by Brittany Shideler of Injury Board

Disruptive mood dysregulation disorder (DMDD). When someone says this disorder out loud, most people think, “Huh?” That is because DMDD wasn’t officially diagnosed for the first time until 2013. That same year, DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), making it an infant in the world of recognized mental health disorders. Before DMDD recognition, mental health experts would commonly diagnose adolescents with this disorder as bipolar (BD). We now know it is a very different condition.

The National Institute of Mental Health defines DMDD as “a childhood condition of extreme irritability, anger and frequent, intense temper outbursts. DMDD symptoms go beyond being a “moody” child. Children with DMDD experience severe impairment that requires clinical attention.” Reactions are excessive for the situation and affect a child’s ability to function in school and at home. The struggle to control these extreme emotions makes it challenging for these children to socialize or succeed in a typical school environment.

A psychologist once shared that children with DMDD experience emotions at a much more magnified intensity than neurotypical people. The example he gave was one of being in an earthquake. A neurotypical person can feel an emotion, stop and think before giving a response. However if that same person were in an earthquake, the feeling of panic would come on abruptly. The person may respond impulsively, without thinking if the reaction is appropriate. The doctor’s point was that this is how a person with DMDD feels.

While there are similarities, and both conditions affect functioning, DMDD and BD are different and need to be treated as such. People with BD may feel intense irritation during manic episodes, but the feeling dwindles when the episode subsides. Adolescents with DMDD feel irritated almost constantly. According to the Mayo Clinic, “When your mood shifts to mania or hypomania, you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.” Mania is another significant distinction. It is a symptom of BD but not one of DMDD. Treatment cannot be successful without an accurate diagnosis, so if the medical professional has doubts, seek a second opinion.

Parents who suspect their child may have DMDD should begin recording their observations, such as what was said or done during the outburst, how frequently they occur and possible triggers. Teachers, daycare providers and other people who interact with the child regularly may also have valuable information to share. Take these observations to a psychologist for proper analysis. For a doctor to make a DMDD diagnosis, symptoms must be present multiple times per week for at least 12 months, and the child must be between the ages of 6 and 18. Treatment options vary, so families must work with their mental health professional to decide on appropriate therapy, medication, or both. It is not uncommon for adolescents with DMDD to have other conditions, such as ADHD. A mental health professional can help determine if this is the case.

Also, parents should speak with their child’s school about the process for requesting an evaluation. Doing so is the first step in obtaining an Individual Education Plan (IEP) that could open up special education services and accommodations for the child. Parents can pay to have an evaluation conducted outside of school if the school refuses. However, schools do not have to accept these results. Parents should check their state’s IEP rules for options if this happens. There are organizations in each state, such as the Michigan Alliance for Families, that help provide education and resources to people navigating the IEP process and obtain help when families hit roadblocks.