Diagnosis Of Disruptive Mood Dysregulation Disorder Research Articles

Prevalence and comorbidities of disruptive mood dysregulation disorder

IntroductionFollowing the release of DSM-5 in 2013, a newly introduced diagnostic category emerged in psychiatric classification—the disruptive mood dysregulation disorder (DMDD). DMDD is a depressive disorder that begins in childhood and is marked by a consistently irritable or angry mood, frequently accompanied by temper outbursts that are notably severe.ObjectivesIt is to study the prevalence and comorbidities of DMDD in Morocco, specifically at Arrazi University Psychiatric HospitalMethodsData were collected from youths aged 6 to 18 years who underwent a systematic assessment of symptoms. This assessment was extended to all patients consulting at Arrazi Hospital in Salé within the pediatric department over a period of four months (sample accrued from July 2023 to October 2023). The diagnosis of DMDD was established utilizing the diagnostic criteria outlined in DSM-5ResultsAbout 31% of the young participants met the operational criteria for DMDD. Those with DMDD exhibited increased comorbidity rates with attention-deficit/hyperactivity disorder (ADHD), another Depressive disorder and conduct disorder compared to those without DMDD. Additionally, they displayed elevated symptoms of aggressive behavior, rule-breaking, social issues, anxiety/depression, attention problems, and thought problems in comparison to all other participants without DMDD. It’s noteworthy that youth with DMDD presented with at least one psychiatric comorbidity.ConclusionsGiven that DMDD is accompanied by other comorbid psychiatric disorders, particularly depression and anxiety, and appears to impact familial and occupational status in adulthood, the early detection and subsequent effective treatment of DMDD symptoms are of utmost importance.Disclosure of InterestNone Declared

Suicide in Adolescents with Mood Disorders

IntroductionAdolescents patients presenting with mood disorders, including disruptive mood dysregulation disorder (DMDD), often present with the comorbid disorders such as oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD).Objectives1) Evaluate the association between suicide in adolescents and various mood disorders. 2) To study the impact of comorbid conditions in DMDD on suicide ideation and attempt in adolescents.MethodsWe used 2016-2017 National Inpatient Sample dataset to select patients with mood disorders. Rao Scott adjusted Chi-Square test used to compare the groups with SPSS v26.ResultsIn this study, 15195 patients were in the DMDD group (Mean age:12.1,F: 38%) and 219205 in the ‘other mood disorders’ group (Mean age:14.4,F:67%). The odds of SI/SA were two times more in patients with the ‘other type of mood disorder’ (OR:2.07, 95%CI: 1.77-2.14). Patients with the primary diagnosis of DMDD sub-classified into four groups (Group 1: DMDD only (n=5160), Group 2: DMDD+ADHD (n=7240), Group 3: DMDD +ODD (n=700), and Group 4: DMDD+ADHD+ODD (n=2095). SI/SA was prevalent in 30.8%, 26.0%, 22.9% and 26.3% in Group 1, 2, 3 and 4 respectively (p: 0.03). SI/SA was more prevalent in females compared to males (31.3% vs. 25.2%). An increase of 1 year in age was associated with a higher SI/SA (OR:1.05, 95%CI:1.01-1.08, 0.01). The SI/SA odds were 5% more in female patients (OR:1.27, p:0.01).ConclusionsThe study reveals that the risk of suicide ideation or suicide attempt is almost twice in the adolescent with mood disorders without DMDD compared to the DMDD group.DisclosureNo significant relationships.

Diagnostic Trends and Prescription Patterns in Disruptive Mood Dysregulation Disorder and Bipolar Disorder.

Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends. A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to< 18 years with≥183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated. There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p< .0001) and treated prevalence (0.08%-0.35%, p< .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p< .01) and treated prevalence (0.42%-0.36%, p< .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%). Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis.

