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Disruptive Mood Dysregulation Disorder: Children's Version of Bipolar Disorder

Updated: Sep 28

Temper tantrums are very common displays among younger children. It is their way of expressing their anger towards their limitations or not being able to get things his/ her way. However, frequent, difficult-to-control tantrums that appear out of proportion to the environment, may require children to test for Disruptive Mood Dysregulation Disorder (DMDD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), first listed DMDD as a diagnosis in 2013. The DSM-5 categorizes DMDD as a kind of depression because affected children have trouble managing their emotions and moods in an age-appropriate manner. DMDD is a childhood disorder and is characterized by extreme rage, impatience, and frequent outbursts of anger. While youngsters often throw temper tantrums, DMDD is more than just typical child moodiness. Children with DMDD frequently have strong, powerful outbursts of anger that can cause serious disruption in a variety of facets of a child's life.



This disease was initially recognized as a diagnosis in the Diagnostic and Statistical Manual's (DSM-5) fifth edition, which was released in 2013. To help allay worries about probable overdiagnosis and treatment of bipolar disorder in youngsters, this disease was added to the DSM-5.

However, due to the lack of empirical data on DMDD, there exists controversy regarding the addition of this disorder.


Symptoms

A child must be between the age of 6 and 18 to be diagnosed with disruptive mood dysregulation disorder.

DMDD symptoms include the following:

Extreme, frequent temper tantrums: These outbursts may include shoving, hitting others, or destruction of property.

Frequent outbursts around three or more times a week: Even if a child may not always experience these many outbursts in a week, there are still chances that they may have DMDD. There could be more tantrums in one particular week than the next for children. For the diagnosis, there must be tantrums three or more times each week on an average.

Tantrums that are out of proportion: While we may anticipate a child to get upset when they don't get a toy they desire or get things done the way they want, a child with DMDD may act out with excessive physical aggressiveness and intense verbal outbursts.

Temper tantrums that are inappropriate for the child's age: It might not be shocking to us if a young child throws a temper tantrum that involves wailing and sobbing while falling on the floor of a supermarket when not given the chocolate or toy he/ she wants to buy. However, such behaviour is not expected from a 12-year-old. Children with DMDD may display behaviours that are considered inappropriate according to their age.

Irritable and angry moods in between tantrums: Children with DMDD frequently feel furious and very irritable in between episodes of intense emotional outbursts. These moods are typically present and are observed by others.

Symptoms can occur in several contexts: This implies that temper tantrums don't just happen in one place, like at school. Tantrums in at least two contexts, such as at school, at home, or with peers, are a hallmark of DMDD.

In addition to the aforementioned requirements, the symptoms must have persisted for at least a year with no more than three consecutive months failing to meet the diagnostic standards. Psychiatrists will also rule out additional factors including substance use and developmental disabilities in addition to whether or not the patient meets these criteria.




DMDD is thought to occur more often in boys than in girls, and in children who have a family member with any psychiatric condition.


Due to these concerns, children with DMDD are more likely to experience:

● Familial conflict

● Difficulty in social interaction

● Difficulties in their school setups


Difference between DMDD and Bipolar Disorder

In order to combat what psychiatrists believed to be an overdiagnosis of Pediatric Bipolar Disorder, DMDD was developed as a diagnosis. Irritability is the defining trait of DMDD, whereas manic or hypomanic episodes are symptoms of bipolar disorder. A heightened, expansive, or irritated mood that frequently includes inflated self-esteem, racing thoughts, or trouble paying attention is referred to as a manic episode. A less severe kind of mania known as hypomania is one that doesn't interfere with daily functioning. Although both DMDD and bipolar illness can result in irritability, DMDD's irritable mood is continuous and severe while bipolar disease's manic episodes tend to happen infrequently. Furthermore, children with DMDD typically do not display the euphoria, insomnia, and goal-directed conduct connected to mania. It can be difficult to tell the difference between DMDD and bipolar disorder, thus both conditions must be properly evaluated by a mental health specialist.

While Bipolar Disorder is a lifelong condition that could happen at any age, it typically starts developing during late adolescence or early adulthood. However, medical professionals only identify DMDD in youngsters between the ages of 6 and 18.




Extreme discomfort brought on both DMDD and BD can make it difficult to function. However, BD only exhibits irritation during manic episodes. A person returns to experience emotions at a normal level after a manic episode. In contrast, a child with DMDD is frequently irritated and angry. A person with BD may go through periods of joy or despair, whereas a youngster with DMDD is more likely to feel agitated or angry.

Common Treatments for DMDD

A person should consult a psychiatrist if they believe their child may have DMDD. A person's relationships, education, and quality of life may suffer as a result of DMDD.


Medication: DMDD may be treated with drugs like antidepressants, stimulants, and antipsychotics. Anyone using these drugs to treat DMDD should watch out for any side effects that can occur, like weight gain or suicidal thoughts.

Psychotherapy: Counseling can support a child's development of mood regulation and frustration tolerance. It can also teach kids how to control their anger and reconsider how they react to small irritations.




Parental training: This kind of instruction teaches parents or other caregivers how they could interact in a way that lessens hostility. Furthermore, it can support healthier parent-child interactions.

Training on a computer: Children with DMDD may have problems interpreting ambiguous facial expressions as furious. These kids might benefit from computer-based instruction to better grasp facial expressions


References

Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal psychology: an integrative approach. Nelson Education Ltd.

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