Explosive Childhood Mood Disorders: Differences in Behavior and Emotions

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Disruptive Mood Dysregulation Disorder: The Mimicker

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Sharon McCutcheon

A childhood disorder that tends to mimic other disorders is Disruptive Mood Dysregulation Disorder (DMDD). DMDD is defined in the DSM-V as severe, recurring temper outbursts that can occur verbally or behaviorally and are disproportionate in intensity or duration to the provocation.

These outbursts are inconsistent with the child’s developmental level and must occur three or more times a week. The child’s mood in between outbursts is constantly irritable or angry and is witnessed by parents, teachers, and friends.

The outbursts and irritable mood must be present for one year or more and during that time the child has not had a period of three months where they did not experience an outburst or irritable mood. The outbursts and irritable mood need to be present in at least two of three settings (e.g. at home, school, or with friends).

The age of onset for these symptoms should be before 10 years old and a child cannot be diagnosed for the first time before the age of 6 or after the age of 18. Additionally, there can only be one day where manic or hypomanic symptoms are present. These behaviors also do not occur solely during a major depressive episode.

DMDD cannot coexist with oppositional defiant disorder (ODD), intermittent explosive disorder (IED), or bipolar disorder (BD). If a child meets for DMDD and ODD, then a diagnosis of just DMDD is given.

DMDD vs Bipolar Disorder

Since a diagnosis of DMDD and IED or BD is not possible, it is important to be able to differentiate between DMDD and the other two disorders. An important aspect that differentiates DMDD from BD is that in DMDD the child has a severe and chronic irritable mood that is seen as characteristic of the child. This irritability may wax and wane, but it is always there.

On the other hand, in BD there is only an episodic presentation of symptoms and the mood change that occurs during a manic episode is noticeably distinct from the child’s normal mood. Additionally, in BD there is a deterioration of cognitive, behavioral, and/or physical symptoms, such as a decreased need for sleep, that is markedly different from baseline. Feelings of grandiosity and elevated mood are also only found in BD.

Furthermore, in DMDD a child can experience one day of manic or hypomanic symptoms, however if the symptoms last longer than one day then the diagnosis would switch from DMDD to a possible BD. A difference in prevalence between males and females also helps to differentiate these two disorders as DMDD is seen more in males than females, while the male to female ratio is about equal in BD.

DMDD vs Intermittent Explosive Disorder

When it comes to the difference between IED and DMDD, children with IED experience severe temper outbursts similar to those with DMDD, however a diagnosis of IED does not require a persistent irritable mood between temper outbursts.

IED also only needs three months of verbal or physical aggression while DMDD has a one-year requirement. Additionally, a diagnosis of IED can be given to adults and is not specific to children under the age of 18. IED, unlike DMDD, does not require that its onset of symptoms be present before a certain age.

The data for prevalence rate of gender for IED is mixed. Some studies have found that it is greater in males than females while others have found that there is no difference. Given this information it seems like the most important factor that one should consider when differentiating IED and DMDD is whether a persistent irritable mood is present in between temper outbursts.

If You Need Help:

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1–800–273–8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see the National Helpline Database.

Disclaimer

The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your condition.

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Clinical Psychologist M.A. (PsyD 2023) Specialize in mood, anxiety, and trauma disorders. Mental health and cultural diversity advocate.

Philadelphia, PA
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