# Disruptive Mood Dysregulation Disorder: The Basics

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## What is disruptive mood dysregulation disorder?

Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts. The symptoms of DMDD go beyond a “bad mood.” DMDD symptoms are severe.

Youth with DMDD experience significant problems at home, at school, and often with peers. They also tend to require mental health care services, including doctor visits and sometimes hospitalization. Additionally, these children are at an increased risk of developing anxiety and depression in the future.

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

### Did you know?

DMDD was added to the *Diagnostic and Statistical Manual of Mental Disorders* (*DSM-5*) in 2013. The *DSM* is used to assess and diagnose mental disorders.

## What are the signs and symptoms of DMDD?

Children or adolescents with DMDD experience:

- Severe temper outbursts (verbal or behavioral), on average, 3 or more times per week
- Outbursts and tantrums that have been happening regularly 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

Youth with DMDD are 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.

Over time, as children grow and develop, the symptoms of DMDD 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.

### What is the difference between typical and 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. But 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.

## How is DMDD diagnosed? 

If you think your child may be experiencing symptoms of DMDD, talk to your child’s health care provider. Describe your child’s behavior, and report what you have observed and learned from talking with others, such as their teacher or counselor.

An evaluation by your child’s health care provider can help clarify problems underlying your child’s behavior, and the provider may recommend next steps. You can also ask your health care provider for a referral to a mental health professional with experience working with children and adolescents. DMDD symptoms also can occur at the same time as other disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety disorders. An accurate diagnosis is vital for effective treatment.

Learn more about the diagnosis and treatment of children. To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), or visit the SAMHSA online treatment locator **. Learn about ways to find help for you, a friend, or a family member.

## How is DMDD treated?

DMDD is a relatively new disorder; few DMDD-specific treatment studies have been conducted. Current treatments are primarily based on what has been helpful for other childhood disorders associated with irritability, such as ADHD, oppositional defiant disorder, and anxiety disorders.

Treatment for DMDD generally includes certain types of psychotherapy (sometimes called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later. However, at times, providers recommend that children receive both psychotherapy and medication at the start of their treatment.

NIMH is funding studies focused on improving these treatments and identifying new treatments specifically for DMDD. Parents or caregivers should work closely with their child’s health care provider to make treatment decisions that are best for their child.

### Psychotherapies

**Cognitive behavioral therapy (CBT)** targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. Researchers at NIMH 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.

**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.

Learn more about psychotherapy.

### 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 your child’s DMDD symptoms.

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 the most up-to-date information on medications, side effects, and warnings.

- Stimulants  are often used to treat ADHD, and research suggests that stimulant medications also may decrease irritability in youth with DMDD.
- Antidepressants  are sometimes used to treat irritability and mood problems that children with DMDD may experience. One small study suggests that 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 haven’t worked.

### Tips for parents and caregivers

Being a parent or caregiver for a child or adolescent with DMDD can be stressful and overwhelming. To help build a supportive environment for you and your child, you may want to consider the following:

**Learn as much as you can about the disorder.**Talk to your child’s health care provider or mental health professional. Ask questions about treatment options, including risks and benefits. Find additional information about DMDD (including the latest news, videos, and information about clinical trials).

**Talk to your child’s teacher, counselor, or school psychologist.**Together, you may develop strategies, plans, and accommodations to help your child thrive in school. Learn more about children and mental health.

**Find ways to manage your stress.**Take practical steps to manage your stress to avoid the risk of negative health effects.

**Seek additional support and professional help.**Parents and caregivers may be able to find resources and encouragement through their local chapter of the National Alliance on Mental Illness**, the National Federation of Families**, Mental Health America**, and other organizations.

**Communicate regularly and effectively with your child’s health care provider.**Find tips to help you prepare for your child’s appointment. For additional resources, including questions to ask your health care provider, visit the Agency for Healthcare Research and Quality website **.

## What are clinical trials and why are they important? 

Children are not little adults, yet they are often given medications and treatments that have been tested only in adults. Research shows that, compared to adults, children respond differently to medications and treatments, both physically and mentally. The way to get the best treatments for children is through research designed specifically for them.

Clinical trials are research studies that look at ways to prevent, detect, or treat diseases and conditions. These studies help show whether a treatment is safe and effective in people. Some people join clinical trials to help doctors and researchers learn more about a disease and improve health care. Other people, such as those with health conditions, join to try treatments that aren’t widely available.

NIMH supports clinical trials across the United States. Talk to a health care provider about clinical trials and whether one is right for your child. Learn more about participating in clinical trials.

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## For more information

MedlinePlus ** (National Library of Medicine) (en español **)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNIH Publication No. 23-MH-8119 Revised 2023