CADDRA Expert Series 2, Session 3: Disruptive Mood Dysregulation Disorder DMDD: Where did it come from and what can we do about it?

By the end of this session, participants will be able to:

1. Describe the symptoms of disruptive mood dysregulation disorder (DMDD).
2. Identify the relevance of emotion dysregulation as it occurs in ADHD to DMDD.
3. Discuss the evaluation of DMDD Formulate treatment options for DMDD.

Is there a disorder of extremely volatile and destructive but chronic form of irritability? To answer that question, a disorder was invented, initially called “severe mood dysregulation” and then adopted into the American Psychiatric Association’s DSM 5 nomenclature as Disruptive Mood Dysregulation Disorder. DMDD may provide a diagnostic home for children and adolescents with chronic, non-episodic irritability and outbursts disproportionate with the trigger. DMDD is characterized by high rates of comorbidity with other psychiatric disorders especially ADHD and Oppositional Defiant Disorder. This has evolved not only because of the definitional confusion posed by mania criteria, but also the elimination of emotion dysregulation from the DSM conceptualization of ADHD. Rates of ADHD in DMDD are 60-80%. ADHD is almost always comorbid with ODD as well as internalizing, learning and language disorders. Although irritability decreases with age, about 5-10% of people it is chronic into adulthood. In a Recruited ADHD/DMDD sample of 7 year olds, at age 10,58% “remitted” but children still had tantrums. DMDD measures up to now have been repurposed from interviews and rating scales. We need measures that identify triggers, ways of operationalizing “proneness to anger”, and measures of outbursts that include their frequency, severity and duration. Tonic irritability may be addressed by treating triggers with appropriate cognitive-behavioral therapies. Phasic irritability/ outbursts are psychiatric emergencies. So far the most effective treatments are optimized ADHD medications with adjunctive medications for residual symptoms. For many children that isn’t enough.

Dr. Gabrielle Carlson:

Gabrielle A. Carlson, M.D., has been professor of Psychiatry and Pediatrics since 1985. She founded and directed the Division of Child and Adolescent Psychiatry until 2013. She obtained her MD degree from Cornell University Medical College. She did her psychiatry training at Washington University in St. Louis, the NIMH and UCLA where she subsequently taught on the faculty. Dr. Carlson specializes in the subjects of childhood and adolescent depression, bipolar disorder and irritability. She has written over 300 papers and chapters on those subjects. Her research interests include the phenomenology, long term follow up and treatment of young people with bipolar disorder, and the relationship between behavior disorders, like ADHD, developmental disorders and mood disorders. Dr. Carlson has won numerous awards in the US including those from the American Psychiatric Association for research in child and adolescent psychiatry and another for prevention. She was awarded the American Psychopathological Association’s: Zubin Award, for playing a fundamental role in psychopathology research. She is especially proud of the Virginia Q Anthony Outstanding Woman Leader Award given by the American Academy of Child and Adolescent Psychiatry (AACAP). Dr. Carlson was Program Chair for four years for AACAP and is now is recent Past President of that organization. Her presidential initiative has been on emotion dysregulation in children.

CADDRA – Canadian ADHD Resource Alliance has been approved by the College of Family Physicians, the Royal College of Physicians and Surgeons of Canada and the Canadian Psychological Association to offer 1.25 continuing education credits for this session.  CADDRA maintains responsibility for the program.

Participation in a discussion forum is required to claim full credits.