Disruptive Mood Dysregulation Disorder (DMDD)

Medically reviewed by Dr. Jennie Stanford, MD, FAAFP, DipABOM, Dr. April Brewer, DBH, LPC, and Julie Dodson, MA

Overview

Disruptive mood dysregulation disorder (DMDD) is a mental health condition that affects children and adolescents. It is most often diagnosed in children between the ages of six and 18 years old and is characterized by mood swings, symptoms of anxiety and depression, and frequent episodes of extreme irritability, anger, and tantrums or temper outbursts that occur persistently. These episodes may cause significant distress¹ for both the child as well as family members or caregivers.

Symptoms of DMDD may have some overlap with those of other conditions, such as oppositional defiant disorder (ODD).² However, oppositional defiant disorder usually lacks the mood symptoms of DMDD, which is why oppositional defiant disorder is a separate diagnosis.

Treatment for disruptive mood dysregulation disorder (DMDD) usually consists of a combination of psychological therapies such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), as well as psychoeducation and family-based interventions. CBT helps people understand how their thought patterns and beliefs can influence their behavior, while DBT focuses on assisting individuals in learning how to be mindful and more effectively manage intense emotions.

Medication may also be prescribed in some instances. The goal of treatment for disruptive mood dysregulation disorder is to help the individual develop better coping skills so they can regulate their moods more effectively and reduce disruptive behavior.

Symptoms

The symptoms of DMDD often begin before age ten and may continue into adulthood if not adequately treated. The signs of disruptive mood dysregulation disorder may include:

Intense temper outbursts
Difficulty managing emotions in response to everyday situations
Frequent mood swings
Impaired functioning in social settings
Sleep problems like insomnia or hypersomnia
Thoughts of hopelessness, helplessness, or worthlessness
Poor concentration
Aggression toward others

According to the diagnostic criteria for DMDD per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), if these outbursts occur three times per week or more on average, then the condition may require professional treatment.

People with disruptive mood dysregulation disorder (DMDD) may also display other symptoms, such as extreme anxiety, self-harming behavior, or suicidal thoughts. It can be difficult for these individuals to maintain relationships due to the unpredictable nature of their moods and behaviors. In some cases, those affected by DMDD may also experience difficulties in school due to their inability to control their emotions. Furthermore, it may lead to isolation as they struggle to make and keep friends.

In addition to extreme mood swings, individuals with disruptive mood dysregulation disorder often experience symptoms of anxiety and depression. They may feel anxious in social situations or when faced with new tasks or challenges. Irritability—a common symptom of both anxiety and depression—may also manifest as restlessness and agitation in daily life.

Individuals may also become overwhelmed with thoughts of impending doom, uncertainty about the future, frequent worrying, and an inability to concentrate or complete tasks. They may experience prolonged periods of low energy, lack of motivation, and persistent sadness even when surrounded by loved ones.

See Resources

Causes

Disruptive mood dysregulation disorder (DMDD) is a childhood mood disorder believed to be caused primarily by biological and environmental risk factors.³

The precise cause of disruptive mood dysregulation disorder is unknown, but several possible causes have been proposed, including the following:

Genetic factors. Individuals with a family history of depression or bipolar disorder may be more likely to develop this mental health disorder.
Environmental factors. Exposure to stressful events, unhealthy lifestyle choices, or trauma—such as abuse, neglect, bullying, family dysfunction, or poverty—may increase the risk of developing DMDD.
Biological factors. Abnormalities in brain structure or function or disruptions in brain chemistry—such as low levels of serotonin—may contribute to the development of DMDD.
Social-emotional problems. Low self-esteem and difficulty making friends, for example, may trigger the onset of DMDD in some children.

Biological causes may include abnormalities in brain chemistry or structure. Neurotransmitter imbalances have been linked to DMDD, such as low levels of serotonin, which are known to affect mood regulation. There may also be an underlying genetic basis, as children are more likely to develop DMDD if their parents or siblings have a mental health condition like depression.

Environmental risk factors for DMDD include traumatic experiences (such as abuse or neglect), chronic stressors, and unhealthy parenting. The triggers of trauma for children who experience DMDD can vary from person to person and can include experiences such as family dysfunction, physical or sexual abuse, neglect, poverty, bullying, or any other traumatic event that may be overwhelming for children. Research has found that experiences like these can contribute to an increase in distress, anxiety, fear, and anger in children with DMDD.

Additionally, social-emotional problems such as low self-esteem and difficulty making friends may cause the onset of DMDD in some children.

See Resources

Treatments

There is no specific form of treatment designed for DMDD in particular, so treatment providers often utilize interventions for conditions with related symptoms. The goal of treatment is often to help the individual develop healthy emotion regulation skills, learn to positively express emotions, practice problem-solving techniques, address underlying issues that may be contributing to the symptoms, and build healthier relationships with others. Common treatments for disruptive mood dysregulation disorder (DMDD) typically include the following.

