Treatment for disruptive mood dysregulation disorder often involves talk therapy and may also include medications.
Every child has temper tantrums. But for the child with DMDD, irritability, sadness, or anger happens every day — and outbursts can happen several times a week.
Doctors once thought youth with DMDD were living with pediatric bipolar disorder. Now, they know DMDD is different.
Parents of youth with DMDD can work with a mental health professional for a DMDD treatment plan. It usually includes talk therapy and may include additional medicines.
As healthcare and mental health professionals learn more about the condition and how to treat it, there’s greater hope for these youth and their families.
A mental health professional may be able to help with a diagnosis of DMDD. You can start a conversation with a healthcare professional, like a family doctor.
They may want to know what you have observed with your child, and what you have heard from their teachers, coaches, or other caregivers.
The criteria for a DMDD diagnosis include:
- regular occurrence of severe temper outbursts (3 times a week or more)
- out-of-proportion, or bigger, emotional reaction to events
- daily occurrence of sadness, irritability, or anger
- trouble functioning in multiple settings — at home, school, or with friends or peers
To meet the diagnostic test, symptoms must be present for at least a year.
DMDD is a condition that often affects young people, with symptoms starting around or before the age of 10. However, DMDD is not often diagnosed in anyone younger than 6 or older than 18.
Bipolar disorder and DMDD are different conditions.
Before the condition was added to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children with symptoms of DMDD often received a diagnosis of pediatric bipolar disorder (PBD).
Unlike with PBD, DMDD includes:
- ongoing, persistent irritability (non-episodic)
- no episodes of mania
Children with DMDD do not typically develop bipolar disorder in adulthood. However, they may experience other mental health conditions, such as major depressive disorder or generalized anxiety disorder.
A treatment plan for DMDD usually starts with talk therapy. It may also include medications.
There are three common talk therapies mental health professionals may use for DMDD.
Cognitive behavioral therapy (CBT)
CBT helps children cope with their feelings. For example, if a child experiences anxiety, a cognitive behavioral therapist may expose them to situations which may bring on that anxiety and offer techniques to respond.
CBT can also help kids respond to frustrations and anger with the goal to control or reduce the frequency of outbursts.
Dialectical behavior therapy for children (DBT-C)
There is also some research into DBT adapted for children with DMDD. DBT is different from CBT, as it focuses on the emotional and social aspects of living.
Therapists help people learn relationship strategies as well as personal strategies, so youth aren’t trying to change their feelings — as with CBT — but instead are trying to live with them.
A 2017 randomized clinical trial studied DBT-C compared to treatment as usual (TAU) — including taking psychiatric medications — for DMDD. Parents were significantly more satisfied with the DBT-C therapy than with TAU. Researchers concluded there was preliminary evidence of the therapy’s effectiveness.
Parent training for DMDD
Since DMDD affects young children and adolescents, parents have a big role in reaching treatment goals for disruptive mood dysregulation disorder.
One role you may play is to engage in parent training. This is a technique where you learn to anticipate aggressive behavior and work to prevent it. Among the possible strategies is to reward positive behavior and to be consistent with your child with DMDD.
A 2021 pilot study of parent management training for DMDD found that although the techniques did not reduce irritability, they did succeed in reducing overt aggression and behavioral difficulties and increasing pro-social behaviors among the youth.
Researchers are also studying how computer training can help you deal with disruptive mood dysregulation disorder.
Researchers in this study found that the use of computer training — which teaches kids to have more happy judgments about ambiguous expressions — resulted in less irritability.
However, a 2021 study found that although computer training could change perceptions of faces, there were no consequent improvements in irritability, anxiety, depression, or functional impairment. This led the researchers to conclude computer training requires further study.
Medication may also be part of treatment for DMDD. But since DMDD is a relatively new diagnosis, there’s no definitive list of medication for DMDD.
Many doctors prescribe medicines that reduce irritability and outbursts in youth with other diagnoses, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).
Most healthcare and mental health professionals start with therapy first before adding medication to a treatment plan for DMDD.
A doctor may prescribe a stimulant-like methylphenidate (Ritalin) for DMDD to help with irritability.
Ritalin is commonly prescribed for ADHD, and research shows that up to 85% of kids with ADHD also have DMDD.
It’s not known whether Ritalin works in DMDD by reducing irritability directly, or by mitigating ADHD symptoms, which in turn helps the youth to feel less irritable.
An antidepressant — like citalopram (Celexa) — may be prescribed alone or along with a stimulant for DMDD. Citalopram is also prescribed for a condition that has symptoms — like irritability — similar to DMDD, such as premenstrual dysphoric disorder (PMDD).
Because antidepressants can increase suicidal thoughts and behaviors, doctors closely monitor youth on these medicines.
The Food and Drug Administration (FDA) has approved the antipsychotics risperidone (Risperdal) and aripiprazole (Abilify) for irritability in autism. These drugs may also be prescribed to treat DMDD.
However, experts worry about the unknown effects of their long-term effects on children.
Antipsychotics are often the last line of intervention after other strategies have been tried.
For parents, DMDD can bring about many challenges. As much as you can do for your child, it’s important to also take care of yourself. Your physical and mental health increases your ability to support your child.
Strategies that may help include:
- developing healthy eating habits
- exercising regularly
- engaging in healthy activities that lower stress, such as yoga or meditation
- maintaining your social circle
If you need additional help, consider talking with someone you trust about your feelings or making an appointment with a healthcare or mental health professional.
Doctors are learning more every day about DMDD. You can support your child and your family by learning all you can about the condition. Reading stories of other caregivers of youth with DMDD, like this piece in Parents magazine, can help you know that you’re not alone.
Talking with a trusted expert, like your family doctor, can also provide you with resources and support.
You can also check out these resources for parents offered by the American Academy of Child & Adolescent Psychiatry.
With time, you and your family can find the right treatment plan and support network to build a healthy and happy life for your child.