DMDD Diagnosis: DSM 5 Criteria for Disruptive Mood Dysregulation Disorder

Assigning the disruptive mood dysregulation disorder (DMDD) diagnosis in a child has not always been an option.  In fact, this is a relatively new diagnosis, added to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013.  

The addition of DMDD to the DSM-5 was, in part, to address the over-diagnosis and overtreatment of bipolar disorder in children.  Since disruptive mood dysregulation disorder is a newly recognized mental health disorder, there are no specific assessment tools used for diagnosis.  Thus, even for trained medical and mental health professionals, it can be difficult to determine whether a child should be assigned a DMDD diagnosis or that of another psychiatric disorder.  Yet, the difficulty in diagnosing is not only due to the lack of assessment tools; disruptive mood dysregulation disorder symptoms can look similar to those found in other psychiatric disorders in children (i.e. – depression, posttraumatic stress disorder, oppositional defiant disorder, bipolar disorder, etc.)  Nonetheless, an accurate diagnosis is possible, as there are specific disruptive mood dysregulation disorder criteria a child must meet to receive the DMDD diagnosis.

DMDD Diagnosis: Criteria

In general, a clinician considering disruptive mood dysregulation disorder will look for severe temper outbursts and consistent irritability and anger in between the outbursts.  Prior to making a diagnosis of DMDD, the clinician will rule out any other possible causes or contributing factors to the presenting DMDD symptoms.  The diagnostic criteria a child must meet in order to receive a DMDD diagnosis is:

1. Recurrent and severe temper tantrums or outbursts
   • The tantrums/outbursts may be expressed verbally and/or behaviorally (physical aggression towards other people or property).
   • The tantrums/outbursts are considered out of proportion (in duration and intensity) to the situation or triggering event
   • The tantrums/outbursts are inconsistent with the child’s developmental level
   • The tantrums/outbursts occur three or more times per week, on average
2. Persistent irritability or anger
   • The irritable/angry mood occurs nearly every day, for most of the day
   • The irritable/angry mood is observable by others (peers, parents, teachers, etc.)
3. The recurrent temper tantrums and persistent irritability/anger have been present for 12 months or longer
   • Throughout the 12 months of ongoing temper tantrums and irritability/anger, the child has not had a period lasting 3 or more consecutive months without all of the diagnostic symptoms.
4. Symptoms are present in at least two of three primary settings, either home, school, or in social situations.
   • Symptoms are severe in at least one of the three primary settings.
5. DMDD diagnosis should not be assigned before age 6 or after age 18.
6. The age of onset of disruptive mood dysregulation disorder is before 10 years old.
7. The symptoms are not better explained by another mental illness, such as depression, posttraumatic stress disorder, or autism (DMDD and Autism: How Are the Two Related?).  

Disruptive Mood Dysregulation Disorder Controversy

The addition of DMDD to the DSM-5 is helpful in many ways, but it comes with controversy as well.  Many are concerned this new mental health disorder will lower the threshold for diagnosing children who are perhaps just going through a difficult time (What are the Causes of DMDD?). There is fear DMDD will be over-diagnosed (as was previously the case with bipolar disorder), as tantrums and bad moods are not uncommon in children.  Yet being inaccurately diagnosed with DMDD prevents professionals from identifying what might truly be going on with a child.

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