Explosive Tantrums: Disruptive Mood Dysregulation and the DSM-VJanuary 6, 2013 • Contributed by Zawn Villines
At the beginning of December, the American Psychiatric Association voted to approve revisions to the new Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM provides guidelines for mental health diagnoses and aims to promote consistent diagnostic criteria among mental health professionals. One of the new additions to the DSM, disruptive mood dysregulation disorder (DMDD), is targeted specifically to children.
What Is DMDD?
DMDD meets many of the diagnostic criteria previously used to diagnose pediatric bipolar—a controversial diagnosis that has been on the rise in recent years. The new so-called disorder is characterized by chronic mood instability, extreme tantrums, and difficulty controlling one’s emotions. The diagnostic criteria include:
1. Severe temper tantrums that are disproportionate to the situation and that are not consistent with the child’s developmental level; a 2-year-old throwing a tantrum because she wanted a new toy, for example, probably would not meet this diagnostic criteria
2. The tantrums must be regular, consistent, and, on average, occur at least three times a week
3. Consistent angry or irritable mood
4. Symptoms have been present for 12 months or longer, and the child has not been without symptoms for longer than three consecutive months
5. The child must be over the age of 6, and the behavior must be present in at least two contexts; a child who is angry with an unstable mood only when at school would not qualify for a diagnosis
How Is It Treated?
There is disagreement about how DMDD should be treated. Some clinicians argue that it is directly related to bipolar and that the best line of treatment is the use of antipsychotic and mood stabilizer medications. However, others emphasize that it is more closely related to depressive issues and that antidepressants and, occasionally, anti-anxiety medications might be most effective. Because the diagnosis is reserved only for children, family therapy can be helpful and enable parents and siblings to adjust to a child’s diagnosis. Lifestyle changes, a regular schedule, and patient, consistent parenting can also help. Symptoms often are made worse by stress and sudden changes, so preparing children for stressful events could also be helpful.
The DSM has a far-reaching impact on the diagnosis and treatment of mental health conditions as well as on insurance payments for mental health treatment. Consequently, changes to the DSM are often controversial, and the new diagnosis of DMDD is no exception. While proponents of the disorder’s inclusion argue that it is less stigmatizing than a diagnosis of pediatric bipolar disorder, opponents emphasize that the diagnosis is stigmatizing in its own right. Further, the diagnostic criteria could be construed in such a way that they apply to a wide variety of normal childhood behavior, and many of the symptoms are commonly exhibited by children under immense stress or who have recently experienced a loss or trauma. Diagnosing them with a mental health condition could potentially minimize the impact of the child’s environment and prevent appropriate treatment.
- DSM-V child and adolescent disorders work group. (2010). Justification for temper dysregulation disorder with dysphoria. American Psychiatric Association.
- Frances, A. (2012, December 03). DSM-V is a guide, not a bible: Simply ignore its ten worst changes. Huffington Post. Retrieved from http://www.huffingtonpost.com/allen-frances/dsm-5_b_2227626.html
- Pliszka, S. R. (2011). Disruptive mood dysregulation disorder: Clarity or confusion? The ADHD Report, 19(5), 7-11. doi: 10.1521/adhd.2011.19.5.7
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GeorgiaJanuary 6th, 2013 at 11:28 AM
Sorry, but I don’t see this as something that even remotely warrants a diagnosis other than a good talking to and a revamping of parenting skills!
I think that there are far too many parents who are too permissive with their kids and allow them to act like spoiled little brats when they really need to do a better job with some stricter parenting and setting expectations for their child’s behavior.
I see a lot of them just trying to talk to their kids or even resporting to spankings to little effect. There are so many other methods that don’t include any of these things, and one of the biggest I think is telling your children from a very early age exactly what you expect of them and then insisting that they meet those standards and expectations.