Hunger Hormones in Adolescents with Disruptive Mood Dysregulation Disorder: An Exploratory Study

Background: Hunger hormones, including ghrelin and leptin, are associated with appetitive behaviors in various psychiatric disorders. Biochemical and hormonal status in disruptive mood dysregulation disorder (DMDD) in adolescents is largely unexplored. Objectives: The study aimed to assess levels of leptin and ghrelin and find their association with lipid profiles in adolescents with DMDD. Methods: Twenty adolescents with a DSM 5 diagnosis of DMDD with age and gender-matched 19 healthy controls were recruited, followed by clinical assessment. They were assessed for leptin, ghrelin, and lipid profiles, respectively. Results: Adolescents with DMDD were comparable in age, education, family income, domicile status, psychiatric illness in the family, and body mass index (BMI) with matched controls. There was no difference in mean lipid profile and ghrelin in both groups. However, the DMDD group had a statistically significant higher mean level of leptin as compared to the control group (t=1.84, p &lt; 0.05). As measured by the Modified Overt Aggression Scale in DMDD, aggression showed a significant positive correlation with lipid profile measures. Conclusion: Adolescents with DMDD have elevated serum leptin levels. Further research is needed to confirm this finding.

Disruptive Mood Dysregulation Disorder and its Impact on Rates of Bipolar Disorder among Children and Adolescents

Background: In 2013, Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the DSM-5 in part to curb the rapid rise in the rates of bipolar diagnosis among children and adolescents during the decade before the DSM-5 publication. DMDD proved to be a controversial diagnosis for many reasons. Objective: This brief review aims to provide an overview of the DMDD diagnosis and its origins and summarize available data on the impact of the introduction of the DMDD diagnosis on the rates of bipolar disorder among children and adolescents. Methods: Multiple scientific databases were searched using the related terms “DMDD”, “Disruptive Mood Dysregulation”, and “pediatric bipolar disorder” in combination with the terms “diagnosis” and “impact”. The retrieved articles were reviewed carefully. Results: The DMDD diagnosis rates have steadily increased since its introduction. Furthermore, available data show a decrease in the rates of bipolar disorder diagnosis among children and adolescents over the past few years. Conclusion: The very limited available data since 2013 show a decline in the diagnosis of bipolar disorder among children and adolescents. More time and further research are needed to more accurately determine the impact of the DMDD diagnosis on the rates of bipolar disorder in this population.

Disruptive mood dysregulation disorder (DMDD) in psychiatric inpatient child admissions: Prevalence among consecutive admissions and in children receiving NOS diagnoses

BackgroundMany children present with uncontrollable outbursts that present diagnostic challenges. Disruptive mood dysregulation disorder (DMDD) is a diagnosis that may capture their behavior. We examined the prevalence of DMDD in a series of 100 child discharges from inpatient care after the introduction of DSM-5 and in 100 children who received diagnoses of mood or bipolar disorder NOS prior to the advent of DSM-5. MethodsAll children were re-diagnosed with a retrospective chart review procedure. In the first sample, 100 consecutive discharges were reviewed. In the second study, children seen prior to the release from DSM-5 had their charts reviewed. The reviews addressed the presence of DMDD, as well as other conditions that may be co-morbid with DMDD. Results18 of the 100 consecutively discharged children (18 %) received a retrospective diagnosis of DMDD and 9 (50 %) received a comorbid diagnosis of major depression. Only 4 of the 18 children had a discharge diagnosis of DMDD. For the 100 children with NOS diagnoses prior to DSM-5, 37 (37 %) received retrospective diagnosis of DMDD. The major specific feature of DMDD was the higher frequency of temper outbursts. Longer length of stay and higher discharge GAF scores were also seen DiscussionDMDD was present in approximately the same proportion of children as previous studies, in samples admitted before and after DSM-5. Clinical diagnoses of mood disorders NOS are common in children who meet criteria for DMDD and DMDD diagnoses still do not appear to be given to many children who meet the criteria.

