Disruptive Mood Dysregulation Disorder Research Articles

DSM-5 intermittent explosive disorder: Relationship with Disruptive Mood Dysregulation Disorder

ObjectiveThis study was designed to estimate how many adults with DSM-5 Intermittent Explosive Disorder (IED) would also meet diagnostic criteria for Disruptive Mood Dysregulation Disorder (DMDD). This was done by examining how many individuals with IED would meet the DMDD criterion of being persistently angry in between impulsive aggressive outbursts. MethodsThe first one-hundred study participants diagnosed with DSM-5 IED in our clinical research program were included in this study. Two questions were added to the IED module from the Structured Clinical Interview for DSM-5 Disorders (SCID) inquiring about the duration of anger in between impulsive aggressive outbursts in IED study participants. Data regarding aggression, impulsivity, anger expression, and related dysphoric variables were also collected. ResultsThe proportion of time spent as angry in between impulsive aggressive outbursts was <50% of the time (~35%) for the vast majority (92%) of study participants with DSM-5 IED. Despite this, persistently-angry (i.e., angry >50% time in between outbursts) IED study participants displayed no differences from not-persistently-angry IED study participants in dysphoric and aggression/impulsivity related variables. ConclusionsThese data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.

A Latent Variable Approach to Differentiating Neural Mechanisms of Irritability and Anxiety in Youth

Comorbidity is ubiquitous in psychiatry, but it is unclear how to differentiate neural mechanisms of co-occurring symptoms. Pediatric irritability and anxiety symptoms are prevalent and frequently co-occur. Threat orienting is pertinent to both phenotypes and is an ideal context in which to examine their unique and common neural mechanisms. To decompose the unique and shared variances of pediatric irritability and anxiety symptoms and to determine neural correlates of these differentiated phenotypes during threat orienting. This investigation was a cross-sectional functional magnetic resonance imaging study. The setting was a research clinic at the National Institute of Mental Health. Participants were youth aged 8 to 18 years spanning multiple diagnostic categories (141 youth with disruptive mood dysregulation disorder, anxiety disorder, and/or attention-deficit/hyperactivity disorder and 56 healthy youth). This combination provided wide variation in levels of irritability and anxiety symptoms. Data were acquired between June 30, 2012, and June 28, 2016. Participants and parents rated youth's irritability on the Affective Reactivity Index and anxiety on the Screen for Child Anxiety Related Emotional Disorders. Bifactor analysis decomposed the unique and shared variances. A functional magnetic resonance imaging dot-probe task assessed attention orienting to angry (ie, threat) vs neutral faces. Whole-brain analyses examined associations between the bifactor-derived phenotypes and both neural activity and amygdala functional connectivity. Among 197 participants included in the final analysis, the mean (SD) age was 13.1 (2.7) years, and 91 (46.2%) were female. The best-fit bifactor model (Comparative Fit Index, 0.959; Root Mean Square Error of Approximation, 0.066) included unique factors of parent-reported irritability, youth-reported irritability, and anxiety, as well as a common factor of negative affectivity. When the task required attention away from threat, higher parent-reported irritability was associated with increased activity in the insula, caudate, dorsolateral and ventrolateral prefrontal cortex, and inferior parietal lobule (t189≥4.15 for all, P < .001 for all). In contrast, higher anxiety was associated with decreased amygdala connectivity to the cingulate, thalamus, and precentral gyrus (t189≤-4.19 for all, P < .001 for all). These distinctive neural correlates did not emerge using a diagnostic approach. A latent variable approach to parsing co-occurring symptom dimensions revealed a novel double dissociation. During orientation away from threat, only irritability was associated with neural activity, whereas only anxiety was associated with amygdala connectivity. Despite the challenges of symptom co-occurrence for clinical neuroscience, data-driven phenotyping may facilitate a path forward.

A Review on the General Stability of Mood Disorder Diagnoses Along the Lifetime.

The purpose of this review is to review the most recent literature regarding diagnostic stability of mood disorders, focusing on epidemiological, clinical-psychopathological, and neurobiological data for unipolar and bipolar affective disorders. Unipolar depression follows a chronic course in at least half of all cases and presents a considerable diagnostic stability across all age ranges. Studies using latent class analysis are allowing improved profiling of depressive subtypes and assessment of their prevalence. Advances have been made in our understanding of the neurobiological underpinnings of depression, with data highlighting the roles of amyloid deposits, the ApoE4 allele, and atrophy of the anterior hippocampus or frontal cortex. The diagnostic instability of bipolar disorder is manifest in the early years, seen in both the extent of diagnostic delay and the high rate of diagnostic conversion from unipolar depression. Regarding disruptive mood dysregulation disorder, we have little data to date, but those which exist indicate a high rate of comorbidity and minimal diagnostic stability for this disorder. Diagnostic stability varies substantially among mood disorders, which would be related to the validity of current diagnostic categories and our diagnostic accuracy.