JessicaJanuary 6th, 2013 at 7:06 PM
This is helpful in consideration of my son, who is not bipolar but whose dr has him on a slew of meds for tantrums, aggressiveness, explosive tears, and treating symptoms of his Aspergers (bc he doesn’t grasp social cues he’ll impulsively grab arms, talk very loud in faces, etc). I’ve asked for fewer prescriptions and demanded he take him off a stimulant bc my son was on it for years. As soon as he went off, his anxiety and extreme bug phobia went away and it was a dream come.true to be able to take him places all summer without him screaming and hitting me and terrorizing his much younger sisters. I’d love for the doctor to take him off clonidine and wellbutrin (his antidepressant approach to me saying no stimulants, my child grew 6 inches and is normal again) and to add a mood stabilizer/anticonvulsant. He’s also on reperidone, .5mg twice a day. I’m wondering if after all these years I should find a new dr for my preteen or just keep following his advice, or if anyone thinks that a boy whose constantly crying and throwing explosive tantrums bc he needs to shower or get socks on or we’re out of juice should go the mood stabilizer route? sorry so long..I guess I needed to vent
DanielJanuary 7th, 2013 at 3:48 AM
Well there are valid points from both the sides.TO have it as a disorder and to treat it as just another childhood behavior.While I think better parenting can solve many of these problems,it is not always possible to keep them under control even with better parenting.Sometimes the child may indeed have a problem.
But even in such cases the treatment should proceed with extreme caution and care.I do not believe in putting young children on meds and then have those meds affect them negatively with all their side effects,thereby causing negative impacts that can last a lifetime.No,that is not how our children should be treated.Even if these tantrum problems are classified as a disorder,I would like to see a treatment devoid of any drugs and consisting purely of therapy and other non-drug methods.That is mainly because it will have almost no side effects and also because unlike meds these methods cannot have an effect on the biology and physical health.
LanaJanuary 7th, 2013 at 3:53 AM
I never thought that I would see the day when parents are looking for a diagnosis for bad behavior and seriously not taking a look at the child’s environment and those around him as a root cause for the problem.
This is a way for any of us to escape culpability, to always have a way out and say that this is not our fault.
But I think that if you get a little more real about the situation, you would discover that nine times out of ten, yes, it probably is something that we are doing wrong in the home that leads to this kind of behavior.
I really don’t mean this to be denigrating to anyone’s parenting skills, because we all know just how difficult it is to be a good parent all the time. But we also have to accept the blame when something clearly avoidable comes back to us and look at better ways to solve the problem instead of always looking to the doctor for a prescription to fix it.
JessicaJanuary 7th, 2013 at 7:43 AM
I’m not looking for this to be my son’s diagnosis. He has one, and I’ve worked with him for years on learning to pick up on what facial cues mean and calming techniques. If you READ, I was asking to compare his meds for somewhat comparable breakdowns for autism to the meds mentioned in this article. Funny, in a class I had at work they said before the dsm classification for it was written ignorance lead to immediately blaming autism on poor mothering.
BillyJanuary 7th, 2013 at 7:54 AM
When I was working in an elementary school as a guidance counselor, we occasionally had students like this. We jokingly said they needed “woodshed therapy” or a return to punishments of days gone by. We were joking, of course, but there is something to good old fashioned discipline.
MaddieJanuary 7th, 2013 at 7:55 AM
How can a temper tantrum be considered a mental illness? For the love of all things good and sacred…
G YahnJanuary 7th, 2013 at 7:57 AM
Consistency and neutrality are extremely critical for dealing with this disorder. Parents and care givers must both be on the exact same page and deal with outbursts in the exact same way. This is so much easier said than done. So much so that in 20 years of dealing with this disorder I’ve never seen it happen.
LakenJanuary 7th, 2013 at 4:04 PM
There is absolutely no substitute for a consistent schedule in a child’s life. This will not always be the easy answer, but for a lot of families just simply sticking to this helps to go a long way.
I don’t think that anyone here is looking to point fingers, and I don’t find it helpful for anyone to take quick offense at reader responses. There is a lot of misunderstanding about behavior and mental illness together, and I think that being quick to judge really does shut down our opportunities to learn from one another.
