Month: January 2018

What is Disruptive Mood Dysregulation Disorder?

Have you heard of DMDD, or disruptive mood dysregulation disorder in children? Unless you work in the mental health field, are a pediatrician, or a parent of a child who struggles with DMDD, it’s quite possible that you haven’t heard of this relatively new diagnosis.

13 Facts About Disruptive Mood Dysregulation Disorder (DMDD)

  1. Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnosis (newly found in the  DSM-5, published in 2013) that describes children who have frequent explosive outbursts that seem grossly out of proportion to the situation and inconsistent with a child’s developmental level; in between the outbursts, these children are chronically irritable. The angry or irritable mood should be observed by parents, teachers, and peers (in more than one place, in other words). So if a child only exhibits such behaviors at home, but not at school, then it’s not DMDD. If a child shows symptoms only at school, but nowhere else, then it’s not DMDD.
  2. The DMDD diagnosis was created to more accurately categorize some children who had previously been diagnosed with pediatric bipolar disorder but do not experience the episodic mania or hypomania symptoms of bipolar disorder, and they don’t typically develop adult bipolar disorder. Years ago, many children were diagnosed with bipolar disorder because there really wasn’t a better descriptor of what was going on with the child, but not all of these kids had true pediatric bipolar disorder.
  3. A clinician considering a DMDD diagnosis for a child would look for severe temper outbursts that occur, on average, three or more times per week. Additionally, the child’s mood between outbursts must be consistently and observably angry or irritable. The child must experience this pattern of frequent outbursts, plus conistent anger or irritability between outbursts, for 12 or more months. During this 12-month period, the child must show symptoms consistently, meaning that he doesn’t experience a break of three or more months without DMDD symptoms.
  4. Outbursts, or elevated or expansive moods that last for longer than a few hours or for days on end, are more likely to be signs of mania, which would rule out disruptive mood dysregulation disorder.
  5. The diagnosis of DMDD cannot be made before age 6 or after age 18. The onset of symptoms typically takes place before age 10.
  6. Parents should work closely with their child’s doctor to learn what works best for their child, but in general, medication or psychological treatments (e.g., psychotherapy, parent training, computer based training) are primarily used to treat DMDD. The National Institute of Mental Health (NIH) recommends that psychological treatments be considered first, with medication added later if necessary, or psychological treatments can be provided with medication from the beginning.
  7. The diagnostic criteria for disruptive mood dysregulation disorder are meant to separate children who have chronic trouble regulating their moods from children who are afflicted with other mental disorders that may also express themselves in intermittent outbursts, irritability and anger, including bipolar disorder, autism, intermittent explosive disorder, or oppositional defiant disorder. But DMDD can occur alongside ADHD, a depressive disorder, conduct disorder, an anxiety disorder, posttraumatic stress disorder (PTSD) or substance use disorder.
  8. Children with DMDD may find it hard to participate in activities or make friends. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his family and peers.
  9. Having DMDD increases the risk of developing depression or anxiety disorders in adulthood.
  10. DMDD has a prevalence of 2%-5% and occurs mostly in boys; bipolar disorder affects boys and girls equally and affects less than 1% prior to adolescence.
  11. Before diagnosing DMDD, it is important for the clinician to assess for a history of psychological trauma. Trauma affects many aspects of a child’s life; in the case of outbursts, it is emotional resilience that is impaired.
  12. It is important to recognize that the child is not “just angry,” but very distressed.
  13. Hugging and verbally consoling the child’s distress is sometimes effective and does not reinforce the behavior unless the parent also yields to demands. But once outbursts begin, you can liken them to a bomb going off – there really isn’t a good intervention at that point. Instead, the task of the family, and over time that of the child, is to recognize and better manage the triggers.

How to Help Kids Deal with Their Feelings

Imagine that you’re at work. Your boss asks you to do something extra, and he wants it to be ready by the end of the day. You mean to take care of it right away, but things start coming up throughout the course of the day and you forget. As soon as you get ready to go home, your boss comes to you and asks for the finished piece of work. Oh no, you completely forgot! You try explaining to your boss that things came up, things that couldn’t be helped.

