Disruptive mood disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense outbursts of anger. DMDD symptoms go beyond being a 'moody' child - children with DMDD experience severe disability that requires clinical attention. DMDD is a fairly new diagnosis, first appearing in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013.

DMDD symptoms usually begin before the age of 10, but it is not diagnosed in children under the age of 6 or adolescents over the age of 18. A child with DMDD experiences:

• Irritable or angry mood most of the day, almost every day
• Severe outbursts (verbal or behavioral) on average three or more times a week that do not suit the situation and the developmental level of the child
• Problems with functioning due to irritability in more than one place (eg at home, at school, with peers)

To be diagnosed with DMDD, a child must have these symptoms regularly for 12 months or more.

It is not clear how widespread DMDD is in the general population, but it is common in children attending pediatric psychiatric clinics. Researchers are investigating risk factors and brain mechanisms of this condition.

DMDD is a new diagnosis. Therefore, treatment is often based on what has been helpful for other conditions that share the symptoms of irritability and tantrums. These disorders include attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and major depressive disorder.

If you think your child has DMDD, it's important to seek treatment. DMDD can affect a child's quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it difficult to participate in activities or make friends. Having DMDD also increases your risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two main types of treatments are currently used to treat DMDD symptoms:

• Medication
• Psychological treatments
  • Psychotherapy
  • Parent training
  • Computer based training

Psychological treatments should be considered first, with medication later if necessary, or psychological treatments can be given along with medication from the outset.

It is important that parents or caregivers work closely with the doctor to make a treatment decision that is best for their child.

Medication

Many medications used to treat children and adolescents with mental illness are effective in relieving symptoms. However, some of these drugs have not been studied in depth and / or have no approval from the U.S. Food and Drug Administration (FDA) for use in children or adolescents. All medications have side effects and the need to continue them should be regularly discussed with your child's doctor.

For basic information on these and other mental health medications, you can visit the NIMH Mental Health Medications webpage. Visit the FDA website for the most current information on medications, side effects, and warnings.

Stimulants

Stimulants are drugs commonly used to treat ADHD. There are indications that in children with irritability and ADHD stimulant drugs also reduce irritability.

Stimulants should not be used in individuals with severe heart problems. According to the FDA, people on stimulant medications should be periodically monitored for changes in heart rate and blood pressure.

Antidepressants

Antidepressants are sometimes used to treat the irritability and mood problems associated with DMDD. Ongoing studies are testing whether these drugs are effective for this problem. It's important to note that while antidepressants are safe and effective for many peopleare effective, they put them at risk for suicidal thoughts and behaviors in children and teenagers. A "black box" warning - the most serious type of warning a prescription can contain - has been added to the labels of these medications to alert parents and patients to this risk. For this reason, a child taking an antidepressant should be closely monitored, especially when they first start taking the medication.

Atypical antipsychotic

An atypical antipsychotic medication may be prescribed for children who have very severe outbursts of temper that involve physical aggression towards people or property. Risperidone and aripiprazole are FDA-approved for the treatment of irritability associated with autism and are sometimes used to treat DMDD. Atypical antipsychotic medications are associated with many important side effects, including suicidal thoughts / behaviors, weight gain, metabolic abnormalities, sedation, movement disorders, hormone changes, and others.

Psychological treatments

Psychotherapy

Cognitive behavioral therapy, a type of psychotherapy, is often used to help children and teens deal with thoughts and feelings that contribute to their feeling of depression or anxiety. Doctors can use similar techniques to teach children to more effectively regulate their mood and increase their tolerance for frustration. The therapy also teaches coping skills to regulate anger and ways to identify and rename the distorted perceptions that contribute to outbursts. Other research psychotherapies are being investigated at the NIMH.

Parent training

Parent training aims to help parents interact with a child in a way that reduces aggression and irritable behavior and improves the parent-child relationship. Several studies show that such interventions can be effective. In particular, parent training teaches parents more effective ways to respond to irritable behaviors, such as anticipating events that could cause a child to have an angry outburst and working ahead to avoid the outburst. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior.

Computer based training

There is some evidence that irritable youth with DMDD are prone to misunderstanding ambiguous facial expressions as angry. There is preliminary evidence that computer-based training designed to overcome this problem can help young people with DMDD or severe irritability.