumstances for the sufferer and anyone in the vicinity. It is important to recognize the signs of when an outburst is about to happen so that others can be removed from the room and the room can be made as safe as possible. As a precaution, in a home with a child with DMDD, it is necessary to lock away all sharp objects, weapons, and medications. It also may be necessary to create a safe place for the child to enter when they feel as though they will become out of control.
Treatment
Treatment is always necessary for children with DMDD. This is not a disorder that will get better on its own without consistent therapeutic intervention. Due to the condition being misdiagnosed for so long as Bipolar Disorder there is no single approved method of counseling for DMDD. Finding a therapist that is comfortable treating conduct disorders such as Oppositional Defiant Disorder is important. It is also necessary that the parents, or caregivers, and other family members participate in family counseling. Handling a child with DMDD causes immense strain on a household. Educating parents about the disorder and how to deal with outbursts at home will increase the probability that treatment will be successful. It is usually required that the child be placed on medication to stabilize mood due to the brain chemistry being involved in behaviors. If the behavior is putting the child or family in danger it might also be necessary to put a child into inpatient care where they can be monitored 24 hours a day and kept safe. It is not yet known how treatable this disorder is when appropriately diagnosed but any therapeutic intervention will allow for improvements in behavior.
Testing for Disruptive Mood Dysregulation Disorder is very difficult as many DMDD symptoms overlap with ADHD, ODD, and Bipolar Disorder. To further complicate matters, anxiety is also a typical comorbid condition for DMDD. Disruptive Mood Dysregulation Disorder assessment typically involves a combination of psychoeducational assessment and social-emotional assessment. Only clinical psychologists and psychiatrists can establish a DMDD diagnosis.
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