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  • Dr Dilshad Parveen

Disruptive Mood Dysregulation Disorder in the youth (DMDD)


INTRODUCTION


DMDD is a type of depressive disorder that typically manifests in childhood and adolescence. It is estimated to affect approximately 2-5% of children and is more prevalent in males. Individuals with DMDD often exhibit frequent temper outbursts and irritability that are disproportionate to the circumstances. These outbursts can be either verbal or behavioral, causing them to harm people or property. It has been observed that around 50% of children experiencing severe and persistent irritability will develop DMDD within a year.


DIAGNOSTIC SYMPTOMS


In accordance with the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), children or adolescents afflicted with DMDD exhibit the following symptoms:

  • Frequent and severe temper outbursts that are much more severe than the reaction expected from same-aged children or adolescents

  • Outbursts occur at least 3 times a week

  • The mood between temper outbursts is persistently irritable or angry most of the day and is observable by others (e.g. parents, teachers, or peers)

  • Duration of symptoms lasting for at least one year, with no interval of symptom-free duration lasting three or more consecutive months

  • Presence of symptoms in at least two of three settings (home, school, peers)

  • The onset of symptoms occurring after the age of 6 but before the age of 18 years

  • Never having met the full criteria for a manic or hypomanic episode for more than one day

  • Symptoms do not occur exclusively during an episode of major depressive disorder and are better accounted for by any other mental disorder

  • Symptoms are not due to the physiological effects of a substance or any medical or neurological condition

CONTRIBUTORY FACTORS


There are several psychosocial factors that elevate the risk of developing DMDD, including:

  • Parental issues such as divorce, separation, or loss of a parent, and children growing away from parents

  • A family history of psychiatric illness

  • A history of childhood sexual abuse

  • Sibling rivalry

  • Difficulties with education

  • A previous history of chronic irritability

TREATMENT


Treatment modalities for DMDD typically encompass specific types of psychotherapy (also referred to as talk therapy) and medications. While no medications have yet been sanctioned by the FDA for the purpose of eradicating DMDD, some medications are effective in mitigating its symptoms.


PSYCHOTHERAPIES:

  1. Cognitive behavioral therapy (CBT) - assists children in augmenting their coping mechanisms for regulating their anger.

  2. Dialectical behavior therapy for children (DBT-C) - imparts skills to children that can aid in regulating their moods and emotions.

  3. Parent training - teaches parents or caregivers more effective ways to respond to irritable behavior, anticipating outbursts and working ahead to avert them.

MEDICATIONS:

  1. Stimulants

  2. Antidepressants (e.g. citalopram) - decrease irritability in youth with DMDD.

  3. Atypical antipsychotic medications - used to treat children with irritability, severe outbursts, or aggression.

All medications have side effects and should be taken only when provided by your child’s doctor.


LONG TERM CONSEQUENCES


Untreated children diagnosed with DMDD are observed to have elevated rates of long-term sequelae, including:

  • Conduct problems

  • Social and functioning impairments

  • Academic decline

  • Comorbid psychiatric disorders such as oppositional defiant disorder (ODD), autism spectrum disorder, and anxiety.

TAKE HOME MESSAGE

  • Antidepressants may increase suicidal thoughts and behaviors in youth, thereby necessitating close monitoring. Hence, over-the-counter antidepressants should never be used.

  • Scientific studies indicate that in India, male children typically come to the doctor for health-related concerns much earlier than their female counterparts. It is, therefore, imperative not to overlook the mental health of female children.

  • An early diagnosis facilitates ease of treatment.



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