Stability of Disruptive Mood Dysregulation Disorder Symptoms (Irritable-Angry Mood and Temper Outbursts) Throughout Childhood and Adolescence in a General Population Sample
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DSM-5 Disruptive Mood Dysregulation Disorder (DMDD) is a controversial new diagnosis. The DSM-5 conceptualizes DMDD as persistent and chronic, but the stability of the two DMDD symptoms (irritable-angry mood and temper outbursts) over time is not known. Mothers rated DMDD symptoms in a population-based sample of 376 children (54 % male) evaluated at 6–12 years (M 9) and again an average of 8 years later (M 16). Mean scores on irritable-angry mood plus temper outbursts at baseline and follow-up were below sometimes a problem, but were higher at baseline than follow-up. Irritable-angry mood and temper outbursts were both often or very often a problem for 9 % of children at baseline, 6 % at follow-up, and 3 % at baseline and follow-up. Only 29 % of children whose baseline symptoms were often or very often continued to have follow-up symptoms at this level (remission rate 71 %). Less than half (45 %) of the children whose symptoms were often or very often at follow-up had these symptoms 8 years earlier (55 % new cases). Our finding of 71 % remission and 55 % new cases indicates instability of DMDD symptoms over an 8-year period. However, the finding that 29 % still had symptoms often or very often 8 years later is clinically significant. DMDD symptoms were found in only one child who did not have symptoms of oppositional defiant disorder (ODD), conduct disorder, ADHD, anxiety, or depression. This suggests that DMDD symptoms are a feature of multiple disorders, particularly ODD, and do not occur in isolation, questioning the validity of DMDD as a unique and independent diagnosis.
KeywordsDisruptive mood dysregulation disorder Irritability Temper Stability
This study was supported by National Institutes of Health grants RO1 HL063772, MO1 RR10732, and CO6 RRO16499.
Dr. Waxmonsky has received research funding in the past from Janssen and Noven Shire, is on the Noven Shire advisory board, and is a member of the speaker’s bureau for Quintiles.
Conflict of Interest
The remaining authors have no conflicts of interest.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Google Scholar
- Axelson, D. A., Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., Horwitz, S. M., et al. (2012). Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the longitudinal assessment of manic symptoms study. Journal of Clinical Psychiatry, 73, 1342–1350.PubMedCentralCrossRefPubMedGoogle Scholar
- Biederman, J., Petty, C. R., Dolan, C., Hughes, S., Mick, E., Monuteaux, M. C., & Faraone, S. V. (2008). The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: Findings from a controlled 10-year prospective longitudinal follow-up study. Psychological Medicine, 38, 1027–1036.PubMedGoogle Scholar
- Copeland, W. E., Shanahan, L., Egger, H., Arnold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. American Journal of Psychiatry, 171, 668–674.Google Scholar
- Fernandez de la Cruz, L., Simonoff, E., McGough, J. J., Halperin, J. M., Arnold, L. E., & Stringaris, A. (2014). Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1016/j.jaac.2014.10.006.PubMedGoogle Scholar
- Kleinman, J. M., Ventola, P. E., Pandey, J., Verbalis, A. D., Barton, M., Hodgson, S., et al. (2008). Diagnostic stability in very young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 4606–4615.Google Scholar
- Leibenluft, E., Uher, R., & Rutter, M. (2012). Disruptive mood dysregulation with dysphoria disorder: a proposal for ICD-11. World Psychiatry, 11(Suppl. 1), 77–81.Google Scholar
- Lindgren, S. D., & Koeppl, G. K. (1987). Assessing child behavior problems in a medical setting: development of the pediatric behavior scale. In R. J. Prinz (Ed.), Advances in behavioral assessment of children and families (pp. 57–90). Greenwich: JAI.Google Scholar
- Mayes, S. D., Calhoun, S. L., Aggarwal, R., Baker, C., Mathapati, S., Anderson, R., et al. (2012a). Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical children. Research in Autism Spectrum Disorders, 6, 1–10.CrossRefGoogle Scholar
- Mayes, S.D., Kokotovich, C., Mathiowetz, C., Baweja, R., & Calhoun, S.L. (2015). Cross-sectional age analysis of DMDD symptoms (irritable-angry mood and temper outbursts) in psychiatric and general population samples. Poster presented at the annual meeting of the Society for Research in Child Development, Philadelphia, PA.Google Scholar
- Nichols, S., Mahoney, E. M., Sirois, P. A., Bordeaux, J. D., Stehbens, J. A., Loveland, K. A., et al. (2000). HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: results from the hemophilia growth and development study. Journal of Pediatric Psychology, 25, 545–556.CrossRefPubMedGoogle Scholar
- Waxmonsky, J. G., Pelham, W. E., Gnagy, E., Cummings, M. R., O’Connor, B., Majumdar, A., et al. (2008). The efficacy and tolerability of methylphenidate and behavior modification in children with ADHD and severe mood dysregulation. Journal of Child and Adolescent Psychopharmacology, 18, 573–588.PubMedCentralCrossRefPubMedGoogle Scholar
- Wechsler, D. (2005). Wechsler Abbreviated Scales of Intelligence (2nd ed.). San Antonio: Psychological Corp.Google Scholar