JessicaJanuary 20th, 2013 at 9:16 AM
In a perfect world, we wouldn’t need a diagnosis for bad behavior or bad parenting. I am a psychiatric nurse that primarily works with children ages 4-12 in an acute care setting. Personally, I don’t care what the behavior/illness is called. It’s there, it’s not going away and treatment/management needs to be provided and paid for. Blaming parenting style does nothing to solve the problem. Unfortunately, a majority of the parents of children I see are simply NOT going to change their parenting (or lack thereof). Often, they don’t have the insight, desire, resources, intelligence or motivation to provide effective parenting. Solutions that I’ve heard and sometimes even thought on my own are to place the child in foster care, educate parents, send the child to Residential Treatment Facility, teach coping skills, etc… The reality is that the foster care system could never manage the numbers. Additionaly consider that often times the transition from their family will cause trauma. As much as I would like to believe it’s this simple, lack of structure/parenting is often only one variable in this problem. I see parents everyday who provide a reasonable amount of structure and parenting only to have children with these problems. My heart falls apart every time I give perfectly good parents advice to “provide more structure” in their home. Are medications the answer? Sometimes yes. Nobody wants to put chemicals in their childs body, but right now, it’s one of the few answers that we have that is effective. I have seen enough children benefit from mood stabalizing medications that I don’t discount them. Part of my job is to evaluate the effectivenss of these medications and when an 8 year old tells you genuinely, “I forgot my medicine today and I feel really bad inside.”, you have to give the medications some credit. I think that another part of the puzzle is that, as a society, we are dysfunctional. The saying, “It takes a village to raise a child.” sums it up. When we see a single mother with several children, we often judge. What would happen if each neighbor said to that mother, “One day a week I can watch your children after school until you come home from work.”? I feel that too often social issues are dealt with by creating laws…privacy laws, reporting laws. What has happened to compassion, social mores?
MelissaMarch 17th, 2013 at 6:19 PM
I am sure that there are children out there who have temper tantrums to get what they want because they have been raised to be brats without any discipline. I can guarantee you, though, that there are plenty of consequences for poor behavior in my home, but my son still has these irrational rages. Whether it is because he is too hot or because he thinks our dog doesn’t like him…he just starts to flip out at the most rediculous things. Since he was real young I have called him Dr. Jeckyll and Mr. Hyde. Not all of it is temper tantrums though, I would describe it more as an extreme overreaction to slightly unpleasant situations. It kills me to read all these posts saying that it’s the parent’s fault. I work so hard to raise my children right. I have tried everything from diet to reward charts to medication. I’m at my wit’s end and I just pray that he will be okay when he grows up.
JenaJune 3rd, 2013 at 6:59 PM
Melissa I can empathize with you. My son is 7 and we have tried almost everything to help him. New parenting tools, diet, natural supplements, family therapy, and even a psychologist. Lots of good things but no magic pill yet. I describe my son as really good and really bad, a Dr. Jekyll and Mr. Hyde as well. We’ve made some good progess but have random setbacks. If you find any answers, let me know and I’ll do the same. Hang in there, I know it can be extremely trying. You are doing an awesome job!
ShaunaAugust 2nd, 2013 at 10:47 PM
Melissa and Jena I could not agree with you more. To those whose comments blame the parents I say you have NO IDEA what you are talking about! You have no idea how parents of these kids have tried everything to no avail – and I mean everything! It is not the kids being raised to be brats by parents who don’t care. Are you joking? We have other children that do not have these explosive episodes – do you truly believe that we parent one child differently than another in the same family? It’s the same parents for heaven’s sake!
Do you not think parents of children with DMDD already blame themselves? We think if we were just better parents we would be able to stop this behaviour. We can’t! Would parents of children with other biological imbalances think “If I was just a better parent my child wouldn’t have diabetes”? Of course not – so why do you judge parents of children with DMDD like that? It’s incredibly insensitive and hurtful to parents like us who have literally spent countless sleepless nights soul-searching for ways to be a better parent or to find out where we went wrong.
My husband and I have done everything we could to help our son. Parenting books, classes, doctor after doctor – there is nothing we would not do to try and help our son. How dare you judge us! You have no clue what it is like to live in a family with a child with DMDD. You could ask your child to please get in the shower and he punches a hole in the wall. You live every day knowing your child is unhappy – not throwing a tantrum because he doesn’t get his way but because he is truly angry and miserable ALL THE TIME!
