How to Treat Disruptive Mood Dysregulation Disorder (DMDD)
Treatment for Disruptive Mood Dysregulation disorder typically includes therapy, medication, or a combination of both to target irritability, temper tantrums, as well as symptoms of ADHD and oppositional defiant disorder (ODD).
Reviewed by J. Russell Ramsay, Ph.D., a member of the ADDitude ADHD Specialist Panel
Disruptive Mood Dysregulation Disorder (DMDD) is a relatively new diagnosis, so studies haven’t yet confirmed which treatments work best at improving irritability and preventing the temper outbursts that are hallmarks of the condition. Because DMDD often co-exists and shares symptoms with ADHD, oppositional defiant disorder (ODD), and major depression, treatments for these conditions can help.1 Thus treatment for DMDD typically includes therapy, medication, or a combination of both.
Treating DMDD with Therapy
A psychologist or other mental health professional can teach kids with DMDD, and their parents, strategies for dealing with the emotions that trigger their irritability and temper outbursts.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) teaches children how to identify and control their anger before it can boil over and set off a temper tantrum.2 CBT is also useful for reigning in depression and anxiety, both of which are common in children with DMDD.
During training, parents learn to identify which situations cause their child to explode, and how to respond to any outbursts that do happen in a more positive, productive way. “It’s about identifying triggers, praising and attending to positive behaviors, and limiting the time they spend getting sucked into arguing,” says James Waxmonsky, MD, division chief, Child Psychiatry at Penn State Health.
A new avenue of research focuses on a tendency that children with DMDD have to misinterpret situations — and specifically, facial expressions. “These children are more likely than those without this disorder to have information processing deficits. Often they misperceive ambiguous or ambivalent emotional expressions as negative or angry. Then, because of that misperception, they react as if they were threatened,” says William French, MD, DFAACAP, associate professor in the University of Washington Department of Psychiatry and Behavioral Sciences.
Computer-based training to help children accurately identify emotions could lead to more appropriate responses. A computer game that alters children’s perception so that they view faces as happy has shown promise for improving irritability.3
Treating DMDD with Medication
Therapy alone is the ideal way to treat DMDD, says French. “But if the symptoms are severe and highly impairing, it may be necessary to start therapy and medication at the same time.” Many of the same drugs prescribed for ADHD and depression also help with DMDD.
It’s not surprising that stimulant medications like Ritalin are often effective in treating DMDD, given that nearly all kids with DMDD also have ADHD.4 Research finds these drugs ease irritability in children who have both conditions. Research also indicates that some stimulants may improve mood.5
Antidepressants like selective norepinephrine reuptake inhibitors (SNRIs) treat irritability and depressed mood. It’s important to note that these medications carry a “black box” warning of suicidal thoughts and behaviors in young people, so doctors need to closely follow their young patients when they start taking these medications.
The Outlook for Kids with DMDD
Eighteen is the cutoff age for a DMDD diagnosis.6 Symptoms don’t simply disappear once a child enters adulthood, but doctors start to consider the possibility that another mental health condition, such as a mood disorder, may be to blame.
Most kids outgrow core DMDD symptoms such as temper tantrums and irritability, according to Waxmonsky. However, other issues may take their place. “What we would watch for in young adults is higher rates of depression and anxiety,” he says.
Research finds that children with DMDD are at increased risk for a host of problems as they get older, including risky behaviors, poverty, violent relationships, STDs, and nicotine use. Yet these children aren’t destined to a dire future. “With any illness, the outcomes are going to be bad if you don’t treat the illness,” French says. “Getting into good treatment can probably mitigate a lot of the potential outcomes.”
1 National Institute of Mental Health. Disruptive Mood Dysregulation Disorder. https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml#part_152554
2 Sukhodolsky DG, et al. Behavioral interventions for anger, irritability, and aggression in children and adolescents. Journal of Child and Adolescent Psychopharmacology. 2016 February 1; 26(1): 58-64.
3 National Institute of Mental Health. Game Corrects Children’s Misreading of Emotional Faces to Tame Irritability. https://www.nimh.nih.gov/news/science-news/2016/game-corrects-childrens-misreading-of-emotional-faces-to-tame-irritability.shtml
4 Masi L, et al. ADHD and DMDD comorbidities, similarities and distinctions. Journal of Child and Adolescent Behavior. https://www.omicsonline.org/open-access/adhd-and-dmdd-comorbidities-similarities-and-distinctions-2375-4494-1000325.php?aid=83936
5 Baweja R, et al. The effectivenss and tolerability of central nervous system stimulants in school-age children with attention-deficit/hyperactivity disorder and disruptive mood dysregulation disorder across home and school. Journal of Child and Adolescent Psychopharmacology. 2016 March; 26(2):154-163. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800382/
6 National Institute of Mental Health. Disruptive Mood Dysregulation Disorder. https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml#part_152554