Disruptive Mood Dysregulation Disorder (DMDD) vs. Disruptive Behavior Disorders (DBDs)

We will try to distinguish mood dysregulation from defiant disorder in this short article. Only recently I learnt what disruptive mood dysregulation disorder is, despite working in psychology and neuroscience for more than a decade.

DMDD is a relatively new diagnosis introduced in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. It is characterized by severe, chronic irritability, frequent and intense temper outbursts - verbally and behaviorally - and a persistently negative mood state between outbursts. [https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd?utm_source] Around 8% of 6-year-olds have it.

Risk factors for children include temperament characteristics. For example, such a child might show low effort in everyday activities, early attention‐deficit and hyperactivity markers despite a lack of gadgets in her life. Parental neglect and psychopathologies might have an impact, as well as in general adverse psychosocial environments. For more details, you can refer to this article:

Dougherty LR... Klein DN. DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children. Psychol Med. 2014 doi: 10.1017/S0033291713003115. https://pubmed.ncbi.nlm.nih.gov/24443797/

There are validated diagnostic instruments such as the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, K-SADS-PL, The Preschool Age Psychiatric Assessment, PAPA, and the Breton, Bergeron and Labelle DMDD Scale (see https://link.springer.com/article/10.1007/s00787-021-01840-4?utm_source=chatgpt.com). For evaluation, we gather information about psychosocial stressors and family context. Additionally, you should consider neuropsychological testing to assess executive function and emotional regulation. We check for regularly taken medications, sleep hygiene, and physical activity.

It is easy to mess it up with disruptive behavior disorders (DBDs), including conditions such as Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), which primarily involve defiant, hostile, or antisocial behaviors. Neuroimaging and neurobiological studies showed deficits in emotion regulation, reward processing, and executive control. Unlike DBDs, children with DMDD show a negative interpretation of everything happening around them and impaired social communication. Similarly, they have limited regulation of executive systems in the brain.

When it comes to correction and treatment for disruptive behavior, parent‐management training (PMT) and behavioral therapies remain the gold standard. But in DMDD, because it is less studied, there is no gold standard and treatments are often adapted from DBD and include behavioral therapy, emotion‐regulation training, family therapy, and PMT.

Psychological and therapeutic interventions are typically a first-line, not medications. The cognitive neurobiologists emphasize the need to strengthen executive control functions and emotion regulation; thus, suggested therapies should incorporate cognitive control training, mindfulness, and structured behavioral routines for such kids. It is important to explain the neurobiological basis of disruptive mood and behavior to parents and educators and show that chronic irritability is not simply “bad behavior” but reflects neural regulation challenges. Only patience, structure, and consistency in interventions can help rewire the brain systems of emotions and self-control.