Disruptive Mood Dysregulation Disorder (DMDD) is characterized by frequent and intense temper outbursts by a child that are disproportionate to the situation. These temper outbursts occur more than three times per week. In order to be diagnosed, the child must also display his angry or irritable mood across settings with parents, teachers, and peers. While it is normal for children to sometimes be moody, children with DMDD spend days in an irritable or annoyed state. It is that chronic irritability interspersed with fits of rage the characterize the disorder and occur with only minimal provocation. It could be something as inconsequential as being asked to wear the wrong pair of pants that can provoke a tantrum. Children with DMDD appear to experience emotions more intensely than others and also display deficits in emotion regulation. Often times their behaviors lead to strained relationships with those who are in their social circle, including family, teachers, and friends. It is important to consider that DMDD is not diagnosed before age 6, when temper tantrums are developmentally appropriate. If the temper tantrums and irritability last for longer than a few hours, it may be a sign of mania, which is associated with Bipolar Spectrum Disorders.
At the Cincinnati Anxiety Center treatment of DMDD begins with a functional behavior assessment to uncover the typical sequence of events leading up to the outbursts along with determining the most common consequences. The clinician will work with the child's family to extinguish the outbursts, while also reinforcing more adaptive responses through a process called contingency management. This will be conducted while also addressing the reality of the intense emotions that the child will need to learn to cope with and regulate. To do this, skills training from Dialectical Behavior Therapy is often incorporated into the treatment program as indicated and may include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills are also taught to parents as a means to increase consistent response styles within the home, while also helping to create a more validating environment for the child.