Trends in diagnosis of bipolar and disruptive mood dysregulation disorders in children and youth

Objective: Rates of pediatric bipolar disorders have increased and some are concerned about diagnostic accuracy. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in 2013. The purpose of this study was to assess diagnostic trends of bipolar disorders and DMDD and to identify predictors of receiving the DMDD diagnosis since implementation of DSM-5. Method: Kentucky Medicaid claims from 2012–2017 for children under 18 years (N = 814,919; 2012 n = 473,389; 2013 n = 470,918; 2014 n = 499,094; 2015 n = 517,199; 2016 n = 529,048; 2017 n = 535,814) were used. Logistic regression was used to identify predictors of a diagnosis of DMDD in 2015–2017 for a sub-sample (n = 5,071). Results: The use of DMDD rose after 2013 and mood disorder NOS decreased steadily through 2017. This decrease was seen when there was a diagnosis of bipolar and oppositional defiant disorder (ODD) combined with mood disorder NOS. A diagnosis of only mood disorder NOS in 2012 did not predict DMDD in 2015–2017, but the same diagnosis in 2013 was predictive (OR 2.14, p = 0.049). The reverse is true for a diagnosis of only ADHD in 2013, which did not predict DMDD in later years, but its presence in 2012 was predictive (OR 1.36, p = 0.010). Conclusions: DMDD increased after 2013, and this was associated with a diagnosis of mood disorder NOS, ADHD, as well as with bipolar disorders comorbid with ODD. Given the complexity of comorbid diagnoses, DMDD may be more accurate in classifying some children. Administrative claims data have limitations, which are discussed; and the data represent only children living in Kentucky.

Exposure-Based Cognitive-Behavioral Therapy for Disruptive Mood Dysregulation Disorder: An Evidence-Based Case Study

Severe, chronic irritability is one of the most frequently reported problems in youth referred for psychiatric care. Irritability predicts adult depressive and anxiety disorders, and long-term impairment. Reflecting this pressing public health need, severe, chronic, and impairing irritability is now codified by the DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD). Since DMDD has only recently been added as its own nosological class, efficacious treatments that specifically target severe irritability as it presents in DMDD are still being developed. In a recent pilot study, we described the general concept of exposure-based cognitive-behavioral therapy (CBT) for irritability. This mechanism-driven treatment is based on our pathophysiological model of irritability that postulates two underlying mechanisms, which potentiate each other: (1) heightened reactivity to frustrative nonreward, and (2) aberrant approach responses to threat. In this case report, we describe and illustrate the specific therapeutic techniques used to address severe irritability in an 11-year-old boy with a primary diagnosis of DMDD. Specific techniques within this CBT include motivational interviewing to build commitment and target oppositionality; creation of an anger hierarchy; in-session controlled, gradual exposure; and parent training focusing on contingency management to counteract the instrumental learning deficits in irritable youth. Parents learn to tolerate their own emotional responses to their youth’s irritability (e.g., parents engage in their own exposure) and increase their adaptive contingencies for their youth’s behavior (e.g., withdraw attention during unwanted behavior, praise desirable behavior). Future directions in the context of this CBT, such as leveraging technology, computational modeling, and pathophysiological targets, are discussed.

Disruptive Mood Dysregulation Disorder

Abstract This article is an overview of disruptive mood dysregulation disorder (DMDD). It reviews history, diagnostic criteria, prevalence, comorbidities, treatment, and recommendations for clinical practice. The diagnosis of DMDD was created to separate the symptoms of chronic irritability punctuated by short-term outbursts in young children. Although controversy exists around DMDD as a sole diagnosis due to comorbidity with other psychiatric disorders, there is evidence of its unique traits. There are limited data regarding treatment, although the efficacy of cognitive behavioral therapy shows potential for first-line treatment. Providers need to support families, validate parental concerns, and teach behavioral modification to complement therapy and pharmacotherapy.

Disruptive Mood Dysregulation Disorder in Juvenile Justice.

Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We compared juvenile justice involved youths with DMDD to those with disruptive behavior disorders (DBDs) and other mood disorders, to clarify the differences and to investigate differential correlates to DMDD relative to DBDs or mood disorders. Diagnostic and demographic data were available for 9,819 youths served by 57 juvenile justice sites. A subsample of 2,498 youths had data relevant to our study. The youths self-assessed mental health status on the Voice Diagnostic Interview Schedule for Children (V-DISC), and we retrofitted the V-DISC data to derive an approximate DMDD diagnosis. The retrofitted criteria for DMDD were met by 3.3 percent of justice-involved youths. Results from multinomial regression showed that, after adjustment for covariates, those with DMDD had fewer differences compared with those with other mood disorders than did those meeting criteria for DBDs. Consistent with the DSM-5 classification of DMDD as a depressive disorder, those with DMDD shared more characteristics with youths with mood disorders than with those reporting DBDs. Externalizing behaviors leading to justice involvement may overshadow internalizing symptoms of DMDD, but mood-related conditions should be identified and treated in this population.

Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people.

Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.

Disruptive mood dysregulation disorder in offspring of parents with depression and bipolar disorder.

BackgroundIt has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.AimsWe examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major depressive disorder and (c) a control group with no mood disorders.MethodWe established lifetime diagnosis of DMDD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children for DSM-5 in 180 youth aged 6-18 years, including 58 offspring of parents with bipolar disorder, 82 offspring of parents with major depressive disorder and 40 control offspring.ResultsDiagnostic criteria for DMDD were met in none of the offspring of parents with bipolar disorder, 6 of the offspring of parents with major depressive disorder and none of the control offspring. DMDD diagnosis was significantly associated with family history of major depressive disorder.ConclusionsOur results suggest that DMDD is not specifically associated with a family history of bipolar disorder and may be associated with parental depression.

Irritability in Children and Adolescents.

Irritability is a common and impairing clinical presentation in children and adolescents. Despite its significant public health impact, irritability remains an elusive construct. Chronic and severe irritability is the primary symptom of the new DSM-5 diagnosis, disruptive mood dysregulation disorder (DMDD). However, empirical and clinical approaches to irritability are in their relative infancy, and questions regarding the validity of the DMDD diagnosis have been raised. Moreover, irritability is a trait distributed continuously in youth, thereby fitting within the National Institute of Mental Health Research Domain Criteria initiative. Thus, there are opportunities for scientific review and integration. Accordingly, the goals of this review include (a) clarifying the definitions of irritability, incorporating clinical and translational animal work; (b) reviewing the historical context surrounding the study of irritability;

An exploratory clinical study of disruptive mood dysregulation disorder in children and adolescents from India.

Children with chronic non-episodic irritability were frequently diagnosed as suffering from pediatric bipolar disorder. Therefore in DSM-5 a new diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) was included for such children. This study aimed to identify DMDD in children and adolescents in Indian child and adolescent psychiatry clinic and elicit its phenomenology and co-morbidities. Children of 6-16 years, presenting with irritability for more than one year were assessed using DSM 5 diagnostic criteria to make a diagnosis of DMDD. Severity of irritability was assessed using Affective Reactivity index (ARI). Co-morbidities were screened on Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version (KSADS-PL) and diagnosed as per DSM-IV TR criteria. Overall behavioral problems were assessed on Conner's parent symptom questionnaire (CPSQ) and impairment in functioning on children's global assessment of functioning scale(C-GAS). 21 subjects were diagnosed with DMDD. Majority of the subjects (15, 71.4%) were in the age group 6-12 years (mean age11.1±2.9 years) and were males (16, 76.2%). Most common presenting complaints were, frequent irritability and anger outbursts in 21 (100%) and inattention towards studies in 20 (95.2%) subjects. Most of the subjects (18, 85.7%) had moderate to severe irritability. 13 (61.9%) subjects had co-morbidities. Mean CGAS was 46.1±6.9. DMDD can be diagnosed in Indian children using DSM 5 criteria. Such children presented with complaints of irritability and problems in studies. They commonly had co-morbidities and had moderate impairment of functioning.

Disruptive Mood Dysregulation Disorder and Bipolar Disorder Not Otherwise Specified: Fraternal or Identical Twins?

