Jun 3, 2013

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.

40 comments:

Anonymous said...

i have heard that the DiSM has dropped Autism as a diagnosis. Is this true? That could be devestating.

Anonymous said...

I think the reason most people tend to "dismiss" mental illness is because it appears to be too subjective. Whenever someone isn't "acting right", they're labeled as disabled by some group of doctors without medically tangible evidence. Mental Illness has become a "catch all" for anyone not being productive.

I remember when my son's school insisted he was ADHD. We had him tested, surprise, he's not. He's a typical boy, goofs off all the time, can't sit still and is generally disruptive when allowed to be. Notice that last part. Parenting is hard work. It takes a lot of effort.

I just don't think labeling kids as disabled does anything for them. Does it build self esteem? Does it get them ready for the real world? I'm all for providing support if the way of medical treatment and tutoring or other necessary support services. But labeling a 7 year old as disabled because he gets angry a lot? Have his mom tell him for the next 11 years he's disabled and can't work or anything, only to be cut off at age 18 by the goverment because magically at 18 you're cured, right? I think that's a horrible disservice to the child.

Anonymous said...

@10:12 Autism is still there. They combined Autism, Asperger's and PDD-NOS into a single Autism Spectrum Disorder. They also changed some of the specific criteria for ASD.

Anonymous said...

"The temper outbursts are inconsistent with developmental level."

The next time I see a psychiatrist apply this criteria correctly will be the first. Much like oppositional defiant disorder (ODD), this impairment will probably be "diagnosed" based on the parents complaints that the child does not listen, acts out and is a generally disobedient. All problems that are typically directly related to the parent's inability to parent...not due to any clinical impairment in the child.

Too often we see parents seeking disability for their children because they are essentially misbehaving and not listening to the parents. As a parent of two young children, it's easy to see that the children are simply seeking attention or taking advantage of a situation. Time for parents to take responsibility.

Anonymous said...

It seems that, regardless of the Listing, a child truly carrying this diagnosis and meeting all of these diagnostic criteria would likely have marked limitations in the domains of interacting and relating to others and caring for yourself.

Anonymous said...

Pretty soon there will be a listing for everything and we will all be able to get disability.

Crisszilla W said...
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Anonymous said...

"It seems that, regardless of the Listing, a child truly carrying this diagnosis and meeting all of these diagnostic criteria would likely have marked limitations in the domains of interacting and relating to others and caring for yourself."

Perfectly stated.

Anonymous said...

When I asked one woman why she thought her 7 year old son was disabled she answered, "I have to tell him three times to brush his teeth." My reply was, "I have to tell my 20 year old son three times to brush his teeth also."

Anonymous said...

What is the test or battery of tests that will confirm a diagnosis with this new condition?

Anonymous said...

Doesn't play well with others, that's a disability now.

Anonymous said...

I'm generally pro-claimant but this seems mushy mouthed.

Anonymous said...

I read this carefully--this "diagnosis" fits my 10-year-old granddaughter to a tee, becase she is a spoiled brat, which I know by watching her mother raise her. So she has a disability? Really? Wow.

Anonymous said...

I find these types of mental diagnoses very problematic. Take personality disorders, for example. To be sure, there are bona fide sociopaths with full-fledged antisocial and/or borderline personality disorder. But what about the person who is just a jerk? He may exhibit a few "cluster B" traits and poof, a guy who is just a jerk is now carrying a mental diagnosis.

Same with many of the childhood impairments, specifically ODD and ADHD. I've seen children afflicted with these impairments, actually afflicted. A true ODD child is terrifying, just watch any of the countless documentaries and other films documenting the behavior of these children and the destruction it causes their lives and their families. Same with ADHD--there are children truly debilitated by their severe inattentiveness, easy distractibility, inabilit to finish tasks, etc.

However, there are children who just smart off at the mouth and defy authority figures (like all of them), and whose behavior gets worse because it is allowed to do so. Has that child actually changed from normal child displaying childish defiance to a child with ODD? I think not.