You can’t possibly fathom what our family life is like. The old saying don’t judge until you have walked a mile in someone’s shoes is truly apropos here. Please think about what you are saying before you blame the parents, especially because you can’t possible know what it is like.
TanaNovember 4th, 2013 at 3:36 PM
Shauna – You took the words right out of my mouth. I couldn’t have said it any better myself! My son was just recently diagnosed with DMDD, and let me tell you how disheartening it is to read so many comments putting full blame on the parents of these children! My husband and I have a very structured household, including 3 other children who never act in this manner. My son thinks the world hates him, he is constantly unhappy, and goes into explosive rages, sometimes, seemingly unprovoked. He is unpredictable, and quite honestly, very frightening. Imagine having your 6 year old pulling down dressers, throwing lamps, spitting, kicking, scratching, cussing, and threatening to kill you, over something very small. And this isn’t just because he didn’t get his way, or get a favorite toy at the store. These tantrums can sometimes last an hour or more, and we often have to hold him in bear hugs just to protect everyone in the house. We are exhausted! And to finally have that “label” that is so frowned upon, is such a relief. Finally, a step in the right direction. Parents need those labels in order to get help. These are not your average, ordinary, throw-a-fit-because-I-didn’t-get-my-way tantrums. Please keep this in mind before blaming the parents! I have raised enough children to know the difference. Like Shauna said, we live in hell at home, rarely a single moment of normalcy. Children with DMDD do not have a sinister motive, some sort of manipulative agenda to get everything they desire…in fact, the tantrums are rarely, if ever, about “getting” something. Please have a little bit of empathy, and open your minds, and your hearts to the reality of this diagnosis. It is VERY real.
MartaDecember 29th, 2013 at 1:07 PM
Please, people. You can not judge until you have lived closely with a family who has a child like this (or walked a mile in their shoes, as they say). I have a niece who has recently been diagnosed with DMDD. She is my sister’s second child. I am a mother of two children myself and also work in the early childhood ed field. I initially thought it was just a toddler/preschooler tantrum phase, and tried to reassure my sister of this when she would call me in tears, insisting that this was way beyond what is normal. Well, she was right. Her first child had the normal tantrums and grew out of it, but this second one has not. At age 8.5 she is very difficult for anyone to be around, has few friends, and is barely getting an education, because the school has given up trying to get her to do anything. Now they just let her sit and draw pictures or hide in a little nest she’s made in a corner. It’s all they can do to keep her from being completely disruptive and having to be hauled out of the classroom in a rage. My sister, a very dedicated mom, has to go to school and sit in the classroom with her and try to get her to complete some of her work. She’s been suspended repeated times, starting in kindergarten, due to her intense and uncontrollable rages. She hits other adults and children and can not be calmed down once she deems anything “unfair”. This child doesn’t just have tantrums. She is angry and irritable pretty much all the time. In fact, many times when she acts “nice”, it comes off as false and creepy, as if she’s imitating the way she sees “nice” children acting on a sickeningly-sweet Disney channel show. Apparently the therapist has said that this is exactly what she is doing– kind of trying to “fake it till she makes it” since she really truly doesn’t know how to be that way, naturally. My sister has constantly blamed herself, wondering what she could have done differently. It’s hard not to blame yourself, when everyone, including many posters here, blame the parent. My sister is not a perfect parent, but she and her husband are probably better than most. Their older child (two years older) is wonderfully behaved and an excellent student, with many talents, and she was parented in exactly the same way. There is a family history of severe depression and ADHD, and I’m sooo happy that we finally have this diagnosis for my niece. Maybe we can finally find a way to help her feel better and be able to get back into learning at school. And maybe my sister can eventually get back to working some. At present, she can’t even work while her kids are at school, because she’s having to attend school WITH her daughter a lot of the time, and when she doesn’t, she’s likely to be called in at a moment’s notice to take her raging child home. So, it’s an extreme financial hardship, to be sure.
JessicaMarch 27th, 2014 at 7:00 PM
Anyone who thinks this is a parenting issue is dead wrong. There are kids who are out of control due to poor parenting and there are DMDD kids. HUGE difference. If you had one you’d know.
