DMDD Key Notes

DMDD Overview

  • Disruptive Mood Dysregulation Disorder (DMDD)
  • Introduced in DSM-5 (2013)
  • Characterized by severe, developmentally inappropriate temper outbursts and persistent irritable mood for at least 12 months.
  • Prevalence of Comorbidity
  • 92.8% of DMDD patients have comorbid disorders like ADHD, ODD, Conduct Disorder, and Anxiety.

Signs and Symptoms

  • Severe temper outbursts (3+ times/week) for at least 12 months.
  • Chronic irritability or anger almost daily.
  • Functional impairment in multiple settings (home, school, social).

Contributing Factors to DMDD

  • Neurological Factors: Abnormalities in amygdala and prefrontal cortex, neurochemical imbalances.
  • Genetic Factors: Family history of mood disorders increases risk.
  • Environmental Influences: Adverse childhood experiences, inconsistent parenting, family conflict, socioeconomic stressors.

DMDD vs ODD

  • DMDD and ODD cannot co-exist according to DSM-5.
  • DMDD caters to severe irritability cases, leading to more functional impairment than ODD.

Effects of DMDD in the Classroom

  • Classroom Challenges:
  • Behavioral issues (difficulty paying attention, making friends).
  • Higher risk of suspension compared to peers.
  • Not directly related to learning disabilities or low IQ.

Treatment Options

  1. Psychotherapeutic Interventions: Behavior therapy, parent training.
  2. Pharmacological Treatments: Antidepressants, mood stabilizers, stimulants, antipsychotics (e.g., Risperidone).

Stigma Related to DMDD

  • Often viewed as medicalization of bad behavior, excuses for tantrums.
  • Stigma increases with medication treatment.

Supporting DMDD in the Classroom

  • Understand trauma's role in DMDD.
  • Implement trauma-informed care and consistent expectations.
  • Use strategies that focus on offering choices and maintaining calm interactions.

What Doesn't Work vs. Alternative Strategies

  • Avoid:

  • Rewards/consequences that don't account for emotional dysregulation.

  • Yelling or aggressive methods during an outburst.

  • Instead, Try:

  • Offering choices and manageable outcomes.

  • Maintaining a calm demeanor and minimal verbal communication.

  • Allowing coping strategies without excessive demands for politeness.

  • Teaching expectations explicitly and praising successes.

Collaborative Efforts

  • Engage parents and family in addressing DMDD, respecting their insights and experiences.