Question: DMDD is a new diagnosis, right? What is it and what’s it about?
Answer: In 2010 the APA Board of Trustees approved and announced changes for the upcoming release of DSM-5. Some changes were made in order to address a controversy among psychiatric experts about whether or not children should be diagnosed with bipolar disorder.
Starting in the 1990’s and early 2000’s more psychiatrists began recognizing and treating children living with bipolar. But the psychiatric community was contentiously divided on this practice. Some medical and psychiatric professionals were unhappy about the increase in pediatric bipolar diagnoses. They cited multiple concerns, including the fact that they didn’t want children to have to cope with a lifelong diagnosis (which bipolar is), the stigma associated with bipolar, and the serious medication used to treat bipolar.
As a result, pediatric onset bipolar disorder had become a controversial idea. So, the DSM committees looked for a way to both mitigate the controversy and to limit diagnosing of children with bipolar disorder. This resulted in a new diagnosis that could be given to children who otherwise would have been diagnosed with bipolar:
This new disorder is called
Disruptive Mood Dysregulation Disorder
or DMDD for short.
The DSM Committees concluded that since some children met the criteria for bipolar disorder with clear episodes of mania (even if they are short), but other children experienced chronic or frequent irritability and/or temper outbursts, there must be two different disorders. What the experts failed to take into account is that frequent irritability and/or temper outbursts can also be signs of both depression and mania in children.
During the public comment period that followed the announcement of DMDD as a new DSM-5 pediatric diagnosis many people objected and submitted concerns. Those who expressed dissenting opinions included such notable organizations and individuals such as the National Alliance for Mental Illness (NAMI) and Dr. Demitri Papolos, author of the Bipolar Child and the research director at the Juvenile Bipolar Research Foundation (JBRF).
One notable concern was this new diagnosis didn’t actually bring the medical community any closer to an effective and reliable treatment for the symptoms children continue to experience. In fact, many children diagnosed with DMDD are prescribed treatment plans that include medications that are specifically not supposed to be prescribed to patients with bipolar disorder, and can cause symptoms to become worse, not better.
Another problem with the committee’s justification for DMDD relates to its concern about prescribing significant mood stabilizers to children. You see, kids are already being prescribed medications (such as antipsychotics) that have serious side effects, which include significant weight gain, increase in cholesterol levels, and an increased risk for type 2 diabetes. So, the questions around prescribing weren’t resolved with the introduction of DMDD.
There are serious outcomes as a result of delaying a bipolar diagnosis in children in favor of DMDD. When a child actually has bipolar disorder, diagnosing DMDD and providing DMDD focused treatments delays the introduction of effective treatments targeted at the causes and effects of bipolar symptoms. This means that neuroprotection is delayed and children don’t have the chance to develop improved functioning across all aspects of daily living.
A misdiagnosis can rob children of their childhood.
At this particular point in time, DMDD is one of the diagnoses of choice for children who express high levels of irritability and temper outbursts. Since both of these symptoms are also signs of depression, mania, and anxiety in children, without also looking to see if there are other symptoms of bipolar a lot of kids wind up being misdiagnosed and given the wrong medications. It is vital that children living with bipolar be identified as early as possible in order to have the best outcomes.
Targeted medications, effective psychotherapies, appropriate accommodations and modifications in academic settings, non-pharmacological solutions, and support to caregivers can positively impact the trajectory of bipolar in young children, emphasizing the need for a more timely and accurate diagnosis.