KamiMay 12th, 2014 at 3:40 PM
Thank you Shawna, Tana and others who have kids like mine. Our situation is horrible and heartbreaking. My 7 year old has attacked me with knives, sticks, wrapped a cord around her sister’s throat, hurt animals, and so much more. Then she cries and says she has no idea what she is so bad. We are trying everything we possibly can. People without a child like this have no idea what they are talking about.
AnaSeptember 8th, 2014 at 2:52 PM
Has anyone tried neurofeedback for DMDD? What were the results? My son is 6.
SandraSeptember 20th, 2014 at 3:21 AM
Wow, I just heard about DMDD today after reading an article sent today. I sent it to my eldest married daughter and asked if she thought of anyone when she read the article. She did, her two youngest sisters, our 14yo and 16yo daughters. Our older 4 children are all married, with their own children. They are all well adjusted and we had no major issues with any of the older children. But our last two meet the criteria of DMDD. Currently I reading a book on the dangers of prescription medications so meds for my girls are not a path we wish to go down. My heart goes out to you other families with this. I agree that people who simply blame parenting need to live this life that we do and see then what their thoughts are.
Rebecca B.October 6th, 2014 at 7:32 PM
My daughter is 10 years old now and she has been diagnosed with severe disruptive disregulation disorder. It breaks my heart to see her go through so much anguish. Any friends she has made is short lived and she is constantly getting into trouble at school. I am in the process of getting her into on going therapy and possible medication. I have taken parenting classes and talked to doctors, along with never ending meetings and conversations with the many schools and babysitters she’s been at. I believe that she and other children like her will have a long and bumpy road ahead. We as parents of these children have to be strong and more creative in order to help them and ourselves endure. We can’t worry about what other people think, our focus should be our children.
LeoDecember 21st, 2014 at 2:04 PM
Im from Argentina (spanish speaking), my son is 7 years old and he was not diagnosed as DMDD by the doctors here (only the have told Behavior Disorder, but not so specific), but reading this article today and all the comments of the mamas Jessica, Melissa, Shauna, Kami,Sandra, Rebbeca… I can confirm that this disorder DMDD describes exactly the problem of my son Nicolas. Huge tamtrums for nothing, in the school he is a hurricane for example when he can not write a word or something.. no friends, no sports, my wife is distroyed. I have two more girls and are excellent at school, home, etc… they have friends and a normal life.
I would like to know more about this problem and share maybe share with your families good practices and experiencies.
MelissaApril 21st, 2015 at 2:01 PM
My 7 year old daughter has been recently diagnosed with this disorder along with OCD. To those who have commented that a good home life and discipline are all a child needs for throwing tantrums, I would say before experiencing this myself first hand I would have agreed with you. However, as with most things you never know what someone is going through until you’ve walked a mile in their shoes. My shoes are exhausted.
This disorder is not just a tantrum; it is a full force rage that my daughter cannot be calmed, spanked, punished or scared out of. Many times after going to what we call the dark place, she will begin chanting stop over and over again for hours and eventually will fall asleep from exhaustion only to have nightmares that keep her from fully resting. It’s a vicious cycle, and any of her OCD issues can set it off – shoes not being tight enough, pants being too tight, a drop of water on her shirt, etc. It happens at least three to four times a week.
We are happily married parents. We go to church. We are not smokers or excessive drinkers. Her older brother is well a well adjusted happy kid. I refused to believe for a long time she had any problem that I could not handle even though my husband said for a while she needed help. However, the tantrums finally became too much for me, and I began to see how miserable she truly was/is. She now goes to see a counselor and a psychiatrist. She is on medication – something I never thought I, as a parent, would ever do. So to those who are dealing with this, my heart and prayers go out for you.
As to things that have helped, when she starts chanting or getting manic, which usually is a precursor to a meltdown, I try singing her favorite song to her or playing her favorite song on my phone. If I’m at home, I can turn on her favorite TV program. I have also found results with asking her off the wall questions that I know she will stop and answer me. I will say none of these work all the time and there is no consistency.
