Disruptive Mood Dysregulation Disorder (DMDD) is a childhood disorder characterized by chronic irritability that interferes with academic and social functioning. Frequent outbursts and temper tantrums, at a frequency of about three times per week, are the most obvious behavior externalizations of DMDD, but to be diagnosed with the disorder, the child must also exhibit poor mood or irritability in between outbursts, too (National Institute of Mental Health, 2018). To differentiate DMDD from pediatric bipolar disorder, it is also essential that the child does not exhibit sustained mood elevation or nonepisodic mania (Beweka, Mayes, Hameed, et al, 2016). Moreover, the symptoms of DMDD persist in spite of changes to the child’s environment, evident at home and also in school. Symptoms must also not be temporary, but in place for a year or more. While on the surface DMDD appears no different from any other psychiatric illness, it is in fact a nebulous disorder that closely resembles oppositional defiant disorder. Including DMDD in the DSM-V could lead to the overly eager prescription of medications. The DMDD designation may also be related to a systematic denial of the role that poverty and other contextual variables might play in causing DMDD symptoms (Grau, Plener, Hohmann, et al, 2018).The American Psychiatric Association “controversially” listed DMDD in the DSM-V in 2013 (Copeland, Angold, Costello, et al, 2013, p. 173). Reasons for the controversy over DMDD include its significant overlap in symptomology with several other mood disorders and behavior disruption disorders like oppositional defiant disorder (ODD), which is another and more established childhood disorder classification (Freeman, Youngstrom, Youngstrom, et al, 2016). DMDD also has a comorbidity rate as high as 92%, making it seem as if symptoms of DMDD are actually due more to the comorbid condition rather than to...
Other similar disorders listed already in the DSM include childhood bipolar disorder and attention deficit hyperactivity disorder (ADHD), the symptoms of which closely mirror that of DMDD.
The most important reason for the controversy over DMDD, however, is that there has been a lack of empirical evidence supporting the classification of the disorder at all. As Beweka, Mayes, Hameed, et al (2016) point out, there is “no consensus or even well-validated scales” for the assessment of DMDD (p. 2115). There has been no determination of a neurobiological or genetic component, a means of accurately assessing DMDD, or an established method of distinguishing it from other similar disorders even several years after the disorder was listed in the DSM-V (Baweja, Mayes, Hameed, et al, 2016). Current assessments depend on psychiatric interviews and evaluations, which can be problematic and subjective. In spite of the practical and ethical problems surrounding the DMDD diagnosis, it remains in place partly to prevent children from being misdiagnosed with other mood disorders and to ensure that children with mood and behavioral disorders do receive appropriate and evidence-based treatment.
As a childhood-only disorder, diagnoses are only offered to individuals between the ages of 6 and 18 (National Institute of Mental Health, 2018). Symptoms include constant irritability and anger, frequent outbursts or tantrums, and trouble functioning socially as a result of these mood and behavioral symptoms. Because the disorder has only been classified for a few years, prevalence rates are inconclusive, with estimates between .8% and 3.3% (Copeland, Angold, Costello, et al, 2013). However, another reason why DMDD was and remains a controversial mood disorder classification is that as many as a third of all children…
