Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience ongoing irritability, anger and frequent, intense temper outbursts. Many children go through periods of moodiness, but children with DMDD experience severe symptoms and often have significant problems at home and school. They may also struggle to interact with peers.

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DMDD can be treated. If you are concerned that your child may have DMDD, talk to your child’s pediatrician or health care provider.

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Signs and Symptoms of DMDD

Children and adolescents with DMDD experience:

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• Severe temper outbursts (verbal or behavioral), on average, three or more times per week

• Outbursts and tantrums that have been ongoing for at least 12 months

• Chronically irritable or angry mood most of the day, nearly every day

• Trouble functioning due to irritability in more than one place, such as at home, at school, or with peers

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Youth with DMDD are typically diagnosed between the ages of 6 and 10. To be diagnosed with DMDD, a child must have experienced symptoms steadily for 12 or more months.

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Risk Factors

It is not clear how widespread DMDD is in the general population, and the exact causes of DMDD are not clear. Researchers are exploring risk factors and brain mechanisms of this disorder.

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Treatments and Therapies

DMDD is a relatively new disorder and few DMDD-specific treatment studies have been conducted. Treatment is often based on what has been helpful for other childhood disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and anxiety disorders.

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Treatment for DMDD generally includes certain types of psychotherapy (also called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later if needed. However, in some cases, providers recommend that children receive both psychotherapy and medication at the start of their treatment. Parents or caregivers should work closely with their child's health care provider to make treatment decisions that are best for their child.

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The National Institute of Mental Health (NIMH) is currently funding studies focused on further improving these treatments and identifying new treatments to address irritability and temper outbursts.

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Psychotherapies

Cognitive behavioral therapy (CBT) targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. Researchers are also using CBT to help children increase their ability to tolerate frustration without having an outburst. This therapy teaches coping skills for controlling anger and ways to identify and relabel the distorted perceptions that contribute to outbursts.

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Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to temper outbursts and working ahead to avert them. Training also emphasizes the importance of predictable and consistent responses to a child’s outbursts and rewards for positive behavior.

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Medications

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD. However, health care providers may prescribe certain medications—such as stimulants, antidepressants, and atypical antipsychotics—to help relieve a child’s DMDD symptoms.

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• Stimulants are often used to treat ADHD, and research suggests that stimulant medications also may decrease irritability in youth.

• Antidepressants are sometimes used to treat irritability and mood problems that children with DMDD may experience. One small study suggests that the antidepressant citalopram (a serotonin reuptake inhibitor antidepressant), combined with the stimulant methylphenidate, may decrease irritability in youth with DMDD. Please note: Antidepressants may increase suicidal thoughts and behaviors in youth, who should be monitored closely by their health care provider.

• Certain atypical antipsychotic medications are used to treat children with irritability, severe outbursts, or aggression. The FDA has approved these medications for treating irritability associated with autism, and they are sometimes used to treat DMDD. However, because these medications can cause unwanted side effects, they’re usually only tried when other approaches have not worked.

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All medications have side effects. Monitor and report your child's side effects and review the medications frequently with your child's health care provider. Visit the FDA website  for most up-to-date information on medications, side effects, and warnings.