SusieMay 9th, 2015 at 11:53 PM
Question gor parents with children with DMDD: Has anyone found medication that has worked? We have tried everything from biomedical treatments to prescription medication and nothing is working.
JenniferMay 19th, 2015 at 5:51 PM
I have a son, Nicholas, who is 7 and was diagnosed with DMDD when he was 6 years old. Symptoms were apparent in small ways as an infant an became more and more apparent as relationships and social interaction became part of his daily life (daycare, school,etc). I have two other children. 12 and 10. One is very active in the school community and the other, although not an honour roll student, is very well liked by his peers. All raised in the same home, school and environment, all with the same parenting skills.
This disease is a nightmare, debilitating for both the child, parent, peers and supports around him. I am exhausted trying to find supports and help this boy succeed. I can read a handleful of articles available that describe this challenge of a diagnosis. What I need, what I think our child and parents in like situations need is SUPPORTS. First and foremost in our education system. My son has been suspended from school 10+ times since the school year began. And what does it accomplish? Absolutely nothing! The homeroom teacher has replaced 3 times this year (not including the many supply teachers). For a child, whom consistency, schedules and understanding is vital, it only sets him up for failure. My child is extremely intelligent but the school system, as it is structured today, does not nurture him – it discards him. Like a square peg trying to fit in a round hole.
I would home school him myself if I was able. It feels like the homework I’ve spent the time sound with him on weekends is the only thing he’s learned this year. But I work full time, as a sole income earner/parent in our home and that is not our reality.
I’m looking for some ideas, direction and support with parents of like children.
Leonardo P.May 20th, 2015 at 4:37 AM
Susie, in the last 6 months my son Nicolás (8 years old) has improved his mood dramatically. I could say 80% of improvement. Now he can share the time with classmates at school, he began to learn writing, reading, he has increased tolerance to frustration.
No more prescription medication (risperidone, levomepromazine, valproic acid, NOTHING)
Better and more natural food.
Less time of TV, electronic games, computers.
More footall, sun, fresh air.
Anthroposophical medicine just as a complement.
I have written in this blog in December when he condition of my son was very bad. Now he needs to continue improving, but he is living a happier life.
LoriJuly 1st, 2015 at 12:11 PM
Wow-I cannot believe how all you parents are describing my daughter to a tee. She was diagnosed in the beginning of June with DMDD. Ten years old and in the last 6 months these tantrums have escalated out of control!! We lost my Mom and Dad 6 months apart from each other and that was hard on us both. That is when I noticed the tantrums were getting much worse. She has always had sensory issues but they have also become much worse. besides not wanting to wear any undergarments she also wants none of her clothing laundered anymore. She threw a fitful rage when I washed he filthy clothes from camp last night. She is all the things the others mentioned. Manipulative, selfish, has no friends, always getting into trouble. She has problems with teachers and her counselors. If she can’t control you, she has no interest. When she is really bad she also cries and tells me how sorry she is and that she can’t help it. She is horrible to me and curses at me daily. (especially when she does not get the meal she wants to eat) yet every night she demands to sleep in my bed with me (single parent) She refuses to go back to therapy and I am at my wits end. She refused to go to camp this morning and I don’t know what do to with her at this point. My life is a living hell and I dread going to pick her up at night. There is such a stigma attached to all of this I fear for us. I have been trying to get help Since January of 2015. I finally got an eval and diagnosis this june. Trying to find someone that takes my insurance is impossible I now don’t care I will put it on my charge card because I cannot face another day of this child. She is my daughter and I love her but she scares me too. I am embarrassed of her and afraid to bring her anywhere because of her unpredictable behavior. God Bless us with this DMDD we need it. She called the cops on me last month and they treated me like an animal. I told the cop you should try taking care of her for one day and you would not be treating me this way. I told him he had no idea what is was like to take care of a child like this. He told me I should not of had kids and that she was probably that way because of me!! Karma is a bitch Mr. Cop. I hope when his kid calls him a mother fer he will think of me. Walk a day in my shoes mr. cop man. This is what society thinks of most of us parents with kids like this!! How dare they? Ignorance is all I can say.
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