Therapy

Therapy can be crucial in the treatment of disruptive mood dysregulation disorder. Below are a few modalities and treatments that can be beneficial.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy focuses on identifying negative thought patterns and thoughts associated with stress or anger and working to replace these thoughts with more positive ones. Through this process, individuals may gain control over their emotions and reactions to situations. A therapist can provide instruction on how to recognize challenges that can lead to emotional outbursts and techniques for calming down when overwhelmed or frustrated.

Dialectical behavior therapy (DBT)

Dialectical behavior therapy⁴ combines cognitive-behavioral therapy, mindfulness, and interpersonal therapy to teach individuals how to handle intense emotions more effectively. It can be used to treat conditions like DMDD as well as bipolar disorder, depression, and others. The goal of DBT is to help clients learn skills to better cope with distress while decreasing problematic behaviors such as aggression.

Dialectical behavioral therapy (DBT) is an evidence-based treatment approach used to treat DMDD as well as other mental health disorders. The primary goal of DBT is to help individuals learn how to regulate their emotions better and build self-esteem over time. To achieve this, DBT focuses on four primary skills: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

Mindfulness teaches individuals to be aware of their thoughts and feelings without judgment, while distress tolerance helps people accept complex situations and manage stress more effectively. Emotional regulation enables individuals to better recognize and manage their emotional states, while interpersonal effectiveness encourages healthy communication within relationships.

Family therapy

In addition to these approaches, family counseling may play an essential role in helping family members understand the disorder and work together to manage the child's symptoms. Parents or caregivers may learn techniques for parenting a child with DMDD that can reduce stress levels at home while helping the child develop healthier coping strategies when faced with challenging emotions.

Medication

Medication may be used in combination with psychotherapy in some instances to treat disruptive mood dysregulation disorder. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed to regulate mood and reduce irritability. Antipsychotic medications may also be recommended, though their effects on children have not been widely studied.

Medication is not always used for treatment, as therapy is often found to be the primary method for many treatment strategies. Medication may only be utilized at the discretion of the treatment provider. Consult a medical doctor before starting, changing, or stopping a medication for any condition. In addition, the above information is not a replacement for medical advice or diagnosis.⁵

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Resources

There are several resources available to individuals coping with disruptive mood dysregulation disorder, including the following.

Educational resources

Organizations like the National Alliance on Mental Illness (NAMI), the Child Mind Institute, and the American Psychological Association (APA) provide information about treatment options, educational materials, and support services. The Substance Abuse And Mental Health Services Administration (SAMHSA) also provides various resources that may help individuals learn about the condition and where they can find treatment and support.

Support groups

There are also online forums and support groups dedicated to helping the families of children living with disruptive mood dysregulation disorder. These online forums may provide comfort and understanding from people who have similar experiences or are going through similar challenges.

One helpful hub of support is DMDD.org. DMDD.org is an online resource created to help people with disruptive mood dysregulation disorder and their families find appropriate support and treatment options. The website provides information about DMDD, including details about its symptoms, causes, treatments, and personal stories from those living with the disorder.

Visitors to the site can get resources for finding mental health professionals in their area who specialize in treating children with DMDD and can also participate in discussion forums where members share their experiences with the disorder and offer mutual support to each other.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988.

Please also see our Get Help Now page for more immediate resources.

Research

Disruptive mood dysregulation disorder is a relatively new diagnosis, first recognized by the American Psychiatric Association in 2013. Research into DMDD is still considered to be in its early stages, with much more research needed to understand its symptoms, causes, and treatment options. DMDD is a diagnosis that is beginning to be used more and more by physicians in the treatment setting, with many providers opting on the side of caution before prescribing medications to children.

In one study, researchers investigated the ability of cognitive-behavioral therapy and emotional regulation techniques to address the symptoms and causes of DMDD. In their research, they discovered that these treatment methods were effective for modulating DMDD and related conditions such as depression and anxiety. This study illustrates that these two forms of therapy have been shown to be effective in helping adolescents reduce feelings of irritability and be more mindful of their behavior and thought patterns.

Disruptive mood dysregulation disorder (DMDD) can have serious implications for children's mental health and well-being. For this reason, it can be crucial for psychologists and doctors to continue researching this field so that effective methods of diagnosis and treatment can be developed for those affected by this condition.

Statistics

2% to 5% of children live with disruptive mood dysregulation disorder

Disruptive mood disorder impacts 2% to 5% of children and adolescents from two to 17. Rates were highest in preschool-aged children.¹

¹HHS Public Access

Below are more critical statistics on disruptive mood dysregulation disorder:

Individuals with DMDD are significantly more likely to experience other forms of mental health disorders like attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders.
Studies suggest that over 20% of children aged three to 17 will experience a mental health condition at some point.
CBT can be an effective form of treatment for children and their parents who experience this condition.

Associated terms

Updated on June 24, 2024.

For additional help and support with your concerns

Speak with a licensed therapist

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.