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

This review discusses the changes in the diagnostic criteria for depressive disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and recent findings exploring the etiology of and treatment strategies for these disorders. Depressive disorders are typically characterized by depression in the absence of a lifetime history of mania or hypomania. New developments in the DSM-5 include the recognition of new types of depressive disorders, such as disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, and the addition of catatonic features as a specifier for persistent depressive disorder. These diagnostic changes have important implications for the prognosis and treatment of this condition. A thorough understanding of both the clinical phenotype and the biosignature of these conditions is essential to provide individualized, long-term, effective treatments to affected individuals. This review contains 1 table and 52 references Key words: brain volumes, depressive disorders, DSM-5, hormones, inflammation, neuropeptides, somatic therapy, stress

Construct validity and parent–child agreement of the six new or modified disorders included in the Spanish version of the Kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5)

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

Traits of empathy and anger: implications for psychopathy and other disorders associated with aggression

Empathy and anger are two social emotions that modulate an individual's risk for aggression. Empathy is an emotional reaction to another individual's emotional state. Anger is an emotional reaction to threat, frustration or social provocation. Reduced empathy, seen in psychopathy, increases the risk for goal-directed aggression. Atypically increased anger (i.e. irritability), seen in conditions like disruptive mood dysregulation disorder and borderline personality disorder, increases the risk for reactive aggression. In this paper, I will outline core neurocognitive functions that correspond to empathy and which are compromised in individuals with psychopathic traits. In addition, I will outline neurocognitive functions involved in either the generation or regulation of anger and which are compromised in psychiatric conditions at increased risk for irritability/reactive aggression. It can be hoped that improved understanding of empathy and anger will lead to better assessment tools and improved interventions to reduce aggression risk.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

This review discusses the changes in the diagnostic criteria for depressive disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and recent findings exploring the etiology of and treatment strategies for these disorders. Depressive disorders are typically characterized by depression in the absence of a lifetime history of mania or hypomania. New developments in the DSM-5 include the recognition of new types of depressive disorders, such as disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, and the addition of catatonic features as a specifier for persistent depressive disorder. These diagnostic changes have important implications for the prognosis and treatment of this condition. A thorough understanding of both the clinical phenotype and the biosignature of these conditions is essential to provide individualized, long-term, effective treatments to affected individuals. This review contains 1 table and 52 references Key words: brain volumes, depressive disorders, DSM-5, hormones, inflammation, neuropeptides, somatic therapy, stress

Psychosocial Treatment of Irritability in Youth.

Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD. In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N=10) suggest feasibility. Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.

The Efficacy of Emotion Regulation Training on Stress, Anxiety, Depression and Irritability of the Students With Disruptive Mood Dysregulation Disorder

The Efficacy of Emotion Regulation Training on Stress, Anxiety, Depression and Irritability of the Students With Disruptive Mood Dysregulation Disorder

The forthcoming ICD-11 chapter on mental disorders

The ICD-11 chapter on mental disorders is going to be approved by the World Health Assembly in 2018. An effort has been made to harmonize the two main diagnostic systems existing in psychiatry (the ICD and the DSM), and indeed the metastructure of the two systems will be the same. There will be, however, several differences between the two systems. There will be some diagnostic categories in the ICD-11, which do not appear in the DSM-5, such as complex post-traumatic stress disorder and prolonged grief disorder, and there will be some diagnostic cate-gories that appear in the DSM-5 but will not be included in the ICD-11, such as disruptive mood dysregulation disor-der. Conditions related to sexual health and sleep-wake disorders will appear in chapters of the ICD-11 diagnostic system different from that on mental disorders. The new diagnostic system has been tested through four sets of field studies: international surveys of views of psychiatrists and psychologists on the classification of mental disor-ders; formative field studies (aimed to guide decisions on the basic structure of the classification), Internet-based field studies (using vignette methodology to examine decision making in relation to ICD-11 categories), and clinic-based field studies (assessing the reliability and clinical utility of the diagnostic guidelines with real patients).

Identifying Clinically Significant Irritability in Early Childhood

Advances in developmentally sensitive measurement have enabled differentiation of normative versus clinically salient irritability in early childhood. However, clinical application of these measures is still nascent. The authors developed an optimized model of clinically salient irritable behaviors at preschool age. Based on this model, the authors derived an empirically based cutoff in relation to concurrent DSM-5 irritability-related disorders (i.e., oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) and used longitudinal models to test the predictive validity of the cutoff for impairment and irritability trajectories and later DSM disorders. Preschool children oversampled for irritability were followed over 3 time points into early school age (N= 425; mean age at baseline 4.7 years, mean follow-up 2.9 years). Mothers reported on children's irritability using the developmentally validated Multidimensional Assessment of Profile of Disruptive Behavior (MAP-DB) Temper Loss scale, impairment using the Family Life Impairment Scale, and DSM categories using the Preschool Age Psychiatric Assessment and the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Of 22 MAP-DB Temper Loss behaviors, 2 behaviors-1 normative (easily frustrated) and 1 rare dysregulated (destructive tantrums)-were uniquely related to cross-domain impairment. At baseline, these 2 irritability items identified diagnostic status (oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) with good sensitivity (70-73%) and specificity (74-83%). Children above the irritability cutoff at baseline also exhibited more persistent irritability and impairment and greater likelihood of DSM disorders in early school age. Clinical identification of early-onset irritability can be enhanced using brief, developmentally optimized indicators. Further research to apply these findings to tiered early intervention is important.

