DMDD

Question 1

DMDD Main Symptoms

Answer 1

Severe recurrent temper outbursts grossly out of proportion in intensity or duration to a situation

Frequency of outbursts – 3+ times per week

Pervasive irritable/angry mood between outbursts observable by others

Chronic negative mood – it can be sad, but DMDD is really looking at sad-irritability.

• if it’s just angry-irritable, it shouldn’t be DMDD
• “angry-angry” could be CD & APD
• DMDD dx captures sadness (depressive disorder categorization)
• *Irritability manifests as disagreeableness and oppositionality
• Sad/ internal is more characteristic of bipolar spectrum, and mania is seen as rages
• Anger without sadness and rages= externalizing, conduct disorders

Question 2

DMDD Other Criteria

Answer 2

Pattern of frequent outbursts + consistent anger/irritability between outbursts for 12 or more months

During this 12 month period:

• child must show symptoms consistently in two or more settings (e.g. home and school)
• child does not experience a break of 3 or more months without symptoms of DMDD

Diagnostic age limits: 6-18
[prior to age 6, it is normal for children to throw tantrums]

Onset of symptoms typically take place before age 10

Question 3

DMDD Exclusionary Criteria

Answer 3

Distinct period of more than one day of a manic or abnormally elevated mood

• +1 manic moods = bipolar disorder
• Mania in children is not as expansive, mania has quicker cycles

[also to consider: true manic presentation, or reaction to meds? Meds for ADHD, ODD, DMDD may contribute to elevated mood

Cannot coexist with Bipolar or ODD
*If DMDD & ODD = DMDD dx is given preference

Not better accounted for by other disorders, e.g. anxiety disorders, autism etc., [though comorbidity with these disorders does not necessarily exclude]

Question 4

DMDD Development/Prevalence/Criticisms

Answer 4

Dx was developed as a way to distinguish negative mood without mania from negative mood with mania in response to overdiagnosis of pediatric bipolar disorder

Persistent vs. Distinct periods

Possibly more prevalent in boys (research continues)

Depression is more prevalent in girls, possibly resulting in more bipolar dx for girls

Incidence: 2-5%

Critics say it will turn temper tantrums into a mental disorder, however, Dr Ohr points out that the outbursts observed in DMDD are NOT tantrums, they are very exaggerated