All too often these diagnoses are made by people who either have minimal expertise or who do not have sufficient personal observation of the child and rely on subjective, unverified reports from parents (who are frustrated and may not give the most accurate descriptions).

tl;dnr--these impairments are real, but their symptoms are mimicked by misbehaving children, and too often medical sources mistake this transient, common childish bevahior allowed to grow out of control due to bad parenting as signs of a serious mental disorder.

Jennifer said...

As a mom of a child that just got diagnosed with Disruptive Mood Dysregulation Disorder TODAY, I want to state that not all therapists or doctors are like that. She has diagnosed him based on the fact that if he was to drop a pen, he breaks down in to being fully irritated and can have an upset outburst because of something really small like that. He is 9, I've been dealing with this and thought it was anxiety and I'm VERY happy she isn't just tossing medicine into my child, so before you try to down too much of what they are changing because they "mislabeling" kids with issues, you don't live the lives some parents live. and you don't see what kids go through, and you can't base what you see off of what may actually happen elsewhere. My autistic child has outbursts and such as well, and I refused medicine for awhile until it got severe, and then she acts perfectly normal now. Please think before you post, because there are lots of wonderful people helping people like me that work and have kids and know something is going on when their child(ren) have outbursts

Unknown said...

Haters,you don't live with disruptive mood disorder.When you live with a child with a mood disorder.Then come talk to me.

Erica5587 said...

It really angers me how people can just down people about an illness that they probably know nothing about. I have a 9 yr old son who was diagnosed with adhd and disruptive mood disregulation disorder about six months ago. I promise you that you have no idea how hard it is living with a child with this condition. It is nerve wrecking and there is not a day that goes by that i don't blame myself. I discipline my child and I did the same thing by not letting them give my son medication and it backfired. I am now getting my son the help he needs and i always encourage him that regardless of his diagnosis that he can do anything. I think you should really know more about this before you make judgments.

Michelle Obama said...
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Michelle Obama said...

By that logic let's blame the parents of autistic children for not preparing them for the real world. "Parents there's nothing wrong with your children, YOU poorly prepared them for social interactions and change. Bad parent, go to your room." I'm sorry it doesn't work like that. Any reputable psychiatrist will rely less on what the parents says and more on reports from school and what they themselves see. My 10yr old is dx with both adhd and dmdd. I barely had to say anything. If the dx is there it will be made without a parents input. I also have other children that display no sx. So explain that. I'm married a nurse for 15 yrs and will be receiving a master's in psychology specializing in early childhood development. Both my mother and grandmother were special education teachers. I pay for my private insurance without asking for any assistance. You're just the type of person I'd like to write my thesis on, someone who freely judges from their pedestal wearing rose colored glasses while not even beginning to understand the problem but, that's probably more of a social science thesis. I'm so tired of parents assuming that a chemical imbalance, that is what mental disorders boil down to, is some how environmental or a parents cry for help.

Michelle Obama said...

I feel your pain and I totally agree my 10 yr old dtr was dx with adhd at 4 and dmdd about a year ago. It's literal hell some days and people have the nerve to say is not real. Wth

Michelle Obama said...

I feel your pain and I totally agree my 10 yr old dtr was dx with adhd at 4 and dmdd about a year ago. It's literal hell some days and people have the nerve to say is not real. Wth

Unknown said...

I've literally cried all night because of my son's behavior. He's 8 years old and diagnosed with ADHD and DMDD. I pray we can get to a point of normalcy. Anonymous can go kick rocks. You don't know the struggle. I'm constantly called to get him from school. He's always in trouble in his after school care. He's today been expelled from his after school program. I discipline him. He gets spanked. I take toys and privileges. I've done it all. At home he's always crying always upset. Speaks on how he wants to die. And he doesn't grasp that these things aren't normal. He has tricare insurance. I've paid over a thousand out of pocket for psych testing. His meds aren't working. Every day is a battle. Don't try to tell me this diagnosis isn't real.

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Custom Hair Bows said...

Hey sir, inform yourself first before coming and make the ridiculous about something that you know nothing about it. The judgmental people look disgusting!