He interrupts you. In a loud, angry voice he shouts, “I’m not interested in your excuses! What I’m interested in is you getting it done! What am I paying you for?!” As you open your moth, he says, “Save it,” and walks off to the elevator.

You finish gathering your things and leave the office. On the way home you meet a friend. You’re so upset that you find yourself telling her about what just happened.

picture courtesy of Pixabay

Your friend tries to “help” you in eight different ways. And as this example from “How to Talk So Kids Will Listen & Listen So Kids Will Talk” by Adele Faber and Elaine Mazlish asks, as you read each response, tune in to your immediate “gut” reaction:

Denial of Feelings

“There’s no reason to be so upset. It’s foolish to feel that way. You’re probably just tired and blowing this whole thing out of proportion. Surely it’s not as bad as you make it out to be. Come on, smile…”

The Philosophical Response

“Look, life is like that. Things don’t always turn out the way we want. You have to learn to take it in stride. In this world, nothing is perfect.”


“You know what I think you should do? Tomorrow morning go straight to your boss’s office and say, ‘Look, I was wrong.’ Then sit down and finish your work, and don’t get trapped by those little things that come up. And if you’re smart and you want to keep that job of yours, you better make sure nothing like that ever happens again.”


“What exactly did you have to do that could have possibly caused you to forget a special request from your boss? Didn’t you realize he’d be angry if you didn’t do it? Has this ever happened before? Why didn’t you follow him when he got mad and left so you could explain again?”

Defense of the Other Person

“I can understand your boss’s reaction. He’s probably under a lot of pressure. You’re lucky he doesn’t lose his temper more often.”


“Oh, you poor thing. That is terrible! I feel so awful for you, I could cry.”

Amateur Psychoanalysis

“Has it ever occurred to you that the real reason you’re so upset by this is because your employer represents a father figure in your life? As a child you probably worried about not pleasing your father, and when your boss scolded you it brought back your early fears of rejection. Would you say that’s true?”

Empathic Response

“Boy, that sounds like a rough experience. To be yelled at like that in front of those other people, especially after having been under so much pressure, must have been pretty hard to take!”

What was your “gut” reaction?

Okay, so what do you think? What was your “gut” reaction after reading each of the different types of responses your friend gave you? Did you leave your friend feeling better or worse? Heard or unheard? Like your friend had your back or not so much?

Maybe you’re thinking Adele Faber and Elaine Mazlish were being a little extreme. But were they? Though the situation might be different, I can recall so many times when I’ve responded to my own kids in each and every one of these ways!

Fortunately, one of these responses is more helpful than the others. Whether you’re listening to your child tell you about how awful it felt to have to go in from recess today or how terrible it felt when their science teacher unwittingly singled them out when they called upon them in class or even just listening to a friend talk about their rough day at work, using an empathic response will always prove most helpful.

The Language of Empathy

An empathic response demonstrates that you’re really trying to tune into the feelings of the other person. Kids (and adults) can usually help themselves if they have a listening ear and an empathic response. Kids don’t always need advice or pity, and they’re probably not going to be ready for you to defend the person that hurt their feelings when they first come to you after something as such has happened. And denying their feelings is going to affect them for the worse, whether it be in the short-term or long-term (or both).

picture courtesy of Pixabay

Unfortunately, the language of empathy doesn’t come so naturally to us. Most of us grew up having our feelings denied, often unintentionally by well meaning people. As “How to Talk So Kids Will Listen & Listen So Kids Will Talk” delves into, to learn a new language of acceptance, we have to learn and practice its methods. It might not sound natural to you when you first start trying to use an empathic response, but keep with it… It’s well worth it.

More important than any words we do use is our attitude when we respond. “If our attitude is not one of compassion, then whatever we say will be experienced by the child as phony or manipulative. It’s when our words are infused with our real feelings of empathy that they speak directly to a child’s heart.”

Stay tuned in, I’ll be giving you some helpful tips on communicating with your children in future posts. And if you’re interested in learning more yourself, I highly recommend the book “How to Talk So Kids Will Listen & Listen So Kids Will Talk” by Adele Faber and Elaine Mazlish. You can find a link here.

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