DMDD is a new disorder created to more accurately categorize some children who had previously been diagnosed with pediatric Bipolar Disorder. For children with DMDD, their behavior is stable and not episodic, as in Bipolar Disorder.

What are the symptoms of DMDD?

Specific DMDD symptoms are as follows:

Core Symptoms

  • Severe verbal and/or behavioral temper outbursts (e.g., verbal rage, physical aggression) that are out of proportion with the situation
  • The outbursts are inconsistent with age expectations
  • The outbursts occur three or more times per week
  • The individual’s mood in between outbursts is persistently irritable or angry most of the day

How is DMDD diagnosed?

A child-adolescent psychiatrist will diagnose a child DMDD after determining whether the symptoms they are experiencing meet the diagnostic criteria; are occurring with sufficient regularity; and are resulting in significant impairment in other aspects of everyday functioning (e.g., social, academic, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver in order to determine the specific nature of the child’s or teen’s verbal and/or behavioral symptoms, although many practitioners also use behavior and emotion rating form results to support the diagnosis. The practitioner will also seek to determine that the child’s or teen’s symptoms are not related to something unforeseen.

DMDD Facts

Worldwide frequency of the condition

DMDD is estimated to be present in 0.08% to 3.3%% of the world's population. There is no recent, specific epidemiological data for Greece.

Burden of the condition in Greece

DMDD accounts for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.

Gender ratio

Gender comparative data for DMDD suggests that males are more likely to be diagnosed than females at a rate of 3:1.

Peak age of onset

Data suggests that DMDD is diagnosed more in the preschool years than in any other age group.

Proportion of the condition that emerges before age 18

DMDD must emerge before 10 years of age. As such, the proportion that emerges before age 18 years is 100%. ​​This means that 100% of individuals with DMDD will have been diagnosed by the time they are 18 years old.

What are the associated factors for DMDD?

Some common factors associated with DMDD are:

  • Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • Environmental factors. These include adverse and stressful life events, such as childhood neglect or abuse, and caregivers with mental health problems.

What other disorders co-occur with DMDD?

Co-occurrence rates for DMDD are elevated, and DMDD is rarely diagnosed alone. Children and adolescents with DMDD might typically present with a wide range of disruptive behavior, mood, anxiety, and ASD-related symptoms or diagnoses.

How is DMDD treated?

The goal in DMDD treatment is to help children or teens learn to control their emotions and stop having temper tantrums. Treatment involves psychotherapy and sometimes medication. Because DMDD is a relatively new condition, most of the evidence that supports its treatment comes from comorbid conditions such as anxiety and depression.

A type of psychotherapy called Cognitive-behavioral therapy is commonly used to help children and adolescents to more effectively regulate their mood. This therapy also teaches coping skills and ways to re-label the distorted perceptions that contribute to outbursts.

Parent Training is also frequently used to help parents interact with a child in a way that will reduce irritable behavior and improve the relationship in the family.

When therapy is not an option or when therapy alone is not working, medication to help the child control their emotions is sometimes given, especially when irritability is accompanied by other symptoms. Antidepressants (e.g., escitalopram being the most studied in this condition), stimulants (e.g., methylphenidate) and atypical antipsychotics (e.g., aripiprazole, risperidone) are the most common medications used for DMDD. Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their child-adolescent psychiatrist regularly, especially if their dosage has recently changed.

Where to find more information

If you need more information on persistent anger and reasons for concerns, you can also go to "Persistent anger" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Brænden, A., Zeiner, P., Coldevin, M., Stubberud, J., & Melinder, A. (2022). Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria. JCPP Advances, 2(1). https://doi.org/10.1002/jcv2.12060
  • Child Mind Institute. (2021, September 7). Quick guide to disruptive mood dysregulation disorder. https://childmind.org/guide/disruptive-mood-dysregulation-disorder-a-quick-guide/
  • Miller, C. (2022, July 14). DMDD: Extreme tantrums and irritability. https://childmind.org/article/dmdd-extreme-tantrums-irritability/

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. American Journal of Psychiatry, 170(2), 173–179. https://doi.org/10.1176/appi.ajp.2012.12010132
  • Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145(4), 390–409. https://doi.org/10.1037/bul0000183
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Munhoz, T. N., Santos, I. S., Barros, A. J. D., Anselmi, L., Barros, F. C., & Matijasevich, A. (2017). Perinatal and postnatal risk factors for disruptive mood dysregulation disorder at age 11: 2004 Pelotas Birth Cohort Study. Journal of Affective Disorders, 215, 263–268. https://doi.org/10.1016/j.jad.2017.03.040

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Brænden, A., Zeiner, P., Coldevin, M., Stubberud, J., & Melinder, A. (2022). Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria. JCPP Advances, 2(1). https://doi.org/10.1002/jcv2.12060
  • Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. American Journal of Psychiatry, 170(2), 173–179. https://doi.org/10.1176/appi.ajp.2012.12010132

Interventions

  • Breaux R, Baweja R, Eadeh HM, et al. Systematic review and meta-analysis: Pharmacological and non-pharmacological interventions for persistent non-episodic irritability. Journal of the American Academy of Child & Adolescent Psychiatry. Published online June 2022:S0890856722003033. doi:10.1016/j.jaac.2022.05.012
  • Epstein RA, Fonnesbeck C, Potter S, Rizzone KH, McPheeters M. Psychosocial interventions for child disruptive behaviors: A meta-analysis. Pediatrics. 2015;136(5):947-960. doi:10.1542/peds.2015-2577
  • National Institute of Mental Health, U.S. Department of Health and Human Services. Disruptive Mood Dysregulation Disorder: The Basics (NIH Publication No. 20-MH-8119). National Institute of Mental Health; :4. https://www.nimh.nih.gov/health/publications/disruptive-mood-dysregulation-disorder
  • Tourian, L., LeBoeuf, A., Breton, J.-J., Cohen, D., Gignac, M., Labelle, R., Guile, J.-M., & Renaud, J. (2015). Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder.

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