Anonymous said...

Coming from the experience of someone in the field of education, I've seen many children who are diagnosed that shouldn't be and vice versa. My 6 year old son is actually one of the children who has been recently diagnosed with DMDD. His grandfather was the one who brought up ss/disability for him, as we have forked out thousands and thousands of dollars for neurophyschological testing, weekly appts with a psychologist, and monthly appts with a psychiatrist.
These meltdowns are not nearly temper tantrums. He has thrown things at his teachers, other students, and myself. Chairs, pencils, and pretty much anything not nailed down. He has scratched his face until he bled. Banged his head against a door or window until he cried out in pain from the welt that formed. The simplest upset for him results in him screaming that he hates you or wishes you (or himself) is dead. I am fighting to keep him in a special ed classroom with additional help instead of shipping him off to a therapeutic day school. Until you are in the shoes of someone who deals with this on a daily basis, someone who almost lost their job due to the amount of calls from their child's school (whether due to restraints, suspensions, him breaking something, or trying to hurt someone), there is no room to judge. Cancel your plans all the time and only go to the store when it can be without your child, because an outburst in the store only results in you putting him in your arms and carrying him out screaming and kicking, while you yourself are fighting back tears. Please tell me that I spoiled him, or that it's a normal tantrum.... I can't take the looks and comments I get from random strangers anymore.
If you can tell me what my child is going through is normal, I beg of you- come spend a day with me. Listening to your six year old tell you he'd rather die so that you could have a son that can be good and loving all the time and then breaking down crying saying how sorry he is is one of the worst feelings I have ever experienced in my life.... Having to convince him that he's enough.... At 6....
Don't tell me what I go through every day of my life isn't real..... You have no right.

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Unknown said...

I totally agree with the parents going through this daily with a child who has a mental disorder...I've been going through so much with my son all his life of him not being happy, anger outbursts getting worse, behavior issues at home and school...my 10 year old was just recently diagnosed with DMDD and anxiety disorder by a neuropsychologist...it's real so don't place judgement on all us parents going through this...not easy being told by professionals just how depressed your so really is...and yes, I have MDD and my grandma was bipolar so again, it's REAL!

Unknown said...

I totally agree with the parents going through this daily with a child who has a mental disorder...I've been going through so much with my son all his life of him not being happy, anger outbursts getting worse, behavior issues at home and school...my 10 year old was just recently diagnosed with DMDD and anxiety disorder by a neuropsychologist...it's real so don't place judgement on all us parents going through this...not easy being told by professionals just how depressed your so really is...and yes, I have MDD and my grandma was bipolar so again, it's REAL!

Stacey Jost said...

Right on! My daughter was diagnosed this week with DMDD. She also was diagnosed with PTSD anxiety and depression prior to this.
I have been reading these posts and it saddens me that people don't truly understand the magnitude of mental illness and say and post these awful things.

Anonymous said...

U know that's harsh because some kids really do have these problems abd need extra help and it has nothing to do with a parent not being capable of parenting.but a parent doing what's best for their child I have two young kids to and my son is 9 well in first grade the school asked me to have him tested for adhd and dyslexia which he was not the age for dyslexia but they did say he was adhd he was borderline of falling with no return.he is now in 3rd and they sent him to be tested for dyslexia I talked with the last told her my concerns about the other person just saying he was with a 30 min testing she tested him for adhd again and we are still doing some testing and his is already full blown adhd DMDD dyslexic and we are still waiting on some..y'all think it's based off what parents say and do but u know they talk to these kids and it's not normal for a nine year old to fail a test or have a bad day at school and come home and try to hit the wall of his siblings yes my son gets punished but guess what he still does this his mind thinks it's okay to be mean to others and take it out on him and he told his therapist that u need to walk in someones shoes and see what they deal with before u JUDGE

Beth said...

