Explosive Tantrums: Disruptive Mood Dysregulation and the DSM-V
January 6th, 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 disorder—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.
Controversy
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.
References:
- 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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12 Comments | Click here to leave a comment.
Comments
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.
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
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.
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.
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.
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.
How can a temper tantrum be considered a mental illness? For the love of all things good and sacred…
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.
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.
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?
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.
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!
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