Disruptive mood dysregulation disorder abbreviated as DMDD is a condition featuring chronic and severe irritability. This has been added to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders catering to adolescent and childhood disorders. DMDD is explained through severe temper tantrums that are disproportionate to existing situations with inconsistencies with developmental level. This occurs severally each week. The mood between various outbursts becomes persistently irritable or angry while symptoms should be presented for between 12 and 17 months in the various contexts. DMDD is not diagnosed in children less than six years of age. However, it is observed from 10 years and above. The inclusion also allows DSM-5 to develop controversial convert to the existing disorder. Indeed, the DMDD support is based on research that focuses on extreme mood dysregulation (SMD). This condition is characterized by severe and chronic irritability together with hyperarousal symptoms. They share symptoms with oppositional defiant disorder (ODD), depression, attention and mania deficit hyperactivity disorder (ADHD). SMD was initially conceptualized as one of the possible bipolar disorder phenotypes without much literature support. Longitudinal studies explain the dimensional and SMD measures of chronic irritability in predicting unipolar anxiety and depressive disorders as compared to bipolar disorder. Traditional view allows bipolar disorder to develop among pre-pubertal children while rarely becoming a prevalent issue in adolescence. The symptoms among young children are largely based on the adult analysis (Shirazi, Shabani, & Shahrivar, 2014). Contrasting stances assert that the existing bipolar disorder is common in children such as toddlers and preschoolers. The symptoms are rather different from the ones observed in the adults. In alternative views, the episodic bipolar disorder nature is absent among young patients while mood changes are much common. However, this is different in adults as the levels of aggressiveness, sleep disturbance; increased energy and irritability are the symptoms often gained by children having bipolar disorder and in adults sharing similar illnesses (Johnson & McGuinness, 2014). Proponents of such views maintain that bipolar disorder normally shares a misdiagnosed co-morbid with the attention based on deficit hyperactivity disorder (ADHD). Indeed, the disorder shows significant symptom overlaps with existing bipolar disorder advancing in both children and adolescents.

Although uncommon, pre-pubertal children show symptoms of DSM-IV consistent criterion for bipolar disorder. This demonstrates continuity with every form of adult bipolar disorder and other poor outcomes. Controversy, in this case, refers to views that bipolar disorder presents different elements in children as compared to adults. The dispute type is common with similar processes occurring regarding depression. However, this was settled through acknowledgment of adult diagnostic criterion with applicable minor modifications for children (Meany-Walen, Bratton & Kottman, 2014). In this case, differences refer to the definition of mood abnormality and episodes.

Some researchers and clinicians hold that the extensive symptoms of manic episodes include abnormal, expansive, persistently elevated, or irritable moods and increased energy or activities which are absent in children. Important questions include whether or not such children having bipolar disorder compare to adults with a similar illness and have episodes of severe nonepisodic irritability (Manis, Norris, Paylo & Kress, 2015). This is a developmental presentation of pediatric mania against the euphoria as a common characteristic in adult mania sickness. It is possible to conclude that there are groups of severely impaired children showing symptoms overlapping with bipolar disorder among different ADHD cases. However, most of them do not meet the strict criteria for diagnosis and potential of acquiring a new or different disorder. The present techniques focus on children with the behavioral and emotional problems that have different forms of hypomania or mania. The children show characteristics of heightened irritability and chronically unstable mood. The frequent use of existing treatment describes the phenotype as a severe mood dysregulation with equivalent status of disruptive mood dysregulation disorder (Meany-Walen, Bratton & Kottman, 2014).

SMD includes hyper-arousal symptoms (as in the case of manic episodes and ADHD) together with severe chronic and non-episodic irritability. Even as various researchers observe that adolescents and children suffering from bipolar disorder present narrow behavioral phenotypes, there is a resemblance of bipolar disorder in adults. It is important to have clear episodes of mania and of depressed mood where SMD patients lack well-defined episodes. However, bipolar disorder among adolescents and children and SMD patients shows comparable impairment levels. Evidence shows that SMD improves risks of early anxiety disorders and adulthood depressive disorders with a likelihood of bipolar disorder. This is less frequent in the observation of families of children sufferings from SMD as compared to families of children having bipolar disorder patients in both clinical and community populations (Waxmonsky, Wymbs, Pariseau, Belin, Waschbusch &...

