Disruptive mood dysregulation disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Yashasvi Aryaputra[3]

Overview

Disruptive mood dysregulation disorder is defined as severe verbal or behavioral temper outbursts out of proportion to the situation that occur several times a week for at least 12 months. This occurs in children and adolescents, and symptoms are similar to those of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).

Historical Perspective

Disruptive mood dysregulation disorder was first added to the DSM-V in 2013, being put under the depression disorder module.

Classification

There is no established system for the classification of disruptive mood dysregulation disorder.

Pathophysiology

The exact pathogenesis of disruptive mood dysregulation disorder is not fully understood.

Differential Diagnosis

• Autism spectrum disorder
• Attention-deficit/hyperactivity disorder
• Bipolar disorders
• Intermittent explosive disorder
• Major depressive disorder
• Oppositional defiant disorder

Epidemiology and Demographics

Prevalence

Among children and adolescents, the 6 to 12 month prevalence of disruptive mood dysregulation disorder is 2,000-5,000 per 100,000 (2%-5%).

Risk Factors

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety disorder
• Major depressive disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Disruptive Mood Dysregulation Disorder

“

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. AND B. The temper outbursts are inconsistent with developmental level. AND C. The temper outbursts occur, on average, three or more times per week. AND D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). AND 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. AND F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. AND G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. AND H. By history or observation, the age at onset of Criteria A-E is before 10 years. AND 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 hypomanicepisode 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 (e.g., 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. AND K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

”

Treatment

Medication

• While mood stabilizing medication can be used to help treat disruptive mood dysregulation disorder, it has not proven to be effective on it's own.
• Mood stabilizers, when combined with Amantadine, have an 85% success rate in children with disrputive mood dysregulation disorder.

Psychotherapy

• Contingency management, in which parents reward good behavior and punish negative behavior, has been proven useful in treating ADHD and ODD symptoms, which are found in many individuals who have disruptive mood dysregulation disorder, but is not effective in treating disruptive mood dysregulation disorder itself.

References

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