Disruptive Mood Dysregulation Disorder DRAFT

What is Disruptive Mood Dysregulation Disorder or DMDD

Disruptive Mood Dysregulation Disorder is a relatively new childhood disorder in the mental health field. The condition is characterized by persistent, severe irritability, anger, and frequent, extreme temper outbursts that are greatly disproportional to the situation at hand.

DMDD appeared for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that was published in 2013. The development of Disruptive Mood Dysregulation Disorder was in efforts to replace the diagnosis of bipolar disorder in children.

What is Dysphoric Mood

The originally proposed disorder for the DSM-5 was called Temper Dysregulation Disorder with Dysphoria (TDD). Dysphoria or dysphoric mood is an emotional state that often accompanies a number of mental illnesses and physical conditions. An individual who experiences a dysphoric mood has intense anguish and unhappiness with their life. Severe depression, anxiety, and agitation follow closely behind the unbearable uneasiness that the individual experiences.

TDD (now published as DMDD in the DSM-5) was designed to replace the diagnosis of childhood bipolar disorder by further explaining that the behaviors of Disruptive Mood Dysregulation Disorder do not only occur during the course of a Psychotic or Mood Disorder.

Prior to the publishing of the DSM-5, many children received a pediatric bipolar disorder diagnosis although they did not have all of the clinical signs and symptoms of the disorder. For example, the children do not have the episodic mania or the hypomanic episode characteristics of bipolar disorder.

Furthermore, additional research continues to show that children with DMDD generally do not go on to receive a bipolar disorder diagnosis as an adult. Instead, they are more likely to struggle with depression or anxiety disorders.

Creating DMDD was in efforts to provide a more accurate mental health diagnosis for these children.

Mood Disorder Definition

A mood disorder is a psychological disturbance in which an individual’s emotional state directly affects their normal, day-to-day activities.

There are two main categories of mood disorders: Major Depressive Disorder (MDD) which includes major depression and dysthymia, and Bipolar Disorder which involves moods that cycle between mania and depression.

Experts still do not fully understand the underlying causes of mental illness. However, the symptoms are scientifically valid and many disorders are extremely common and widespread.

List of Symptoms of Disruptive Mood Dysregulation Disorder

Experts say that occasional temper tantrums in children are a normal part of growing up. Many children experience agitation or moodiness from time to time; it’s not anything to panic over. However, when children are consistently angry, have chronic irritability, and temper tantrums are severe and occurring regularly, there may be something more serious than growing pains going on.

The most common symptoms of DMDD include:


Severe, frequent verbal and/or behavioral temper outbursts that occur at least three times a week. The temper outbursts that are not consistent with the developmental level. In other words, the child is most likely far too old to be having a temper tantrum about the situation at hand.

Outburst Definition

An outburst is the sudden release of a strong emotion, especially anger. Some may describe an outburst as an eruption or an explosion. Often they may seem to appear with no real warning and for no real reason.

A child with DMDD may manifest the outburst verbally or behaviorally.

Verbal outbursts may include screaming, verbal rage, and/or crying out uncontrollably.

Behavioral outbursts may include physical aggression or rage towards another person or an inanimate object.

Most often, verbal and behavioral outbursts coincide with one another.

Irritable Mood Every Day

The mood between the temper outbursts is irritable, sad, or angry nearly every day. The child is rarely, if ever, seen acting as you would imagine a “typical” child would. We completely understand and acknowledge the hormonal changes a preteen is going through. Not to mention, the endless, unfortunate possibilities (likeliness) of online bullying and harassment that comes with growing up with today’s technology. Figuring out who they are as young people amidst all of the chaos can be incredibly challenging for many and result in moodiness and not feeling their best. We want to stress that this is so much more than that. 

The Mood is Observable

The child’s mood is observable by others (i.e. teachers, friends, parents) commonly at school through disruptive behavior. The child has a hard time functioning in more than one place due to irritability (i.e. home, school, with friends) and this inability to adjust is very apparent.

