Disruptive Mood Dysregulation Disorder (DMDD) is a pediatric mood disorder characterized by severe recurrent temper outbursts manifested verbally (verbal rages) and/or behaviorally (physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. These outbursts occur, on average, three or more times per week and the mood between temper outbursts is persistently irritable or angry most of the day, nearly every day. The symptoms must be present for 12 months before a diagnosis can be made, and diagnosis should not be made before age 6 or after age 18.
DIAGNOSTIC CRITERIA (From the DSM-5)
A. Severe recurrent temper outbursts manifested verbally (verbal rages) and/or behaviorally (physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts in persistently irritable or angry most of the day, nearly every day, and is observable by others (parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of the three settings (at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age of onset of Criteria A-E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/ hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.
A DMDD diagnosis is typically given by a licensed psychiatrist and should be confirmed only after the child has undergone a complete assessment to rule out other underlying conditions that could be causing similar symptoms - learning disabilities, neurological disorders, autism, etc. If you believe your child may have DMDD, please consult with a board-certified psychiatrist who specializes in pediatric mood disorders. Choosing a psychiatrist is one of the most important steps in the DMDD journey. Here are some tips to make the process easier. 1. Get Referrals Start with a referral list of potential psychiatrists from your primary care doctor. You can add to this list by asking family, friends, and other healthcare providers for recommendations. Take the time to research the doctors’ credentials and experience. You'll discover that there are many different types of psychiatric practices and clinical subspecialties. As you narrow down your list, call each psychiatrist’s office to make a consult appointment to meet and interview the doctor. 2. Research the Psychiatrist’s Credentials Board certification is one of the most important factors to consider when you are choosing a psychiatrist. It tells you that the doctor has the necessary training, skills and experience to provide healthcare in psychiatry. Also confirm that the psychiatrist has no history of malpractice claims or disciplinary actions. You can find the psychiatrist’s medical school, training hospital, certifications, and malpractice and disciplinary history on Healthgrades.com and state websites. 3. Consider the Psychiatrist’s Experience When you’re facing mental health issues, experience matters. The more experience a psychiatrist has with pediatric mood disorders, the better your results are likely to be. Ask how many patients with pediatric mood disorders the psychiatrist has treated. If you are looking for a specific treatment plan, ask how many patients the doctor has treated with that plan and their outcomes. 4. Consider Gender If your child will also receive therapy from the psychiatrist, it’s important they feel comfortable openly discussing personal information. The gender of the psychiatrist may play a role in how comfortable they feel. 5. Research Hospital Quality Your doctor’s hospital is your hospital. Therefore, you also need to consider the quality of care at the hospital where the psychiatrist can provide care. Hospital quality matters to you because patients at top-rated hospitals have fewer complications and better care. Additionally, consider whether the hospital’s location is important to you. Should you need to go the hospital for tests or treatment, you want the location to encourage, rather than discourage timely care. 6. Evaluate Communication Style Choose a psychiatrist with whom you are comfortable talking and who supports your information needs. When you first meet the psychiatrist, ask a question and notice how he or she responds. Does he or she welcome your questions and answer them in ways that you can understand? Trust your instincts. Therapy can take months or years and you will need to build a relationship of mutual trust. Find a psychiatrist who shows an interest in getting to know you, who will consider your treatment preferences, and who will respect your decision-making process. 7. Review Patient Satisfaction Surveys Reading what other people have to say about a doctor can provide insight into how a doctor practices medicine, as well as how his or her medical practice is operated. Patient satisfaction surveys typically ask people about their experience with scheduling appointments, wait times, office environment, and office staff friendliness. You can learn about how well patients trust the doctor, how much time he or she spends with their patients, and how well he or she answers questions. 8. Know What Your Insurance Covers Your insurance coverage is a practical matter. To receive the most insurance benefits and pay the least out-of-pocket for your care, you may need to choose a psychiatrist who participates in your plan. You should still consider credentials, experience, outcomes, and hospital quality as you select a psychiatrist from your plan.
Diagnostic Criteria Bipolar I disorder Bipolar II disorder
Essential diagnostic features:
a. At least one lifetime manic episode
b. The manic episode was not due to the effects of medications, substances, or medical illness
Diagnostic note: an episode of depression is not required to make a diagnosis
Essential diagnostic features:
a. At least one lifetime hypomanic episode
b. At least one lifetime major depressive episode
c. Neither the hypomanic nor the depressive episode(s) was due to effects of medications, substances, or medical illness
