3/17/2017 NIMH Disruptive Mood Dysregulation Disorder

TheNationalInstituteofMentalHealth:https://www.nimh.nih.gov/health/topics/disruptivemooddysregulationdisorder
dmdd/disruptivemooddysregulationdisorder.shtml

TheNationalInstituteofMentalHealth:www.nimh.nih.gov

DisruptiveMoodDysregulationDisorder
Definition
Disruptivemooddysregulationdisorder(DMDD)isachildhoodconditionofextremeirritability,anger,
andfrequent,intensetemperoutbursts.DMDDsymptomsgobeyondabeingamoodychildchildren
withDMDDexperiencesevereimpairmentthatrequiresclinicalattention.DMDDisafairlynew
diagnosis,appearingforthefirsttimeintheDiagnosticandStatisticalManualofMentalDisorders
(DSM5),publishedin2013.

Readtranscript.

SignsandSymptoms
DMDDsymptomstypicallybeginbeforetheageof10,butthediagnosisisnotgiventochildrenunder6
oradolescentsover18.AchildwithDMDDexperiences:

Irritableorangrymoodmostoftheday,nearlyeveryday
Severetemperoutbursts(verbalorbehavioral)atanaverageofthreeormoretimesperweekthat
areoutofkeepingwiththesituationandthechildsdevelopmentallevel
Troublefunctioningduetoirritabilityinmorethanoneplace(e.g.,home,school,withpeers)

TobediagnosedwithDMDD,achildmusthavethesesymptomssteadilyfor12ormoremonths.

RiskFactors
ItisnotclearhowwidespreadDMDDisinthegeneralpopulation,butitiscommonamongchildren
whovisitpediatricmentalhealthclinics.Researchersareexploringriskfactorsandbrainmechanismsof
thisdisorder.

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TreatmentandTherapies
DMDDisanewdiagnosis.Therefore,treatmentisoftenbasedonwhathasbeenhelpfulforother
disordersthatsharethesymptomsofirritabilityandtempertantrums.Thesedisordersincludeattention
deficithyperactivitydisorder(ADHD),anxietydisorders,oppositionaldefiantdisorder,andmajor
depressivedisorder.

IfyouthinkyourchildhasDMDD,itisimportanttoseektreatment.DMDDcanimpairachilds
qualityoflifeandschoolperformanceanddisruptrelationshipswithhisorherfamilyandpeers.
ChildrenwithDMDDmayfindithardtoparticipateinactivitiesormakefriends.HavingDMDDalso
increasestheriskofdevelopingdepressionoranxietydisordersinadulthood.

Whileresearchersarestilldeterminingwhichtreatmentsworkbest,twomajortypesoftreatmentare
currentlyusedtotreatDMDDsymptoms:

Medication
Psychologicaltreatments
Psychotherapy
Parenttraining
Computerbasedtraining

Psychologicaltreatmentsshouldbeconsideredfirst,withmedicationaddedlaterifnecessary,or
psychologicaltreatmentscanbeprovidedalongwithmedicationfromthebeginning.

Itisimportantforparentsorcaregiverstoworkcloselywiththedoctortomakeatreatmentdecisionthat
isbestfortheirchild.

Medication
Manymedicationsusedtotreatchildrenandadolescentswithmentalillnessareeffectiveinrelieving
symptoms.However,someofthesemedicationshavenotbeenstudiedindepthand/ordonothaveU.S.
FoodandDrugAdministration(FDA)approvalforusewithchildrenoradolescents.Allmedications
havesideeffectsandtheneedforcontinuingthemshouldbereviewedfrequentlywithyourchilds
doctor.

Forbasicinformationabouttheseandothermentalhealthmedications,youcanvisittheNIMHMental
HealthMedicationswebpage.Forthemostuptodateinformationonmedications,sideeffects,and
warnings,visittheFDAwebsite.

Stimulants

StimulantsaremedicationsthatarecommonlyusedtotreatADHD.Thereisevidencethat,inchildren
withirritabilityandADHD,stimulantmedicationsalsodecreaseirritability.

Stimulantsshouldnotbeusedinindividualswithseriousheartproblems.AccordingtotheFDA,people
onstimulantmedicationsshouldbeperiodicallymonitoredforchangeinheartrateandbloodpressure.

Antidepressants

Antidepressantmedicationissometimesusedtotreattheirritabilityandmoodproblemsassociatedwith
DMDD.Ongoingstudiesaretestingwhetherthesemedicinesareeffectiveforthisproblem.Itis
importanttonotethat,althoughantidepressantsaresafeandeffectiveformanypeople,theycarryarisk
ofsuicidalthoughtsandbehaviorinchildrenandteens.Ablackboxwarningthemostserioustype
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ofwarningthataprescriptioncancarryhasbeenaddedtothelabelsofthesemedicationstoalert
parentsandpatientstothisrisk.Forthisreason,achildtakinganantidepressantshouldbemonitored
closely,especiallywhentheyfirststarttakingthemedication.

AtypicalAntipsychotic

Anatypicalantipsychoticmedicationmaybeprescribedforchildrenwithveryseveretemperoutbursts
thatinvolvephysicalaggressiontowardpeopleorproperty.RisperidoneandaripiprazoleareFDA
approvedforthetreatmentofirritabilityassociatedwithautismandaresometimesusedtotreatDMDD.
Atypicalantipsychoticmedicationsareassociatedwithmanysignificantsideeffects,includingsuicidal
ideation/behaviors,weightgain,metabolicabnormalities,sedation,movementdisorders,hormone
changes,andothers.

