Temper tantrums are a part of growing up. Many parents become skilled in anticipating the situations that may “set off” an emotional episode in their children. If your child is exhibiting tantrums that seem out of proportion, are difficult to control, or seem to be happening constantly, you may consider having your child evaluated for disruptive mood dysregulation disorder (DMDD).
DMDD is a psychiatric condition. It’s typically only diagnosed in children. The main symptoms include irritability, emotional dysregulation, and behavioral outbursts. Outbursts are usually in the form of severe temper tantrums.
The condition was introduced in 2013. It was defined in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DMDD was developed as a diagnosis to help reduce the overdiagnosis of bipolar disorder in children.
DMDD is classified as a depressive disorder. The common feature of all depressive disorders is a clinically significant impairment in mood. Mood may be described as a person’s internal emotional experience.
In DMDD, the disturbance in mood is observable to others as anger and irritability. The key symptoms of DMDD that set it apart from other psychiatric conditions include:
Severe temper tantrums: These may take the form of verbal outbursts (yelling, screaming) or behavioral outbursts (physical aggression toward people or things).
Temper tantrums that aren’t normal for a child’s age: It’s not uncommon for toddlers to have meltdowns or for older children to yell when they don’t get their way. In DMDD, the tantrums aren’t what you would expect for a child’s developmental level in terms of how often they occur and how bad the episodes are. For example, you wouldn’t expect an 11-year-old to regularly destroy property when they’re angry.
Outbursts occur approximately three or more times a week: This isn’t a hard-and-fast rule. For example, a child wouldn’t be disqualified for diagnosis if they have two tantrums one week, but usually have more than two.
Irritable and angry mood between tantrums: Even when the child isn’t in an explosive episode, caregivers will see a disturbance in mood for most of the day, nearly every day. Parents may regularly feel like they are “walking on eggshells” to avoid an episode.
Tantrums occur in multiple settings: DMDD may not be the right diagnosis if a child only has outbursts in certain situations, like with one parent or a particular caregiver. For diagnosis, symptoms should be present in at least two settings, such as at home, in school, or with peers.
In addition to the above symptoms, diagnosis requires that:
- The disturbance in mood has been present most of the time for a year.
- The child is between 6 to 17 years in age. Diagnosis isn’t made before or after this age range.
- The symptoms were present before the age of 10.
Finally, a child will only be diagnosed with DMDD if the tantrums aren’t due to another condition, like autism spectrum disorder, a developmental disability, or the effects of substance abuse.
DMDD was introduced as a diagnosis to address what psychiatrists and psychologists believed to be the overdiagnosis of pediatric bipolar disorder. The key feature of bipolar disorders is the presence of manic or hypomanic episodes.
A manic episode is defined as a period of elevated, expansive, or irritable mood. In addition, a person also has an increase in goal-directed activity or energy. Hypomanic episodes are less severe versions of manic episodes. A person with bipolar disorder doesn’t always experience manic episodes. They aren’t a normal part of their daily functioning.
DMDD and bipolar disorders may both lead to irritability. Children with DMDD tend to be persistently irritable and angry, even when full-blown tantrums aren’t present. Manic episodes tend to come and go. You may ask yourself if your child is persistently in a bad mood, or if their mood seems to be out of the ordinary. If it’s persistent, they may have DMDD. If it’s out of the ordinary, their doctor may consider a bipolar disorder diagnosis.
Additionally, the key feature of DMDD is irritability, while mania may also include:
- euphoria, or extreme positive emotion
- extreme excitement
- goal-directed behavior
Differentiating DMDD and bipolar isn’t always straightforward and should be done by a professional. Talk to your child’s doctor if you suspect either of these conditions.
One study of over 3,200 children between the ages of 2 and 17 years found that between 0.8 and 3.3 percent of children meet criteria for DMDD. DMDD may be more common in children than among teens.
Specific risk factors for this disorder are still under investigation. Children with DMDD may have temperamental vulnerabilities, and at a young age may have been more prone to:
- difficult behavior
They may have previously met diagnostic criteria for:
- oppositional defiant disorder
- attention deficit hyperactivity disorder
- major depression
- an anxiety disorder
Having a family member with a psychiatric condition may increase risk. Male children are more likely to present with DMDD. Also, children with DMDD are more likely to experience:
- family conflict
- social difficulties
- school suspensions
- live in settings of economic stress
If you’re concerned that your child or a loved one may be experiencing this condition, you should get a professional assessment. Contacting your family doctor can be the first step. They can refer you to a specialist, such as a psychiatrist or psychologist. The specialist can conduct a formal assessment. Assessments may take place at a hospital, a specialized clinic, or a private office setting. It can even be made at school by a school psychologist.
DMDD is diagnosed by a medical doctor, psychologist, or nurse practitioner. Diagnosis is only made following an assessment. The assessment should involve an interview with caregivers and an observation or meeting with the child. Standardized questionnaires, school visits, and interviews with teachers or other caregivers may be part of the assessment.
Helping children with DMDD may involve psychotherapy or behavioral interventions, medication, or a combination of both. Non-medication treatments should be explored first. Treatments aren’t necessarily specific for DMDD. There are a variety of approaches that are commonly used for various mental health difficulties in children.
Psychotherapy and behavioral interventions
During psychotherapy, parents and children meet with a therapist every week to work on developing better ways of relating to one another. Among older children, individual therapy, such as cognitive behavior therapy, can help children learn to more effectively think of and respond to situations that upset them. Additionally, there are approaches that focus on empowering parents to develop the most effective parenting strategies.
A variety of medications are used to treat emotional and behavioral problems in children. These should be discussed with a psychiatrist. Commonly used medications include antidepressants, stimulants, and atypical antipsychotics.
An important consideration for treatment
The most effective interventions for all emotional and behavioral problems in children involve parents and other caregivers. Because DMDD affects how children interact with family members, peers, and other adults, it’s critical to consider these factors in treatment.
Left untreated, DMDD can develop into anxiety disorders or non-bipolar or unipolar depression in late adolescence and adulthood. As is the case with all mental health conditions in childhood, the best outcomes occur when assessment and intervention happen as early as possible. If you’re concerned that your child may have DMDD or a similar condition, don’t hesitate to contact a professional immediately.