Disruptive Mood Dysregulation Disorder (DMDD) is a mental health condition in children and adolescents characterized by severe and chronic irritability, anger, and frequent temper outbursts that are disproportionate to the situation. These outbursts can be verbal or behavioral, such as aggressive or destructive actions.

Although outbursts and tantrums in children with autism appear similar to those in children with DMDD, these are likely driven by difficulties in processing information. Disruptive mood dysregulation disorder and autism can co-occur, but emotional and behavioral problems in the two conditions are a result of different challenges.

Key features of DMDD include:

• Severe temper outbursts: These outbursts occur three or more times per week and are out of proportion to the situation.
• Chronic irritability: Even between outbursts, the child is persistently irritable or angry, and this mood is present most of the day, nearly every day.
• Duration: The symptoms must be present for at least 12 months without a break lasting longer than three consecutive months.
• Age of onset: Symptoms usually begin before age 10, and the diagnosis is typically made in children aged 6 to 18 years.
• Impairment: The condition significantly impacts the child’s ability to function at home, in school, or in social settings.

Over time, as children grow and develop, the symptoms of disruptive mood dysregulation disorder may change. For example, an adolescent or young adult with DMDD may experience fewer tantrums, but they may begin to exhibit symptoms of depression or anxiety. For this reason, treatment may change over time, too.

Children with DMDD may have trouble in school and difficulty maintaining healthy relationships with family or peers. They also may have a hard time in social settings or participating in activities such as team sports. If you think your child has DMDD, seeking a diagnosis and treatment is essential.

DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, primarily to address concerns about the overdiagnosis and treatment of pediatric bipolar disorder. Unlike bipolar disorder, DMDD does not include distinct periods of elevated or expansive mood (mania).

Disruptive Mood Dysregulation Disorder Severe irritability

All children can become irritable sometimes. It’s a normal reaction to frustration. Children experiencing severe irritability (as observed in DMDD) have difficulty tolerating frustration and have outbursts that are out of proportion to the situation at hand. These outbursts occur more often and are more severe than expected for children their age.

For example, a parent tells the child to stop playing a game and do their homework. Any child might be frustrated or annoyed. However, a child with DMDD may become extremely upset and emotional and have an intense temper outburst with yelling or hitting. A child with DMDD experiences these intense temper outbursts a few times a week.

Disruptive Mood Dysregulation Disorder Treatment

• Psychotherapy: Cognitive-behavioral therapy (CBT) helps children manage anger, develop coping skills, and improve emotional regulation.
• Parent training: Teaching parents techniques to manage their child’s behavior and improve the parent-child relationship.
• Medication: In some cases, medication may be prescribed to help manage symptoms, especially if the child has co-occurring conditions like ADHD or anxiety.

Treatment is tailored to each child’s specific needs and usually involves a combination of therapy and support for the child and family. Download an informational flyer from the National Institute of Mental Health to learn more.