Disruptive Mood Dysregulation Disorder: The Childhood Rage-Filled Depressive Disorder You've Probably Never Heard Of

Most kids are grumpy, irritable, or angry sometimes — whether it's for good reason, or seemingly out of nowhere. What if your child was a whirlwind of rage, pretty much all the time, though?

If you were (or, perhaps, are) the parent of such a child, you might conclude that they are experiencing some kind of mental health struggle and that they need professional help. Would you suspect that the culprit may be a diagnosis that lies on the depressive spectrum, though?

Probably not. 

Enter Disruptive Mood Dysregulation Disorder, a diagnosis that appeared in the current and latest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, for the first time ever. Published in the DSM-5's chapter on depressive disorders, Disruptive Mood Dysregulation Disorder can only be diagnosed in children — not before age six, and not after age 18. 

What symptoms can point to Disruptive Mood Dysregulation Disorder in children?

The defining signs (that is, externally-observable symptoms) of Disruptive Mood Dysregulation Disorder are:

• Intense and repeated angry temper outbursts. These rage-filled outbursts may be verbal, manifesting in the form of yelling or screaming, or they may turn your life upside down in the form of a physical acting out — aggression towards people, breaking, or throwing things, for instance. No matter what form the tantrums take, they're much worse than whatever provoked them. 
• The angry outbursts seen in children diagnosed with Disruptive Mood Dysregulation Disorder are considered to go far beyond the kind of tantrums considered normative for the child's age or developmental level. 
• Even during a "break" from the angry outbursts, children with Disruptive Mood Dysregulation Disorder will be irritable or angry most of the time, as observed by people in their lives.

To be diagnosed with Disruptive Mood Dysregulation Disorder, a child will be between the ages of six and 18, with symptoms starting before the child turns 10 — even if the condition is diagnosed later. They'll have the hallmark symptoms of this rage-filled depressive disorder for at least a year, and never go more than three months without displaying all these behaviors in that year. 

The symptoms are consistent across at least two settings (home, school, or when spending time with peers), and relentless in at least one setting. 

Because the same symptoms can also be explained by other diagnoses, an evaluating psychologist or psychologist will want to make sure that the child has never met the criteria for a hypomanic or manic episode (seen in bipolar episode). They'll want to rule out major depressive episodes by ensuring the symptoms don't only strike during periods of depression, since a depressed mood often manifests as irritability in children. A diagnosing mental health professional will also want to rule out conditions such as Oppositional Defiant Disorder, Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and other possible causes of the symptoms. 

OK, so what really is Disruptive Mood Dysregulation Disorder, and what causes it?

As a new diagnosis, much remains unknown about the mechanisms behind the development of Disruptive Mood Dysregulation Disorder. Really, this condition was introduced as a category in the DSM-5 because researchers were concerned that juvenile bipolar disorder was being overdiagnosed — even in children who didn't meet the full diagnostic criteria. Children diagnosed with do have some features consistent with bipolar disorder, but the symptoms of this new diagnosis are distinct. 

The existence of Disruptive Mood Dysregulation Disorder as a diagnosis remains controversial. Some researchers point out that the symptoms can be indistinguishable from those seen in some children who could also be diagnosed with ADHD, Oppositional Defiant Disorder, a conduct disorder, or actually — pretty much take your pick. 

How is Disruptive Mood Dysregulation Disorder treated?

Treatment plans should be tailored to individual patients. When a child is diagnosed with Disruptive Mood Dysregulation Disorder, a combination of psychotherapy (including parent training or "psychoeducation") and medications may be offered. 

Medications that have shown promise in managing children diagnosed with Disruptive Mood Dysregulation Disorder include:

• Antidepressants — but due to the risk of severe side effects including the potential of inducing suicidal feelings, these should be prescribed to children and adolelescents with extreme caution. 
• Stimulants — like the Ritalin famous as an ADHD medication. These show promise. 
• Atypical antipsychotics — like drugs sometimes given to autistic children who struggle with irritability, concretely Risperidone. 

Talk therapy wise, Disruptive Mood Dysregulation Disorder can be managed with cognitive behavioral therapy sessions. Parents should be closely included in treatment, and be trained in methods that help them help their irritable child while preserving their own mental health. Other adults who play a big role in the life of children with a diagnosis of Disruptive Mood Dysregulation Disorder should also ideally receive training, both for the child's benefit and their own. 

Interestingly, computer-based training programs have also been shown to hold potential for children diagnosed with Disruptive Mood Dysregulation Disorder. It appears that these children may misinterpret neutral or unspecific facial expressions as angry, thereby causing them to assume that others are angry with them or hateful. With the help of computer programs designed for the purpose, kids can learn how to perceive facial expressions they see in other people more accurately.