The purpose of this study was to examine similarities and differences between disruptive mood dysregulation disorder (DMDD) and bipolar disorder not otherwise specified (BP-NOS) in baseline sociodemographic and clinical characteristics and 36 month course of irritability in children 6-12.9 years of age. A total of 140 children with DMDD and 77 children with BP-NOS from the Longitudinal Assessment of Manic Symptoms cohort were assessed at baseline, then reassessed every 6 months for 36 months. Groups were similar on most sociodemographic and baseline clinical variables other than most unfiltered (i.e., interviewer-rated regardless of occurrence during a mood episode) Young Mania Rating Scale (YMRS) and parent-reported General Behavior Inventory-10 Item Mania (PGBI-10M) items. Children with DMDD received lower scores on every item (including irritability) except impaired insight; differences were significant except for sexual interest and disruptive-aggressive behavior. Children with DMDD received lower scores on eight of 10 PGBI-10M items, the other two items rated irritability. Youth with DMDD were significantly less likely to have a biological parent with a bipolar diagnosis than were youth with BP-NOS. Children with DMDD were more likely to be male and older than children with BP-NOS, both small effect sizes, but had nearly double the rate of disruptive behavior disorders (large effect). Caregiver ratings of irritability based on the Child and Adolescent Symptom Inventory-4R (CASI-4R) were comparable at baseline; the DMDD group had a small but significantly steeper decline in scores over 36 months relative to the BP-NOS group (b = -0.24, SE = 0.12, 95% CI -0.48 to -0.0004). Trajectories for both groups were fairly stable, in the midrange of possible scores. In a sample selected for elevated symptoms of mania, twice as many children were diagnosed with DMDD than with BP-NOS. Children with DMDD and BP-NOS are similar on most characteristics other than manic symptoms, per se, and parental history of bipolar disorder. Chronic irritability is common in both groups. Comprehensive evaluations are needed to diagnose appropriately. Clinicians should not assume that chronic irritability leads exclusively to a DMDD diagnosis.

The Later Significance of a DMDD Diagnosis at Age 6

Disruptive mood dysregulation disorder (DMDD), a diagnostic entity new to DSM-5, is diagnosed in children as young as 6 years old who have severe temper tantrums and persistent irritability or angry affect in various contexts for ≥1 year. These authors used data from a community-based, longitudinal study to examine the significance …

Disruptive mood dysregulation disorder at the age of 6 years and clinical and functional outcomes 3 years later.

Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.

Disruptive Mood Dysregulation Disorder in a Community Mental Health Clinic: Prevalence, Comorbidity and Correlates.

The revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) added a new diagnosis of disruptive mood dysregulation disorder (DMDD) to depressive disorders. This study examines the prevalence, comorbidity, and correlates of the new disorder, with a particular focus on its overlap with oppositional defiant disorder (ODD), with which DMDD shares core symptoms. Data were obtained from 597 youth 6-18 years of age who participated in a systematic assessment of symptoms offered to all intakes at a community mental health center (sample accrued from July 2003 to March 2008). Assessment included diagnostic, symptomatic, and functional measures. DMDD was diagnosed using a post-hoc definition from item-level ratings on the Schedule for Affective Disorders and Schizophrenia for School-Age Children that closely matches the DSM-5 definition. Caregivers rated youth on the Child Behavior Checklist. Approximately 31% of youth met the operational definition of DMDD, and 40% had Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnoses of ODD. Youth with DMDD almost always had ODD (odds ratio [OR] = 53.84) and displayed higher rates of comorbidity with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder than youth without DMDD. Caregivers of youth with DMDD reported more symptoms of aggressive behavior, rule-breaking, social problems, anxiety/depression, attention problems, and thought problems than all other youth without DMDD. Compared with youth with ODD, youth with DMDD were not significantly different in terms of categorical or dimensional approaches to comorbidity and impairment. The new diagnosis of DMDD might be common in community mental health clinics. Youth with DMDD displayed more severe symptoms and poorer functioning than youth without DMDD. However, DMDD almost entirely overlaps with ODD and youth with DMDD were not significantly different than youth with ODD. These findings raise concerns about the potentially confusing effects of using DMDD in clinical settings, particularly given that DSM-5 groups DMDD with depressive disorders, but ODD remains a disruptive behavior disorder, potentially changing the decision-making framework that clinicians use to select treatments.

