Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder is a recent onset disorder. in the DSM-5 which is fundamentally characterized by the presence of chronic, severe and persistent irritability over time in some children.

Although these symptoms can appear in a wide variety of childhood psychological disorders such as ADHD or bipolar disorder, the creation of this new concept was based on the objective of being able to include tantrums and certain outbursts of anger in the diagnosis.

In fact, some researchers consider severe non-episodic irritability in children as a feature of bipolar disorder. Hence, during the last decades of the 20th century, It was debated whether or not this behavior was a pediatric manifestation. Furthermore, this coincided with a significant increase in rates of bipolar disorder diagnosis in children.

This abrupt increase appeared to be due to clinicians combining at least two clinical manifestations into a single category. That is to say, Both classic episodic presentations of mania and non-episodic presentations of severe irritability had been labeled as bipolar disorder in children.

So, in the DSM-5 the term bipolar disorder was explicitly reserved for the episodic situations in which bipolar symptoms occur. The DSM-IV did not have a diagnosis intended to diagnose children whose hallmark symptoms consisted of very marked and non-punctual irritability.

Thus, the DSM-5, with the inclusion of disruptive mood dysregulation disorder, has provided a different category for such problems. Let’s see what it consists of.

Irritability as a fundamental characteristic

As we said, Chronic irritability, severe and persistent over time, is the fundamental characteristic of this disorder. and has two relevant clinical manifestations:

Frequent outbursts of anger. Persistently irritable or chronically angry mood between severe outbursts of anger.

It is important to note that the first diagnosis of disruptive mood dysregulation disorder should not be made before age 6 or after age 18. Therefore, We are faced with a disorder that is not diagnosed in adults.

Frequent fits of anger

These attacks occur in response to frustration, and they can be verbal or manifest through behaviors (aggression against objects, oneself and other people).

It is not enough that they occur from time to time. They must occur three or more times a week, for at least a year and in at least two different environments (for example, at home and at school). Furthermore, these outbursts of anger must also be inappropriate for the level of development of the child or adolescent.

Persistently irritable or chronically angry mood

This irritable or angry mood must be characteristic of the child. Therefore, must be present most of the day, almost daily. In addition, it must be appreciable by other people in the child’s environment.

Disruptive mood dysregulation disorder

The criteria indicated by the DSM-5 for the diagnosis of this disorder are the following:

TO. Severe and recurrent outbursts of anger that manifest themselves verbally and/or with behavior (e.g., physical assault on persons or property) whose intensity or duration is disproportionate to the situation or provocation.

B. Outbursts of anger They do not match the degree of development.

C. Outbursts of anger occur, on average, three or more times a week.

d. Mood between angry outbursts is persistently irritable or irascible most of the day, almost every day. It is observable by other people (e.g., parents, teachers, peers).

E. AD criteria have been present for 12 or more months. In all this time, the individual has not had a period lasting three or more consecutive months without all the symptoms of the AD criteria.

F. Criteria A and D are present in at least two of three contexts (at home, at school, with peers) and are serious in at least one of them.

G. The first diagnosis It should not be done before age 6 or after age 18.

H. By history or observation, AE criteria begin before age 10 years.

I. There has never been a well-defined period of more than one day during which all symptomatic criteria, except duration, for a manic or hypomanic episode have been met.

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.

K. Symptoms cannot be attributed to the physiological effects of a substance or another medical or neurological condition.

Development and course

As we have seen, the onset of disruptive mood dysregulation disorder must occur before the age of 10, and the diagnosis should not be applied to children under 6 years of age.

Since the symptoms of this disorder are likely to change as the child matures, use of this diagnosis should be restricted to similar age groups to those in which its validity has been established (7-18 years). About half of children with chronic severe irritability will continue to meet criteria for the disorder one year after being diagnosed.

Disruptive mood dysregulation disorder is more common than bipolar disorder before adolescence. The symptoms of this disorder generally become less frequent as the child progresses into adulthood.

Consequences

Chronic irritability is associated with a significant alteration of the child’s family life and relationships with peers, as well as academic performance.

As a result of his extremely low tolerance for frustration, These children have difficulty progressing in school and do not participate in activities that others enjoy. Besides, They will have problems functioning normally in most aspects of their life, because any small problem will make them feel bad.

Prevalence

Disruptive mood dysregulation disorder It is common among children who attend child mental health consultations. Estimates of the prevalence of the disorder in the community are unclear, although It is estimated to be around 2-5% among the general population.

Treatment

In general, you can use medication, psychotherapy and a combination of both as a treatment for disruptive mood dysregulation disorder.

Because the diagnosis is new, Clinical psychologists are still researching which treatments work best. Stimulant medications, antidepressant medications such as selective serotonin reuptake inhibitors, and a type of therapy known as applied behavioral analysis have been used.

Parents should work closely with professionals to learn what works best for their child.. In this regard, caregivers must also learn specific strategies that can be used to respond to the child’s disruptive behavior.

As we have seen, it is a disorder that occurs exclusively in children and adolescents and about which there is still much to investigate.

Bibliography used:

American Psychiatry Association (2014). Diagnostic and statistical manual of disorders mental (DSM-5), 5th Ed. Madrid: Editorial Médica Panamericana.

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