Disruptive mood dysregulation disorder (DMDD) is a newer diagnosis in childhood that is depicted by extreme irritability, anger, and frequent outbursts (National Institute of Mental Health [NIMH], 2016). Irritability is a clinical symptom of both bipolar disorder and DMDD (Wiggins et al., 2016). Comparatively, irritability in DMDD is “severe and relatively invariant over time,” yet irritability experienced with bipolar disorder may occur while a child is euthymic and may increase during manic or depressive episodes (Wiggins et al., 2016, p. 722). Thus the inclusion of DMDD in part allows for appropriate diagnosis for children with “severe, nonepisodic irritability” that is distinct from bipolar disorder (Wiggins et al., 2016, p. 722).
With DMDD being a new diagnosis, treatment is often based on other disorders with shared symptomatology (e.g., attention-deficit/hyperactivity disorder, anxiety disorders, oppositional defiant disorder, and major depression; NIMH, 2016). Cognitive-behavior therapy (CBT), parent training, and computer-based training are recommended psychological interventions (NIMH, 2016) for DMDD, where as medications may also be considered. For instance, stimulants may help address irritability, antidepressants may mitigate irritability and mood problems, and atypical antipsychotics could be used to alleviate severe outbursts with physical aggression (NIMH, 2016).
The potential for adverse effects with some treatments limit their use in children, resulting in the necessity to explore noninvasive means for treatment (Wiggins et al., 2016). For instance, the use of a video game to reduce the misinterpretation of ambiguous faces in children with irritability has shown to help reduce anger-based reactions found in DMDD. The literature has shown that children with DMDD and bipolar disorder tend to rate neutral faces as angry (Wiggins et al., 2016). Research conducted by Wiggins et al. (2016) has demonstrated that a computer game helped to change the tendency to misinterpret ambiguous faces as angry in irritable children. After training, children were more likely to rate ambiguous faces as happy (Wiggins et al., 2016). Such an intervention may appear superficial, however this research has demonstrated that brain activation patterns when labeling emotional faces differs between DMDD and bipolar disorder (Wiggins et al., 2016). Specifically, amygdala activation related to irritability differed between children with DMDD and bipolar disorder; and temporo-occipital regions of the brain had “associations between irritability and activation in response to ambiguous angry faces” (Wiggins et al., 2016, p. 728).
Thus, differing brain activation patterns helped distinguish the clinical presentation of DMDD versus bipolar disorder (Wiggins et al., 2016). As a result, the authors conclude that though irritability is a common symptom of both DMDD and bipolar disorder, they are in fact distinct disorders and given the different neural correlates, treatments may also be different (Wiggins et al., 2016).
National Institute on Drug Abuse (NIDA). (2016). Disruptive Mood Dysregulation Disorder. Retrieved from http://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml
Wiggins, J. L., Brotman, M. A., Adleman, N. E., Kin, K., Oakes, A. H. Reynolds, R. C.,…Leibenluft, E. (2016). Neural correlates of irritability in disruptive mood dysregulation and bipolar disorders. American Journal of Psychiatry, 173, 722-730.
Dannie S. Harris, MA
WKPIC Doctoral Intern