I'm going through the exact same thing. My daughter is 9 and just recently we've had her tested and are awaiting results. By researching, it sounds like she has DMDD. We've been battling this ever since I can remember. We've been to psychologists, to neurologists, to regular Drs trying to determine what is going on. First they told me it was anxiety, then they think it's ODD and ADHD. It's horrible dealing with daily tantrums that last an hr or more at a time. Sometimes multiple times a day. She's kicked holesit doors, thrown things, hits me, threatens to kill herself, hyperventilates, all bc she's been asked to clean her room or when I tell her she can't do something. It's something we suffer with daily. And for those who say it's bc we aren't "parenting", I work with kids that have special needs. I have a college education. I have done all the parental suggestions known to man. Reward charts, punishments, rewards, spanking, etc. and nothing works. We've discussed consequences of actions and being rewarded for good behavior. She understands it but when she becomes explosive, you can not talk to her, reason with her, or calm her down. She's in the "fight or flight" mode. It's literally a nightmare. I only hope that when we get the diagnosis back, we can begin treatment in hopes it helps us get back to normalcy.

Anonymous said...

It's the parents fault. Ignorance of something makes you an expert now. My kid is different than yours. Is that ok with you? I have no problem parenting but some of us know that we have to parent differently. My kid gets no disability and I'm sure he won't. I just happened across this article. People that so easily judge are laughable. Mental illness is REAL you clown!! As you pray to your invisible things in the sky and claim that's accepted mental illness,which it certainly is. Think about this. Some people are different. Take some responsibility mr or Mrs ANONYMOUS. Come visit me and my child so he can whip your ass..:)

Kay Renee said...

I agree with all of the parents that are dealing with a child with DMDD. My daughter is 15 and was recently diagnosed with DMDD and Adjustment Disorder with Mixed disturbance of emotions and conduct. She has had Dyslexia since 5. The DMDD Symptoms since 10. I thought it was just her strong-willed personality but as the years progressed so did her behavior. It has been horrible! Every day she is on level 10 about something. It is can be frustrating, aggravating and so much more. I am a single parent. My grown son is own is own. It is always combative with her. Now, that I am a Mental Health Professional dealing diretly with people who have a DSM-5 diagnosis I truly know that mental illness is real! I am a Christian. I trust the Lord with all of my heart for my daughter's healing and deliverance. I am not a fool to think that she does not need help in the natural that's why God gave man intellect and intelligence to use in this fallen world of sin. Have faith, but also, get the help that is available. Faith without works is dead. For the judgers--read Matthew 7:1-3. Until you walk in someone else's shoes please keep your ignorant comments to yourself or get with others that share your views. This clearly is not the forum for you. Peace & Love!

Unknown said...

So do any one know if a child had received ssi/disability for he dignose

Aadit said...


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Anonymous said...

My child was diagnosed recently with dmdd. I completely disagree. He ia just bad as hell at times. Discipline just doesn't work anymore I'm out of options what should I do?

Word said...

Doesn't matter her or not a parent thinks their kid is disabled. Before my son was diagnosed they did a battery of tests and talked to him, his teachers, past and present, and family friends and his peers before they diagnosed him. Get educated before you open your mouth about something you have no clue about. Thanks.

Ashley Skinner Jones said...
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Unknown said...

My son was given a bipolar dx when he was 7 when we moved they changed it to ends because of his age he is now 11 and we were told until he is older he will stay with the dx although he has been hospitalized for manic episodes of anger and depression. It's not always about discipline mental disorders do exist his father suffers from the same issues and unfortunately back onnour time they didn't treat bipolar correctly. I get negative remarks all the time from people.until I actually go through it u can never imagine how hard it is on a parent or a child.

Anonymous said...

My son 5 was just diagnose with dmdd. He is currently in the behavioral health hospital been there a week. He hurt a kid so bad placed him in the hospital. He has anger outburst on a daily basis kicking hitting yelling screaming. Its bad where hes been suspended from kindergarten twice about to be kicked off the bus and suspended from daycare. With his outburst im about to be fired from my job because i need to get him from school or daycare on a daily basis. Being a parent to a child with dmdd is very very hard. Right now while hes in the hospital he is on 4 different medications. Ots stressful. I feel for the other parents who have to go through this or any disorders.