Emotion Regulation in Severe Irritability and Disruptive Mood Dysregulation Disorder

Abstract

Chapter 14 discusses emotion dysregulation in pediatric irritability and disruptive mood dysregulation disorder (DMDD). Irritability refers to a low threshold for experiencing negative affect, namely frustration and anger in the context of blocked goal attainment. The central diagnostic feature of DMDD is chronic, severe irritability leading to functional impairment. The precursor to DMDD, severe mood dysregulation (SMD), was operationalized for research purposes as severe irritability concomitant with hyperarousal symptoms (e.g., agitation, distractibility). As relevant to emotion regulation, the pathophysiology of severe irritability has been associated with reduced context-dependent regulation; dysregulated attention-emotion interactions; and the misinterpretation of social cues, including a preferential threat bias. Currently, no gold standard, evidence-based treatments exist exclusively for DMDD or SMD. However, interventions designed for related clinical disorders have demonstrated promising findings, including parent management training, cognitive-behavioral therapy, and psychopharmacological interventions. Novel interventions such as computer-based training have garnered preliminary empirical support.