Psychologicaltreatments

Psychotherapy

Cognitivebehavioraltherapy,atypeofpsychotherapy,iscommonlyusedtoteachchildrenandteens
howtodealwiththoughtsandfeelingsthatcontributetotheirfeelingdepressedoranxious.Clinicians
canusesimilartechniquestoteachchildrentomoreeffectivelyregulatetheirmoodandtoincreasetheir
toleranceforfrustration.Thetherapyalsoteachescopingskillsforregulatingangerandwaystoidentify
andrelabelthedistortedperceptionsthatcontributetooutbursts.Otherresearchpsychotherapiesare
beingexploredattheNIMH.

ParentTraining

Parenttrainingaimstohelpparentsinteractwithachildinawaythatwillreduceaggressionand
irritablebehaviorandimprovetheparentchildrelationship.Multiplestudiesshowthatsuch
interventionscanbeeffective.Specifically,parenttrainingteachesparentsmoreeffectivewaysto
respondtoirritablebehavior,suchasanticipatingeventsthatmightleadachildtohaveatemper
outburstandworkingaheadtoaverttheoutburst.Trainingalsofocusesontheimportanceof
predictability,beingconsistentwithchildren,andrewardingpositivebehavior.

Computerbasedtraining

EvidencesuggeststhatirritableyouthwithDMDDmaybepronetomisperceivingambiguousfacial
expressionsasangry.Thereispreliminaryevidencethatcomputerbasedtrainingdesignedtocorrectthis
problemmayhelpyouthwithDMDDorsevereirritability.

JoinaStudy
Clinicaltrialsareresearchstudiesthatlookatnewwaystoprevent,detect,ortreatdiseasesand
conditions.Duringclinicaltrials,treatmentsmightbenewdrugsorcombinationsofdrugs,new
psychotherapiesordevices,ornewwaystouseexistingtreatments.Thegoalofclinicaltrialsisto
determineifanewtestortreatmentworksandissafe.Althoughindividualparticipantsmaybenefit
frombeingpartofaclinicaltrial,participantsshouldbeawarethattheprimarypurposeofaclinicaltrial
istogainnewscientificknowledgesothatothersmaybebetterhelpedinthefuture.

Pleasenote:Decisionsaboutwhethertoparticipateinaclinicaltrialandwhichonesarebestsuitedfora
givenindividualarebestmadeincollaborationwithyourlicensedhealthprofessional.

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3/17/2017 NIMH Disruptive Mood Dysregulation Disorder
ClinicalTrialsatNIMH/NIH

ScientistsattheNIMHcampusconductresearchonnumerousareasofstudy,includingcognition,
genetics,epidemiology,andpsychiatry.ThestudiestakeplaceattheNIHClinicalCenterinBethesda,
Marylandandusuallyrequireregularvisits.Afteraninitialphoneinterviewtoseeifanyoftheclinical
trialsrecruitingsubjectsareagoodmatchforyou,youwillcometoanappointmentattheclinicand
meetwithaclinician.VisittheNIMHClinicalTrialsParticipantsorJoinaStudy:DisruptiveMood
DysregulationDisorderformoreinformation.

HowDoIFindaClinicalTrialNearMe?

Tofindaclinicaltrialnearyou,youcanvisitClinicalTrials.gov.Thisisasearchableregistryandresults
databaseoffederallyandprivatelysupportedclinicaltrialsconductedintheUnitedStatesandaround
theworld.ClinicalTrials.govgivesyouinformationaboutatrial'spurpose,whomayparticipate,
locations,andcontactinformationformoredetails.Thisinformationshouldbeusedinconjunctionwith
advicefromyourhealthprovider.

LearnMore
Multimedia
Watch:DisruptiveMoodDysregulationDisorder:Dr.EllenLeibenluft,SeniorInvestigator
andChiefoftheNIMHEmotionandDevelopmentBranch,explainsthehistoryofDisruptive
MoodDysregulationDisorder.
Watch:IrritabilityinChildrenDr.EllenLeibenluft:Dr.EllenLeibenluft,Senior
InvestigatorandChiefoftheNIMHEmotionandDevelopmentBranch,discussesresearchon
irritabilityinchildren.
Webinar:SevereIrritabilityandDMDDinYouthDr.KennethTowbin:NIMHchildand
adolescentpsychiatristDr.KennethTowbindiscussesNIMHresearchintochildhoodsevere
irritabilityanddisruptivemooddysregulation.
NIMHTwitterChatonDisruptiveMoodDysregulationDisorder(ArchivedTranscript)

ResearchandStatistics

ClinicalTrials.gov:DisruptiveMoodDysregulationDisorder
JournalArticles:ReferencesandabstractsfromMEDLINE/PubMed(NationalLibraryof
Medicine)
JoinaStudy:DisruptiveMoodDysregulationDisorder

LastRevised:January2017
Unlessotherwisespecified,NIMHinformationandpublicationsareinthepublicdomainandavailable
forusefreeofcharge.CitationoftheNIMHisappreciated.PleaseseeourCitingNIMHInformation
andPublicationspageformoreinformation.

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