Disruptive Mood Dysregulation Disorder DSM-5 296.99(F34.8)


DSM 5 Category: Depressive Disorders


New to the DSM-5, disruptive mood dysregulation disorder is a childhood disorder characterized by a pervasively irritable or angry mood. Symptoms include frequent angry or aggressive outbursts combined with an angry or irritable mood on days when outbursts do not occur. Although prevalence is low among the general population, disruptive mood disorder is common among children already being treated for psychiatric illness. Symptoms of disruptive mood dysregulation disorder are common to other disorders such a bipolar disorder, oppositional defiant disorder and conduct disorder. The disorder often co-occurs with depression, anxiety or attention deficit hyperactivity disorder. Although medication is available to treat symptoms of disruptive mood dysregulation disorder, family focused therapy typically has the best outcome.

Symptoms of Disruptive Mood Dysregulation Disorder

The most prominent symptom of disruptive mood dysregulation disorder is an angry or irritable mood characterized by verbal or aggressive outbursts that are out of proportion to the trigger. The outbursts occur at least 3 times each week. Outbursts must occur both at two different locations, such as both home and school. Between outbursts, the child’s mood is pervasively irritable and unhappy. This is not a covert experience, as parents, teachers and others will notice that something is wrong. According to the DSM-5, diagnosis of disruptive mood dysregulation disorder can only be made between the ages of 6 and 18, but onset must occur before the age of 10. Outbursts must be inappropriate for the child’s developmental age. Further DSM-5 diagnostic criterion requires that the pattern of behavior must persist for at least 12 months.

Prevalence of Disruptive Mood Dysregulation Disorder

Prevalence of disruptive mood dysregulation disorder is less than 1% among the general population, but much higher among the clinical population (Copeland, et al., 2013)

Social Consequences of Disruptive Mood Dysregulation Disorder

Children diagnosed with disruptive mood dysregulation disorder face problems at home, at school and in social situations. Low tolerance for frustration means that the child frequently loses his or her temper in class, during play and when interacting with family. They usually have few friends and other children typically avoid playing with the child after an outburst.

Comorbidity and Differential Diagnosis

According to the DSM-5, comorbidity among children diagnosed with disruptive mood dysregulation disorder is extremely common (American Psychiatric Association, 2013). As many as 92% of children diagnosed with disruptive mood dysregulation disorder also meet clinical criteria for another disorder. As many as 68% percent of diagnosed children meet criteria for both a behavioral disorder and emotional disorder (Copeland, et al., 2013). Children with disruptive mood dysregulation disorder may also have attention deficit hyperactivity disorder, anxiety disorders, major depressive disorder or autism spectrum disorder (American Psychiatric Association, 2013). Many experts were concerned that children were being incorrectly diagnosed with bipolar disorder. The DSM-5 created the diagnosis of disruptive mood dysregulation disorder to describe mood dysregulation disorder that does not include manic or hypo-manic symptoms (Axelson, 2013). Other disorders, such as, intermittent explosive disorder and oppositional defiant disorder share similar and overlapping diagnostic features but should not be diagnosed together (American Psychiatric Association, 2013). Children diagnosed with disruptive mood dysregulation disorder are at increased risk of self-harm and suicidal behaviors. Self-harm occurs when a child deliberately hurts him or herself. Common examples of self harm include cutting, burning, skin picking, carving, and pinching, biting, hitting, banging, stabbing, poking, and inserting object under skin. Childhood suicide is shockingly prevalent. 4,000 children die each year from suicide and 125,000 children are treated in emergency rooms each year for suicide attempts (Serani, 2013).

Treatment of Disruptive Mood Dysregulation Disorder

Because Disruptive mood dysregulation disorder is new to the DSM-5, treatment protocol has not yet been standardized. To date, disruptive mood dysregulation disorder is treated similarly to the treatment of related disorders such as bipolar disorder, oppositional defiant disorder and intermittent explosive disorder.Children have little control over their environments and all children who are treated for disruptive mood dysregulation disorder are treated at the request of the parent, guardian or legal decree. Children often have poor insight and a tendency to externalize blame. Consequently, therapeutic relationships may be difficult to establish and maintain. Additionally, children often have a difficult time articulating feelings and concerns. As a result, medications are often prescribed to manage symptoms so that therapy can be more effective. Medications that target anxiety or hyperactivity, for example, can give the child the opportunity to focus in school or make friends. These successes are usually rewarding enough to motivate the child to engage in therapy. Because depression and suicidal behavior are often associated with disruptive mood dysregulation disorder, medication may be used to improve mood (Rutherford, 2010).

Because children spend more time with their parents than with therapists, it is important that the entire family is involved in treatment. Parental involvement is important to treating any childhood psychiatric disorder. A study examining pediatric bipolar disorder, which was the typical diagnosis for disruptive mood dysregulation disorder before the introduction of the DSM-5; reported that suicidal behaviors, threats and attempts are related to poor family functioning (Guillermo, et al., 2011) Parent-child interaction therapy is a method that draws from attachment and social learning theories. The goal is for the parent or caregiver to develop a sense of firm control over their child, while simultaneously nurturing the child and meeting the child’s emotional needs. When the parental relationship is strengthened, the child is more willing to comply. During parent-child interaction therapy, the parent and child attend therapy sessions together. During therapy sessions, parents are instructed to follow the child’s lead and only respond to positive behaviors. This means that the parent focuses on praise, offers reflections and verbal descriptions of behavior. The parent is instructed to avoid commands, criticisms or questions during the interaction. A group component may also be involved, which can include 3-6 families (Wesiz and Kazdin, 2010).

Parents are also taught to use more effective disciplinary skills when necessary. Parents are coached to make clear and direct requests of their child and explain commands. They are also taught to quickly praise good behavior. Parents are also taught to ignore questions or bad behavior that occurs during time-out (Weisz and Kazdin, 2010).


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Axelson. D. (2013) Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive.

American Journal of Psychiatry. 170(2); 136-139.

Copeland, W.E., Angold, A., Costello, J. & Egger, H. (2013). Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. American Journal of Psychiatry. 170(2)

Guillermo, P.A., Youngstrom. E.A., Frazier, T.W., Freeman, A.J., Youngstrom, K.K & Findling, R.L. (2011). Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation? Bipolar Disorders, 13(1)

Rutherford, J.J. (2010). The Everything Parent's Guide to the Defiant Child : Reassuring advice to help your child manage explosive emotions and gain self-control. Cincinatti: F+W Media

Serani, D. (2013) Depression and your child : a guide for parents and caregivers

Lanham : Rowman & Littlefield Publishers, Inc.

Weisz, J.R. & Kazdin, A.E (2010). Evidence-based psychotherapies for children and adolescents

New York : Guilford Press

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