FREQUENT AND SEVERE TEMPER OUTBURSTS: DISRUPTIVE MOOD DYSREGULATION DISORDER?

The new Diagnostic and Statistical Manual Fifth Edition [DSM-V] has a new diagnosis for frequent and severe anger outburts and underlying irritability, Disruptive Mood Dysregulation Disorder[DMDD].  This diagnosis targets children and adolescents who have problems with anger control that do not seem to be related to moods and do not seem to respond to medications for moods.  The symptoms include: severe and frequent [3+ times per week] temper outbursts for over a year and without more than three months without the symptoms.  This diagnosis also involves almost constant irritability inbetween episodes of temper outbursts.  This diagnosis is meant to incease the understanding and treatment of children and adolescents with these symptoms while reducing the number of Bipolar Disorder diagnoses as some research has suggested that Bipolar Disorders may be misdiagnosed in children and adolescents who have symptoms that are now diagnosed as DMDD.

I wonder if a significant percentage of children who will now be diagnosed with DMDD have untreated and possibly undiagnosed ADHD.  I have evaluated a large number of children and adolescents with virtually constant irritability and frequent severe temper outbursts who have ADHD. Often the ADHD symptoms were not treated because of a concern that these medications [amphetamines or methylphenidate] would make the anger and irritability worse.  However, there is a lot of research that shows the opposite. Nancy Rappaport, M.D. et. al. covers this in their review article: Psychotropic Medications: An Update For School Psychologists" in Psychology in the Schools, Vol. 50(6) 2013 as well as in a number of studies published in the Journal of American Academy of Child and Adolescent Psychiatry over the last several years. Thus it is important to carefully assess children and adolescents who are diagnosed with DMDD for ADHD symptoms and treat those symptoms if found.