One of our assignments was to look into one specific disorder and I chose DMDD, here you go...
Depressive disorders include the presence of sad, empty, or irritable mood, as well as cognitive changes, which affect an individual’s functioning (DSM-5, 2013). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has placed Disruptive Mood Dysregulation Disorder (DMDD) under depressive disorders.
Disruptive Mood Dysregulation Disorder
According to the DSM-5 (2013), Disruptive Mood Dysregulation Disorder consists of chronic and persistent irritability. The criteria for this diagnosis include severe recurrent temper outbursts either verbally or behaviorally. The outbursts need to be out of proportion of the situation as well as irregular with an individual’s developmental level (Benarous et al., 2017). To fit criteria, the outbursts happen three or more times a week with irritable and angry mood most of the day, nearly every day. The symptoms need to be present for 12 months or more and within two of the three settings of home, school, or with peers (Benarous et al., 2017). The diagnosis should not be used for children under 6 or older than 18 with the onset criteria being before age 10. To be diagnosed with DMDD, the individual would not have experienced a period of manic or hypomanic episodes lasting more than a day or these behaviors only due to a major depressive episode. Lastly, the symptoms should not be due to the physiological effects of substances or other medical or neurological conditions (DSM-5, 2013).
The prevalence of DMDD from 6-months to 1-year ranged from 2% -5% with a higher rate of school-aged males being diagnosed (DSM-5, 2013). Benarous et al. (2017) study found a prevalence of 8.2% in the general population and around 26-31% in clinical settings. DMDD has an extremely high comorbidity rate. Specifically, with depressive disorders and Oppositional Defiant Disorder (ODD) (Benarous et al., 2017). The DSM-5 (2013) states those who meet the bipolar disorder criteria should not be diagnosed with DMDD and those who meet the criteria for ODD or intermittent explosive disorder and DMDD, should only have the DMDD diagnosis (DSM-5, 2013). Some diagnoses can coexist with DMDD including major depressive disorder, attention-deficit/hyperactive disorder, conduct disorder, and substance use disorder (DSM-5, 2013).
The DSM-5 created the new diagnosis of DMDD over concerns of the increased overdiagnosis of bipolar disorder in children (Mayes et al., 2015). Children with irritable and behavioral dyscontrol typically develop unipolar depressive or anxiety disorder rather than bipolar disorder as they move into adulthood (Martin et al., 2017). The DMDD was previously known as Severe Mood Dysregulation, (SMD) a diagnosis looking at irritability and bipolar disorder (Benarous et al., 2017). The current DMDD does not have the same criteria as SMD and the onset changed from 12 to 10 years old (Benarous et al., 2017). The DMDD diagnosis is thought to be controversial with poor reliability and close similarity to Oppositional Defiant Disorder; two symptoms for DMDD are the same two of eight for ODD (Mayes et. al., 2017). The World Health Organization International Classification of Diseases has even discussed changing DMDD as an ODD specifier and not as a separate diagnosis (Mayes et al., 2015).
The onset of DMDD must be before the age of 10 years old and it usually is diagnosed to those between the ages of 6 and 18. The symptoms of this diagnosis are likely to change as the child matures, but chorionic irritability will continue to be present and has been found to meet criteria one year later (DSM-5, 2013). Children with chronic irritability usually have a complicated history and may be separated from children with bipolar disorder based on family risk. Children with irritability and low frustration levels have been known to struggle in school and participate in dangerous behaviors including suicide and aggression (DSM-5, 2013). As children grow into adolescents and adulthood, those with DMDD symptoms will sometimes decrease, but negative effects could persist (Benarous et al., 2017). Specifically, those diagnosed with DMDD have long-term issues with involvement in illegal activities, poor education, and low socioeconomic status (Mulraney et al., 2016).
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