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.

DBT found effective for children with DMDD

A randomized controlled trial has found that dialectical behavior therapy adapted for preadolescent children (DBT‐C) for the treatment of disruptive mood dysregulation disorder (DMDD) is feasible, and outcomes indicated preliminary efficacy. The irritability and behavior outbursts of DMDD are associated with severe impairment in childhood, and negative outcomes in adolescent and adult years. There are no established treatments for DMDD, so researchers looked at the feasibility and preliminary efficacy of DBT‐C.

Prevalence Rate and Course of Symptoms of Disruptive Mood Dysregulation Disorder (DMDD).

According to DSM-5, Disruptive Mood Dysregulation Disorder (DMDD) is characterized by chronic temper outbursts and irritable moods. So far, little is known about its prevalence rate, course and influence on individual well-being. We assessed the prevalence rates of DMDD symptoms during adulthood and primary school age - the latter retrospectively - and studied their relationship with psychiatric disorders and socioeconomic variables. A total of 2,413 subjects, aged 18-94 years, participated in this population-based, representative study based on self-reports. 12 (0.50 %) subjects reported elevated DMDD symptoms during adulthood, and 19 (0.79 %) reported elevated DMDD symptoms during primary school age. DMDD symptoms were associated with higher rates of depression and anxiety symptoms. Those reporting elevated DMDD symptoms during adulthood were more often single or divorced, and those reporting elevated DMDD symptoms during primary school age were more often childless and unemployed during adulthood compared to subjects without DMDD symptoms. DMDD symptoms seem to show a chronic course and go hand in hand with elevated psychiatric symptoms and impaired socioeconomic and demographic status.

1.1 Disruptive Mood Dysregulation Disorder: Enhancing Objective Assessments in Very Young Children

Chronic irritability and temper outbursts are characteristic of several forms of mental illnesses, including disruptive mood dysregulation disorder (DMDD). This relatively new disorder is characterized by a minimum of three weekly temper outbursts, irritable/angry mood for most of the day nearly every day for at least 12 months, and an onset criterion of at least six years. Several studies, however, have found that DMDD can be identified in children under the age of 6 years. Research on DMDD in very young children has been hampered by the limited availability of measures of irritability in this age group. The current study examines the feasibility and preliminary validity of a brief measure of irritability for use with very young children that was originally developed for older children and adolescents.

4.17 Face Emotion Recognition Differences With Respect to Frustration in Disruptive Mood Dysregulation Disorder (DMDD) and Attention-Deficit/Hyperactivity Disorder (ADHD)

We examined the effect of frustration in emotion recognition across children with ADHD and disruptive mood dysregulation disorder (DMDD) and healthy control (HC) subjects.

1.5 Psychopharmacologic Treatment of Moods, Episodes, and Outbursts

Bipolar disorder (BD) guidelines need to address the prevailing mood being treated (mania or depression), the fact that it is relapsing and recurring, and for some who feel that there is a prepubertal subtype, the fact that there are explosive outbursts that characterize it. Disruptive mood dysregulation disorder (DMDD) is also defined by irritable mood and often crippling outbursts. This presentation will discuss current thinking about treatment of these components. There are some similarities and differences.

4.51 Assessment and Treatment of Hostile Attribution Bias in Children With Disruptive Mood Dysregulation Disorder

4.51 Assessment and Treatment of Hostile Attribution Bias in Children With Disruptive Mood Dysregulation Disorder

The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.

The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.

64.4 Oppositional/Conduct and Disruptive Mood Dysregulation Disorders and Attention-Deficit/Hyperactivity Disorder

Childhood ADHD with affective disturbances that lead to harmful behavior is highly prevalent, but uncertainties in its understanding and treatment persist. This presentation focuses on three common interacting pathogenic factors: generalized impulse control deficits; several affective processes that require careful assessment; and social and environmental factors that affect symptom expression and impairment. Dyscontrolled behavior driven by extreme emotional states is common among children with ADHD. However, key aspects have long eluded consensus, including the underlying psychopathology, diagnostic approaches, and optimal treatment. The controversies are largely reducible to differences in attributing these behaviors primarily to global self-control problems or to an identifiable mood disorder.