Disruptive Mood Dysregulation Disorder Symptoms and Association with Oppositional Defiant and Other Disorders in a General Population Child Sample.

The new Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) diagnosis, disruptive mood dysregulation disorder (DMDD), has generated appreciable controversy since its inception, primarily in regard to its validity as a distinct disorder from oppositional defiant disorder (ODD). The goal of our study was to determine if the two DSM-5 DMDD symptoms (persistently irritable or angry mood and severe recurrent temper outbursts) occurred independently of other disorders, particularly ODD. Other DSM-5 DMDD criteria were not assessed. Maternal ratings of the two DMDD symptoms, clinical diagnosis of ODD using DSM-5 symptom criteria, and psychological problem scores (anxiety, depression, oppositional behavior, conduct disorder, and attention-deficit/hyperactivity disorder [ADHD]) on the Pediatric Behavior Scale were analyzed in a population sample, 6-12 years of age (n = 665). The prevalence of DMDD symptoms (irritable-angry mood and temper outbursts both rated by mothers as often or very often a problem) was 9%. In all, 92% of children with DMDD symptoms had ODD, and 66% of children with ODD had DMDD symptoms, indicating that it is very unlikely to have DMDD symptoms without ODD, but that ODD can occur without DMDD symptoms. Comorbid psychological problems (anxiety, depression, conduct disorder, and ADHD) in addition to ODD did not increase the risk of having DMDD symptoms beyond that for ODD alone. Only 3% of children with psychological problems other than ODD had DMDD symptoms. Our general population findings are similar to those for a psychiatric sample, suggesting that DMDD cannot be differentiated from ODD based on symptomatology. Therefore, it is important to assess all DSM criteria and to examine for comorbid psychopathology when considering a diagnosis of DMDD. Our results support the recommendation made by the World Health Organization's International Classification of Diseases, 11th Revision (ICD-11) panel of experts that DMDD symptoms may be more appropriately classified as an ODD specifier than a separate diagnosis.

Comorbidity and correlates of disruptive mood dysregulation disorder in 6-8-year-old children with ADHD.

This study aimed to characterize the nature and impact of disruptive mood dysregulation disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning. Children with ADHD (6-8 years) were recruited through 43 Melbourne schools, using a 2-stage screening (parent and teacher Conners 3 ADHD index) and case-confirmation (Diagnostic Interview Schedule for Children, Version IV; [DISC-IV]) procedure. Proxy DMDD diagnosis was confirmed via items from the oppositional defiant disorder (ODD) and major depressive disorder modules of the DISC-IV. Outcome domains included comorbid mental health disorders, academic functioning, social functioning, child and family quality of life, parent mental health, and parenting behaviors. Unadjusted and adjusted linear and logistic regression were used to compare children with comorbid ADHD and DMDD and children with ADHD without DMDD. Thirty-nine out of 179 children (21.8 %) with ADHD had comorbid DMDD. Children with ADHD and DMDD had a high prevalence of ODD (89.7 %) and any anxiety disorder (41.0 %). Children with ADHD and DMDD had poorer self-control and elevated bullying behaviors than children with ADHD without DMDD. Children with ADHD and DMDD were similar to children with ADHD in the other domains measured when taking into account other comorbidities including ODD. One in five children with ADHD in their second year of formal schooling met criteria for DMDD. There was a very high diagnostic overlap with ODD; however, the use of a proxy DMDD diagnosis containing items from the ODD module of the DISC-IV may have artificially inflated the comorbidity rates. DMDD added to the burden of ADHD particularly in the area of social functioning.