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Does New DSM-5 Diagnosis Decrease Childhood Bipolar Diagnosis?
I believe that bipolar disorder does exist in children. However, I do believe it is extremely rare. I also believe we have no way of reliably diagnosing bipolar disorder in children. This is verified by the lack of any type of diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When a professional makes a diagnosis of childhood bipolar disorder, they are doing so using clinical judgement and not any kind of standard.
Nevertheless, over the past two decades there has been a 40-fold increase in the diagnosis of childhood bipolar disorder. This troubles many professionals and many worry that it increases the use of untested and unapproved medications, particularly antipsychotics, in children.
In an attempt to reduce the diagnosis of bipolar disorder in children, the new DSM-5 is introducing the diagnosis of disruptive mood dysregulation disorder which aims to differentiate pediatric illnesses.
Disruptive Mood Dysregulation Disorder in the DSM-5
The proposed diagnosis in the DSM-5 actually has nine criteria for diagnosis. They are:
- The disorder is characterized
by severe recurrent temper outbursts that are grossly out of proportion in
intensity or duration to the situation.
A. The temper outbursts are manifest verbally and/or behaviorally.
B. The temper outbursts are inconsistent with developmental level.
- The temper outbursts occur, on average, three or more times per week.
- Between temper outbursts:
A. Nearly every day, most of the day, the mood between temper outbursts is persistently irritable or angry.
B. The irritable or angry mood is observable by others.
- Criteria 1 – 3 have been present for 12 or more months. Throughout that time, the person has not had 3 or more consecutive months when they were without the symptoms.
- Criterion 1 or 3 is present in at least two settings and must be severe in at least in one setting.
- The diagnosis should not be made for the first time before age 6 or after age 18.
- The onset of Criteria 1 – 5 is before age 10 years.
- There has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “2” criteria of mania.
- The behaviors do not occur exclusively during an episode of Major Depressive Disorder and are not better accounted for by another mental disorder. The symptoms are not due to the effects of a drug or to a general medical or neurological condition.
Full details on the criteria can be found here.
Effects of the New Disruptive Dysregulation Disorder Diagnosis
Can the Disruptive Mood Dysregulation Disorder (DMDD) diagnosis cut down on the number of childhood bipolar disorder cases and decrease medication use in children?
Well, we don’t know. The research group that studied and created this diagnosis thought so and so do some others. Todd Finnerty, Psy.D. says:
DMDD is a useful diagnosis for kids who are already being treated by psychologists, psychiatrists and others but often treated poorly. DMDD should be included in DSM-5 to encourage clinicians to make accurate pediatric bipolar diagnoses and reflect the needs of this population of individuals with severe difficulties . . . they are a group of individuals who may benefit from different approaches than someone with a bipolar disorder.
Ideally, if Disruptive Mood Dysregulation Disorder were given to an individual, they would be treated with psychotherapy and rarely medication and this is often not the case in childhood bipolar disorder.
Some call the inclusion of DMDD in the DSM-5 one of its worst changes though and suggest that professionals “ignore” it.
Disruptive Mood Dysregulation Disorder
My feeling is that all disorders are essentially amplification of normal human emotion and experience. Psychosis is essentially excess, uncontrolled imagination. Depression is unchecked despair. And DMDD is temper tantrums, yes, but to a pathological level.
Therefore, with careful and judicious use, this new diagnosis could help individuate a population that is currently being mislabelled and possibly mistreated. The success of this diagnosis, though, will come down to the clinical judgement of professionals and it will only be as useful as the professionals applying it.