Disruptive Mood Dysregulation Disorder

     The new 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the "Bible" of psychiatry, is out. One of the biggest changes in DSM-5 is the addition of the diagnostic category of Disruptive Mood Dysregulation Disorder. This diagnostic category is primarily designed for children and adolescents but I see nothing in DSM-5 that would limit this diagnosis to children and adolescents. 

     This new diagnostic category is important for Social Security since the agency is involved in determining disability in children and adolescents. Many of the children and adolescents filing disability claims will be diagnosed with this disorder.      

     This diagnosis is considered a type of depressive disorder but disruptive mood dysregulation disorder does not fit in Social Security's Listing 112.04 too well. A persistently irritable mood is mentioned in teh Listing but at least four additional criteria must be met to satisfy Part A of the Listing and those other criteria are not part of this diagnosis. My expectation is that Social Security is going to deny virtually all of these cases, at least until the agency updates the Listing.

     I fully expect that Social Security's critics will dismiss disruptive mood dysregulation disorder as merely temper tantrums. That's ridiculous but it won't stop those critics. The critics usually put the term mental illness in quotation marks to begin with since they believe that mental illness isn't, you know, like, really real. I've never quite understood the right's antipathy for psychiatry. I don't think that anyone can get through life without either experiencing mental illness or observing it up close, either in a family member or friend or someone known through work.

     Below are the DSM-5 criteria for the diagnosis of disruptive mood dysregulation disorder. Note how stringent the criteria are and think about how difficult it would be for a child or adolescent with this diagnosis to develop normally.

Disruptive Mood Dysregulation Disorder

Diagnostic Criteria 296.99 (F34.8)

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The temper outbursts occur, on average, three or more times per week.

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

H. By history or observation, the age at onset of Criteria A-E is before 10 years.

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.

Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).

Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

K. The symptoms are not attributable to the physiological effects of a substance or to an other medical or neurological condition.