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DMDD likely atypical after early childhood

Disruptive mood dysregulation disorder — proposed to be included in the DSM-5 — was found to be relatively uncommon after early childhood, researchers reported in the American Journal of Psychiatry. However, the disorder frequently occurred with other psychiatric disorders, including depression and oppositional defiant disorder.

Disruptive mood dysregulation disorder (DMDD) diagnosis will be limited to children aged 6 years or younger. Criteria include severe outbursts combined with persistent irritability. Symptom onset must occur before the age of 10 years and be present for at least 12 months.

William E. Copeland, PhD, of Duke University, and colleagues examined the prevalence rates of DMDD among 3,258 children and adolescents from three separate community studies: Duke Preschool Anxiety Study (participants aged 2 to 5 years), Great Smoky Mountains Study (participants aged 9 to 13 years) and Caring for Children in the Community (participants aged 9 to 17 years). Although none of the studies were designed to measure DMDD, the researchers were able to determine the disorder’s prevalence across the three study populations since its criteria overlap entirely with those of other common disorders.

The 3-month prevalence rates of DMDD ranged from 0.8% to 3.3%, with the highest rate occurring among preschoolers. DMDD frequently overlapped with all common psychiatric disorders, especially with depressive disorders (odds ratios ranging between 9.9 and 23.5) and oppositional defiant disorder (odds ratios ranging between 52.9 and 103). Severe tantrums (80.8%, 45.7% and 49%, respectively) and negative mood (21.1%, 12.8% and 8.2%, respectively) were common across all three study populations.

DMDD occurred with another disorder 62% to 92% of the time, and it occurred with both an emotional and behavioral disorder 32% to 68% of the time. Youth with DMDD had more school suspensions, greater use of mental health services and lived in greater poverty.

Some experts have expressed concerns that adding new diagnostic categories such as DMDD might result in increased medication use in young patients or pathologizing common behavior in children.

“This early look at disruptive mood dysregulation disorder suggests that it meets common standards of psychiatric ‘caseness’ and that it identifies a group of children with severe emotional and behavioral dysregulation,” the researchers wrote. “Its relatively low prevalence and high levels of service utilization moderate worries about ‘pathologizing’ normal behavior, although the core symptoms are common and its rarity comes from strict application of frequency, duration, and cross-context criteria.”

Disclosure: The researchers report no relevant financial disclosures.