The comparison to controls and SMD patients, bipolar disorder rates higher in subjective fear of neutral expressions and SMD participants show under-activation (Manis, Norris, Paylo & Kress, 2015). The altered punishment and reward processing feature relevant varieties of neuropsychiatric conditions with preliminary research suggesting that SMD youths and bipolar disorder individuals not be different from healthy people. This contrasts with psychopathy individuals. The motor inhibition features have relevance in heightened activities in patients and neural recruitment resulting from failed motor inhibition. This differentiates children with bipolar disorder and SMD from one another. Studies on emotional prosody label deficits as indexed inabilities of identifying nonverbal emotional cues that are indicated in similar impairment. The peoples are diagnosed with SMD unlike in situations of controls. It is possible to conclude at the stage underlies brain mechanisms for various processes that have a relationship to the SMD symptomatology. However, this differs between SMD and bipolar disorder patients and healthy people. The approach requires regular updates on the data available (Meany-Walen, Bratton & Kottman, 2014).
The absence of viable empirical evidence sees medications that improve symptoms including depressed mood and irritability becoming valuable. The case is substantiated along antidepressants (such as SSRIs) and mood stabilizers (such as lithium and valproic acid) under consideration. Second, generation antipsychotics including aripiprazole, risperidone, ziprasidone and olanzapine are suggested as beneficial aspects. However, the prescription practices are placed under scrutiny because of marked increment of off-label and on-label use (Johnson & McGuinness, 2014). There are concerns regarding the safety of the medication. Antipsychotic medication causes adverse effects including sedation, extrapyramidal symptoms, cognitive impairment, metabolic changes and weight gain. Therefore, discussion with patients and parents improves the quality of monitoring potential side effects for experienced clinicians warranting prescribed medications (Shirazi, Shabani, & Shahrivar, 2014).

Medication and educational aspects are complementarily used. Particularly, clinicians, parents, and teachers need to continue working closely with the aim of addressing and meeting patients' special needs such as classroom support and more time to accomplish school tests. This refers to medication adverse effects where teachers should have awareness about them. Families and patients should receive education regarding the disorder, related impairments and co-morbid symptoms and approaches to coping and intervention. Finally, lifestyle changes can be addressed together through developing close health professionals (Waxmonsky, Wymbs, Pariseau, Belin, Waschbusch & Babocsai, 2013). The changes include strategies to cope with crises and identification of potential triggers and stressors for such situations. The plan to manage emergencies such as suicidal behavior and loss of control should be put in perspective. Moreover, all parenting programs and family therapy should to consider while allowing children coming from problematic families receive proper care parenting and communication skills. Other parents suffering from psychiatric disorders can be treated in the process. In such cases of referral to psychiatrists, consideration should be made to DMDD.

Studies extend such literature through an examination of environmental and familial correlates and DMDD predictors. DMDD under six years of age is associated with existing concurrent low parental support and lower marital satisfaction levels. The observed parental support remains significant in multivariate analyzes. Higher observations are made on parental lifetime substance use and parental hostility disorders as assessed at three years of age. The outcomes predict that at six years of age, substance use disorder and parental lifetime DMDD are unique DMDD predictors in multivariate analysis. Evidence also links ODD irritability dimension to maternal depression. This is a clear dimension as DMDD is rarely associated with parental disorders (Shirazi, Shabani, & Shahrivar, 2014). Other studies examine associations between parental psychopathology and DMDD as ways to diagnosing parental psychopathology in clinical samples. However, children of parents affected by substance use disorders have a high likelihood of both externalizing and internalizing disorders and poorer social functioning. Parents with substance utilize problems experience environmental and psychological adversities contributing towards family dysfunction and poor parenting.

Despite the similarity, ODD is differentiated from DMDD in various ways. First, like ODD, ADHD is one of the disruptive behavioral disorders without an impact on mood disorders. Even though ODD children show angry, and irritability outbursts, the most salient features include defiant and noncompliant behavior, including refusing to do chores, acting in a spiteful manner, or ignoring parents. Further, children with ODD have a tendency of directing their opposition behavior and defiance towards some…