Disruptive Mood Dysregulation Disorder (DMDD)
296.99 (F34.8)
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No relevant specifiers
6 month to 1 year period-prevalence estimated to be
2-5%
Rates higher in males and younger children than
in females and adolescents
(American Psychiatric Association [APA], 2013)
Treatment Suggestions
Criteria for Diagnosis
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Since DMDD is a relatively new disorder, little
research has been done on its treatment. (Kress &
Paylo, 2015) The following therapies have been shown
to be effective in treating symptoms of DMDD:
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Parent Management Training (PMT)
A meta-analysis of 28 randomized controlled
trials found PMT to be effective in treating children
with disruptive behavior problems. (Michelson,
Davenport, Dretzke, Barlow, & Day, 2013)
In PMT, parents learn to use behavior
interventions to decrease temper tantrums and
outbursts. Counselors teach parents to recognize
symptoms and address them with positive or negative
reinforcement. Role play and skills such as
contracting, negotiating, prompting and fading may
also be used (Kress & Paylo, 2015)
Interpersonal Psychotherapy for Mood and
Behavior Dysregulation (IPT-MBD)
A recent case study (Miller, Hlastala, Mufson,
Leibenluft, & Riddle, 2016) found modifying
techniques from Interpersonal Psychotherapy for
depressed adolescents (IPT-A) to be effective in
treating youth with chronic irritability and outbursts.
High likelihood of comorbidity with diverse disorders including:
 Anxiety disorders
(If symptoms meet criteria for oppositional
 Mood Disorders
defiant disorder or intermittent explosive
 Autism spectrum
disorder and DMDD, diagnosis is DMDD)
(APA, 2013)
Risk and Prognostic Factors
Temperamental:
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Kress, V. & Paylo, M. (2015). Treating those with
mental disorders: A comprehensive approach to
case conceptualization and treatment. Upper
Saddle River, NJ: Pearson Education, Inc.
Chronic irritability
May also meet criteria for
oppositional defiant disorder, anxiety
disorder or ADHD
Genetic and Physiological:
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References
American Psychiatric Association (2013).
Diagnostic and statistical manual of mental
disorders: DSM-5 Arlington, VA: Author.
 Age of onset < 10 years
 Client between 6 and 18 years old
 No manic or hypomanic episodes
lasting more than one day
 Behaviors not attributable to major
depression or another mental disorder
 No comorbidity with oppositional
defiant disorder, intermittent
explosive disorder, or bipolar disorder
 Symptoms not due to substance use or
other medical condition
(APA, 2013)
Comorbidity
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IPT uses techniques such as interpersonal
incidents, communication analysis and role play.
Behavioral management strategies in this study
focused on improving interpersonal functioning and
the relationship between parent and child. (Miller et
al., 2016)
Severe recurrent temper outbursts
Tantrums inconsistent with
developmental level
Outbursts 3+ times per week
Persistent daily observable anger
and irritability
Symptoms present for 12+ months
(no period of 3+ months without
symptoms)
Symptoms observed in 2/3 settings
(home, school, peers) with severe
symptoms in at least one setting
Family history of anxiety, depression,
or substance abuse
Difficulties with face-emotion
labelling
Problems with decision-making and
cognitive control
Dysfunctional attention response to
emotional stimuli
(APA, 2013)
Functional Consequences
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Chronic, severe irritability
Disruption in family and peer
relationships
School performance problems
Low tolerance of frustration may
result in problems participating in
normal childhood activities
Disruptive outbursts disrupt family
life
Trouble initiating and sustaining
friendships
Level of dysfunction comparable to
bipolar disorder
Dangerous behaviour
Severe aggression
Suicidal ideation or attempts
(APA, 2013)
Differential Diagnoses
Culture/Gender Issues
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Ages 6-18
Predominantly male
(APA, 2013)
Michelson, D., Davenport, C., Dretzke, J. Barlow, J. & Day, C. (2013). Do evidence-based
interventions work when tested in the “real world?” A systematic review and meta-analysis of
parent management training for the treatment of child disruptive behavior. Clinical Child and
Family Psychology Review, 16, (1), 18–34. doi:10.1007/s10567-013-0128-0
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Bipolar disorders
Oppositional defiant disorder
Attention-deficit/hyperactivity
disorder
Major depressive disorder
Anxiety disorders
Autism spectrum disorder
Intermittent explosive disorder
(APA, 2013)
Miller, L, Hlastala, S., Mufson, L, Leibenluft, E. & Riddle, M. (2016). Interpersonal psychotherapy for adolescents with mood and behaviour
dysregulation: Evidence-based case study. Evidence-Based Practice in Child and Adolescent Mental Health. Retrieved from
http://www.tandfonline.com/doi/abs/10.1080/23794925.2016.1247679?journalCode=uebh20