Summary about Disease
Unspecified Disruptive Mood Dysregulation Disorder (DMDD) is a childhood condition characterized by severe and recurrent temper outbursts that are grossly out of proportion to the situation. These outbursts occur, on average, three or more times per week. Between outbursts, children with DMDD exhibit a persistently irritable or angry mood that is observable by others (parents, teachers, peers). It's a relatively new diagnosis, intended to address the over-diagnosis of bipolar disorder in children.
Symptoms
Severe temper outbursts (verbal or behavioral) that are grossly out of proportion to the situation or provocation.
Outbursts occur, on average, three or more times per week.
Persistent irritable or angry mood that is observable by others (parents, teachers, peers) most of the day, nearly every day.
The persistent irritable or angry mood and temper outbursts are present for at least 12 months. Throughout that year, the child must not have a period lasting 3 or more consecutive months without these symptoms.
Symptoms must be present in at least two settings (at home, at school, or with peers) and are severe in at least one of these settings.
The diagnosis should not be made for the first time before age 6 years or after age 18 years.
By history or observation, the age of onset of symptoms is before 10 years.
Causes
The exact causes of DMDD are not fully understood, but it is thought to be related to a combination of factors, including:
Genetics: Children with a family history of mood disorders or mental health conditions may be at increased risk.
Neurobiology: Differences in brain structure and function, particularly in areas related to emotional regulation, may play a role.
Environment: Difficult or stressful life experiences, trauma, and exposure to adversity can contribute to the development of DMDD.
Temperament: Children who are naturally more irritable or have difficulty regulating their emotions may be more vulnerable.
Medicine Used
There is no specific medication approved by the FDA specifically for DMDD. Treatment typically involves a combination of therapies, and medication may be used to target specific symptoms:
Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants like fluoxetine, sertraline, or citalopram may be used to help manage irritability and mood.
Stimulants: Medications like methylphenidate or amphetamine, typically used for ADHD, may sometimes be used to help with impulsivity and attention problems that can contribute to disruptive behavior.
Atypical Antipsychotics: In some cases, medications like risperidone or aripiprazole may be used to help manage severe aggression or temper outbursts, but these medications have significant side effects and are usually reserved for more severe cases.
Mood Stabilizers: Medications such as Lithium, Valproic Acid, Carbamazepine or Lamotrigine may be used off label but are usually reserved for children who do not respond to other treatments
Is Communicable
No, DMDD is not a communicable disease. It is not caused by a virus, bacteria, or other infectious agent and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent DMDD, as its causes are complex and not fully understood. However, early intervention and support can help manage symptoms and improve outcomes. General recommendations include:
Creating a Stable and Supportive Home Environment: Providing a consistent, nurturing, and predictable environment can help children feel safe and secure.
Teaching Emotional Regulation Skills: Helping children learn how to identify, understand, and manage their emotions can reduce the frequency and intensity of outbursts.
Promoting Positive Parenting Practices: Using positive reinforcement, clear expectations, and consistent discipline can help children develop self-control.
Seeking Professional Help Early: If you are concerned about your child's mood or behavior, consult with a mental health professional for assessment and treatment.
How long does an outbreak last?
DMDD is not characterized by "outbreaks" in the way an infectious disease is. Instead, it is a chronic condition with persistent symptoms. Individual temper outbursts typically last for a shorter duration, ranging from minutes to hours. The overall condition persists for at least 12 months with no periods of 3 consecutive months symptom-free to meet diagnostic criteria.
How is it diagnosed?
DMDD is diagnosed by a mental health professional (psychiatrist, psychologist, licensed clinical social worker) based on a thorough clinical evaluation. This typically involves:
Clinical Interview: The clinician will interview the child, parents, and possibly teachers to gather information about the child's mood, behavior, and functioning.
Symptom Assessment: The clinician will assess the presence and severity of the symptoms of DMDD, as defined by the diagnostic criteria in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).
Review of History: The clinician will review the child's medical, developmental, and psychiatric history.
Ruling out Other Conditions: The clinician will consider other possible diagnoses, such as ADHD, oppositional defiant disorder, anxiety disorders, or mood disorders, and rule them out based on the clinical presentation.
Standardized Questionnaires/Rating Scales: These can be helpful for gathering information and tracking symptoms, but are not usually diagnostic on their own.
Timeline of Symptoms
DMDD symptoms must be present for a sustained period to warrant a diagnosis. Key elements of the timeline include:
Onset: Symptoms must begin before age 10.
Duration: The persistent irritable or angry mood and temper outbursts must be present for at least 12 months.
Frequency: Temper outbursts must occur, on average, three or more times per week.
Remission Criteria: Throughout that year, the child must not have a period lasting 3 or more consecutive months without these symptoms.
Important Considerations
DMDD is a relatively new diagnosis, and there is still much to learn about its course and treatment.
It is important to differentiate DMDD from other conditions, such as bipolar disorder, ADHD, and oppositional defiant disorder.
Early intervention is crucial to improve outcomes and prevent long-term problems.
Treatment should be individualized to the child's specific needs and may involve a combination of therapy and medication.
Parent training and support are essential components of treatment, as parents play a key role in helping children manage their emotions and behaviors.
Ongoing monitoring and follow-up are important to ensure that treatment is effective and to address any emerging problems.