DMDD Diagnosis and Treatment

Having a child with DMDD can be a challenging reality for parents. The sheer unpredictability of children with the disorder can leave those around them feeling like they are constantly walking on eggshells.

If you feel that your child might have DMDD, we advise you to make an appointment with your mental health specialist. From there, a proper diagnosis and treatment plan can made.

Diagnostic Criteria

There is specific diagnostic criteria necessary for a mental health specialist to diagnose children with DMDD. 

The onset of symptoms of DMDD must be before the child is ten years old. Furthermore, a diagnosis should not be made before the child is six years old or after eighteen years old.

Additionally, as mentioned, outbursts play a considerable role in diagnosing a child with DMDD. However, the key to the disorder is the child’s mood in between outbursts. Children with DMDD are constantly irritable or moody to the degree that it is observable by other parents and teachers. In other words, a difficult interaction between a child and their parent or a child and their teacher is not a clinical sign of DMDD. 

An Overview 

To review, the following symptoms must be present for one year or longer without a remission period of more than three months. Additionally, the symptoms must be present in two or more locations, i.e. school and home. The symptoms must be severe in at least one of these settings.

  1. Severe, recurring temper outbursts (verbal and/or behavioral) that are grossly disproportioned to the situation at hand.
  2. The temper outbursts occur at least three times a week.
  3. The temper outbursts are not consistent with the developmental level of the child (the child is often far too old to be having an outburst over whatever situation is occurring).
  4. Between temper outbursts, nearly every day the child’s mood is extremely irritable or angry.
  5. The irritable mood is observable by peer, teachers, and parents.

Furthermore, with the exception of the duration of a manic or hypomanic episode, there has never been a specific period lasting more than one day where the child has met the full symptom criteria.

Finally, the criteria for diagnosing children with DMDD states that the child’s behaviors are not occurring exclusively during an episode of MDD (major depressive disorder). Also, another mental disorder does not better explain the child’s behaviors.

It should also be stated that, as with all child mental disorders, the aforementioned symptoms can be attributed other diagnoses. Alternative diagnoses include other medical or neurological condition as well as the physiological effects of a substance.

Treatment for Children with DMDD 

Disruptive Mood Dysregulation Disorder is still a relatively new diagnosis. Therefore, researchers are still determining the treatment plan that works best.

Currently, there are two main ways in treating children with DMDD: medication and psychological therapy.

Experts suggest that psychological therapy such as cognitive-behavioral therapy, should be attempted to treat the symptoms of DMDD first. A form of therapy called applied behavior analysis may also be used. 

Other forms of psychological therapy include psychotherapy, parent training, and computer based training. 

If necessary, medication should be integrated in conjunction with psycholoical therapy. Like all medication, those used for treating mental illness also come with a slew of potential side effects. 

A mental health specialist may prescribe: 

Antidepressant Medications

Mental health specialists often prescribe antidepressant medications for anger issues and mood problems. However, studies show that while antidepressants may be safe for many people, they pose a high risk for suicidal thoughts and actions in children and teens. 

Stimulant Medication

A doctor may also prescribe a stimulant medication. While stimulant medications are known to work for individuals with attention-deficit hyperactivity disorder (ADHD), studies now show that stimulant medication may be able to decrease irritability in children with DMDD.  

Atypical Antipsychotic

Your mental health professional may prescribe an atypical antipsychotic if your child is displaying severe outbursts that involve physical violence towards other individuals or property. 

It is imperative the parents of children in treatment for DMDD are working as closely as possible with their doctors. The doctors can aid in teaching parents (as well as other adults in the child’s life like their teachers) how to best respond to a disruptive episode. 


Living with Disruptive Mood Dysregulation Disorder

As a parent, it is incredibly unsetting to recognize that your child may have a mood disorder. Once a cheerful loving child has seemingly made a transformation before your eyes into someone you may not fully recognize. 

The good news is, there is hope. While Disruptive Mood Dysregulation Disorder can be extremely challenging, recognizing that there is a problem is the first step on the path to managing the situation. 

Consult with your mental health specialist and get your child moving in the right direction. DMDD is not the end for your or your child’s happiness. 







author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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