(mellow music)
- Hey everybody, today we're gonna talk
about Disruptive Mood Dysregulation Disorder.
But, before we jump into this very exciting topic,
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Now, Disruptive Mood Dysregulation Disorder,
or DMDD,
is part of the Depressive Disorder section
of the DSM and its core feature is chronic,
severe, persistent irritability.
And it's important to note that
the symptoms must be present before a person
is 10 years old, but cannot be diagnosed
before the age of six.
So, there's kind of this window where it can happen.
Now obviously, most children will throw tantrums
from time to time and go through periods
where they're way more irritable
than they used to be.
But, when these tantrums become more frequent,
intense, and ongoing,
it could be DMDD.
But, that's why it's so important
that we see a mental health professional.
You know, we need to ensure that our child
is being properly diagnosed and treated.
Now, let's get into the nitty-gritty.
And in order for a child to be diagnosed with DMDD,
they must meet the following criteria.
Number one, they must have a severe,
recurrent temper outbursts that are manifested verbally,
like screaming verbal rages,
and/or behaviorally, you know,
showing physical aggression towards people
or damaging property, that are grossly out
of proportion in intensity or duration
to the situation or provocation,
which really just means that the child's upsets
are way more intense than the issue itself warrants
and they last for a much longer time than normal.
Number two, the temper outbursts
are inconsistent with the developmental level.
Remember, they have to be over six,
so terrible twos or threes is not what we're talking about.
Number three, the temper outbursts occur,
on average, three or more times per week.
Four, the mood between temper outbursts
is persistently irritable or angry,
most of the day, nearly everyday,
and is observable by others,
like parents or teachers.
So, this means that those with DMDD
are never really happy or easygoing.
And number five, the criteria one through four
that I just talked about have to have been present
for 12 or more months.
And throughout that time,
the individual has not had a period lasting three
or more consecutive months without all
of the symptoms in those four criteria,
so it must just be pervasive,
it's happening most of the time,
all the time, for a year.
Number six, criteria one through four
are present in at least two of three settings,
like home, school, and with peers,
and are severe in at least one of those settings,
meaning that they can't just be upset
and are throwing tantrums because they really
don't like that one teacher at school
or a certain peer.
Their tantrums happen wherever they are,
regardless of setting and people.
Number seven, the diagnosis should not
be made for the first time before
the age of six or after the age of 18.
And number eight, by history or observation,
the age of onset of the criteria
before one through six is before 10 years,
meaning that even if we're over 18
and we're in seeing a clinician,
if a parent can recall times
when we met the criteria
when we were less than eight years old,
then a diagnosis can be given.
But, if the behavior didn't happen
before we were 10, then it's most likely something else.
And number nine, there has never been a distinct period
lasting more than one day during which
the full symptom criteria, except duration,
for a manic or hypomanic episode have been met.
So, we don't want this to be like Bipolar Disorder,
this is very different.
And finally, the behaviors do not exclusively occur
during an episode of Major Depressive Disorder,
'cause we all know how depression could cause us
to be really, really irritable.
And it's also very important to know
that this diagnosis cannot coexist
with Oppositional Defiant Disorder,
Intermittent Explosive Disorder,
or Bipolar Disorder.
If someone meets the criteria for ODD and DMDD,
they should be given the diagnosis of DMDD, okay?
So, if they have Oppositional Defiant Disorder,
which I have a video about that,
if you're wondering what I'm talking about,
you can click the link in the description.
But, if they have the symptoms of that,
but also meet the criteria for DMDD,
they're only given the DMDD diagnosis, okay?
I know this is kinda difficult to follow sometimes,
but however, if they do meet the criteria
for both DMDD and Bipolar Disorder,
they're only given the Bipolar Disorder diagnosis.
So, these are just things as a clinician
that we have to take into consideration
to make sure we're giving our clients
the proper diagnosis
and we're taking into consideration all of their symptoms.
It's what we call differential diagnosis.
Now, DMDD was added to the DSM-5,
it came out in 2013, remember,
because a lot of mental health professionals
were concerned that children were being misdiagnosed
with Bipolar Disorder when they really felt
that something else was going on.
Therefore, it's important that those two diagnoses,
Bipolar Disorder and DMDD,
are thoroughly considered and ruled out or ruled in,
based on that particular child's symptomatology.
Since this diagnosis is most often given to children,
the treatment needs to be individualized
for that child and work for them at home
and at school.
This means that we may, as a therapist and as a parent,
we'll have to work with the school
to ensure they receive an IEP,
which stands for an individualized education plan,
or a 504, or whatever their specific school offers
to children who have certain needs.
And it's also important that parents
of a child with DMDD ask as many questions
as they need to in order to fully understand
what their child is going through
and what this diagnosis really means
to their child and to their situation,
and everything they're experiencing.
Therapy can be beneficial both individually
with the child and as a family,
part of family therapy,
so that all who live with the child
can better manage the symptoms,
you know, since they can be very disruptive
and upsetting or even violent at times.
Behavioral-based therapies tend to work best.
Think CBT or DBT,
you know, those Bs in there stand for behavioral.
And it's also recommended that parents go
through their own parent training
to ensure they know how to act
when their child is throwing a tantrum.
Understanding effective ways to respond
to irritable behavior, such as even anticipating events
that might lead a child to have a temper outburst
and working ahead to avoid the outburst.
Training also focuses on the importance
of predictability, being consistent with children
and rewarding positive behavior.
And this is great when their child
is also in therapy, you can work together.
You know, so we have the parents getting training,
the child is learning their own techniques,
and together, we can better manage the symptoms.
Medication has also been shown to be effective
when treating specific symptoms of DMDD.
And again, just make sure you ask all
the questions that you may have about it,
understand what the side effects look like
so you can look out for them,
as well as whether or not you wanna try medication at all.
It's always the patient's choice
because it's their life and their symptoms.
And the medication types that,
you know, they talk about and say have been found
to be helpful are antidepressants,
some stimulants, and atypical antipsychotics.
But, as always, ensure that the treatment you
or your child is receiving is what's best.
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If you would like to support the creation
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click the link in the description
and check it out.
Because medication isn't best for everyone,
but if we have symptoms that won't go away
and the behavioral techniques are just not happening,
know that it's another option.
But, what do you think?
Have you or someone you love
been diagnosed with DMDD?
What helped them most?
Are there things that I left out?
Let me know what your thoughts are
on this in those comments down below,
and I will see you next time, bye.