By Jan Cheek, MSW, LCSW

Disruptive Mood Dysregulation Disorder (DMDD) is a condition that is characterized by severe anger, pervasive irritability, and frequent temper outbursts in children and teens ages 6 to 18 years old. It is a relatively new diagnosis introduced in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual (DSM-5). According to the DSM-5, symptoms must be present and cause impairment for at least a year prior to the age of 10 years old. Temper tantrums can be common in kids, but children with DMDD have rageful tantrums and angry outbursts that are extreme, intense, and can lead to significant disruption in many areas of a child’s life. Temper tantrums associated with DMDD are filled with fury and severely out of proportion to what the situation is; and they are not consistent with the child’s developmental level.

DMDD symptoms include:

• Severe, recurrent temper tantrums occurring on average 3 or more times per week: These tantrums include screaming, yelling, name calling, pushing, hitting, and destruction of property.
• Tantrums that are out of proportion to the situation: For example, we might expect a child to be frustrated or disappointed if the ice cream shop is out of their favorite flavor, but a child with DMDD might become physically aggressive and have yelling outbursts and throw items in the store.
• Tantrums that are not appropriate for the child’s age or developmental level: For example, even if it is unacceptable, we might expect a 2 to 3 year-old child to fall to the ground and roll around when extremely angry. However, we would not expect that behavior of an 11 year-old.
• Between tantrums, the mood is persistently irritable, angry, and marked by a state of frustration nearly every day: Moods are consistently angry and extremely irritable and are very apparent to other people such as family, friends, neighbors, teachers, coaches, etc.
• Symptoms occur in multiple settings: Temper outbursts and irritability must occur in more than one setting, such as at home, school, and the neighborhood park, as examples.

The causes of DMDD are not currently clearly known. However, it is believed that contributing factors may include a challenging temperament, the presence of other mental health and medical conditions, and negative childhood experiences.

DMDD is challenging for all involved, particularly the child and caregivers. Handling a child’s intense temper outbursts and irritable mood is physically and emotionally exhausting. DMDD can result in significant problems in a child’s life.

Discipline for kids and teens who have DMDD is crucial, yet, also very challenging. People with DMDD are volatile and parents and teachers often become tentative to “set off” another outburst with disciplinary action. Discipline means teach and the goal of disciplining a person with DMDD is to teach more effective and acceptable ways to handle their BIG emotions and respond to frustrations and disappointments in life.

Some strategies related to disciplining a child with DMDD include:

• Say what you mean and mean what you say. Establish clear rules, boundaries, and limits, and ensure that your child knows what they are. It can be helpful to review the rules and expectations before beginning an activity.
• Have logical consequences in place, and make these clearly known to your child. Such as if a child throws a toy at someone in a rage, then loss of the privilege of playing with the toy would be a natural consequence. If a child stomps on a tech device and breaks it then the natural consequence is no longer having that device and not replacing it.
• Enforce rules and limits consistently with the stated consequences.
• Be predictable in how you approach discipline (how you choose to discipline and what you choose to discipline). Inconsistency and unpredictability are very frustrating and can be a primary trigger for rageful outbursts.
• Reward positive behaviors. Rewarding the positive is as important as applying consequences for the negative.
• Create routines and follow them as much as possible for daily activities.

Develop coping strategies for helping a child stay calm before acting on the BIG feelings. Some common strategies and skills include deep breathing techniques for calming down, counting to 10, counting to 100 by 5s, looking around and finding as many things of your child’s favorite color as possible, and having something cozy and soft to hold.

Over time, experiencing discipline and learning skills to become more self-disciplined will help children have more control over their strong, negative emotions.

Because DMDD affects lives so profoundly, professional help is recommended. There is no specific treatment specifically developed for Disruptive Mood Dysregulation Disorder, but the condition is often treated with behavioral therapy and psychotherapy in conjunction with parent training, psychiatric medication intervention, or a combination of both.

Behavioral therapy and psychotherapy typically include a type of therapy known as Cognitive Behavioral Therapy (CBT) for both the child and parents. CBT focuses on helping kids learn to recognize their thoughts that contribute to angry and frustrated feelings and learn new ways to think about and respond to various situations. Therapists working with parents might also help them be aware of their own thoughts and feelings and learn new more effective ways of responding to their child’s extreme emotions, tantrums and irritable outbursts.

Mental health professionals can offer guidance and interventions to help parents remain as calm as possible in order to be as effective as possible when interacting with a child or teen who has DMDD. In addition, mental health professionals can help a child learn ways to accept and tolerate things not going exactly the way they might expect. This leads to more emotional regulation rather than dysregulation.

DMDD is a challenging condition to navigate and it can result in significant problems in a child’s life and a family’s life. Having DMDD that is poorly managed or untreated can increase a child’s risk of experiencing depression or anxiety later in adulthood. This increases the importance of seeking treatment if you suspect that your child may have this condition.