Disruptive Mood

Dysregulation Disorder:
The Basics
From the NATIONAL INSTITUTE of MENTAL HEALTH

What is disruptive mood

dysregulation disorder?
Disruptive mood dysregulation disorder (DMDD) is a
condition in which children or adolescents experience
ongoing irritability, anger, and frequent, intense temper
outbursts. The symptoms of DMDD go beyond a “bad
mood.” DMDD symptoms are severe. Youth who have
DMDD experience significant problems at home, at
school, and often with peers. They also tend to have
high rates of health care service use, hospitalization, What are the signs and
and school suspension, and they are more likely to
symptoms of DMDD?
develop other mood disorders.
DMDD can be treated. If you are concerned that your Children or adolescents with DMDD experience:
child may have DMDD, talk to your child’s pediatrician • Severe temper outbursts (verbal or behavioral), on
or health care provider. average, three or more times per week
• Outbursts and tantrums that have been ongoing for
at least 12 months
• Chronically irritable or angry mood most of the day,
nearly every day
Did You Know?
• Trouble functioning due to irritability in more than
one place (at home, at school, and with peers)
DMDD is a newly classified disorder, first
appearing in the Diagnostic and Statistical Youth with DMDD are diagnosed between the
Manual of Mental Disorders (DSM-5) in 2013. The ages of 6 and 10. To be diagnosed with DMDD,
DSM is used for the assessment and diagnosis of a child must have experienced symptoms steadily
mental disorders; it does not include specific for 12 or more months.
guidelines for the treatment of any disorder. Over time, as children grow and develop, the
Researchers at the National Institute of Mental symptoms of DMDD may change. For example,
Health (NIMH) developed the DMDD diagnosis an adolescent or young adult with DMDD may
to diagnose more accurately youth who may experience fewer tantrums, but they begin to exhibit
have been previously diagnosed with pediatric symptoms of depression or anxiety. For these
bipolar disorder (despite not experiencing the reasons, treatment may change over time, too.
symptoms needed for a diagnosis of bipolar Children with DMDD may have trouble in school and
disorder). experience difficulty maintaining healthy relationships
For more information on this research, visit the with family or peers. They also may have a hard time
NIMH website at www.nimh.nih.gov and search in social settings or participating in activities such as
for “DMDD.” team sports. If you think your child has DMDD, it is
essential to seek a diagnosis and treatment.
 For more information about diagnosis and treatment
What is the difference of children and tips for talking to your health care
between typical irritability provider, check out NIMH’s Children and Mental
Health fact sheet accessible from the Child and
and severe irritability? Adolescent Mental Health webpage at www.nimh.
All children can become irritable sometimes. nih.gov/children and Tips for Talking With Your
It’s a normal reaction to frustration. Children Health Care Provider fact sheet at www.nimh.nih.
experiencing severe irritability (as observed in gov/talkingtips. If you need help identifying a
DMDD) have difficulty tolerating frustration and provider in your area, call the Substance Abuse and
have outbursts that are out of proportion for the Mental Health Services Administration (SAMHSA)
situation at hand. These outbursts occur more Treatment Referral Helpline at 1-800-662-HELP (4357).
often and are more severe than what you would SAMHSA also has a Behavioral Health Treatment
typically expect for children of this age. Services Locator (https://findtreatment.samhsa.gov)
that can be searched by location.
For example, a parent tells the child to stop
playing a game and do their homework. Any How is DMDD treated?
child might be frustrated or annoyed. But a child
with DMDD may become extremely upset and DMDD is a newly classified disorder, and few DMDD-
emotional and have an intense temper outburst specific treatment studies have been conducted to
with yelling or hitting. A child with DMDD date. Current treatments are primarily based on
experiences these intense temper outbursts a research focused on other childhood disorders
few times a week. associated with irritability (such as anxiety and
ADHD). Fortunately, many of these treatments also
work for DMDD. NIMH is currently funding studies
focused on further improving these treatments and
identifying new treatments specifically for DMDD. It is
important for parents or caregivers to work closely
with their child’s doctor to make treatment decisions
that are best for their child.
Treatment for DMDD generally includes certain types
of psychotherapy (“talk therapy”) and sometimes
medications. In many cases, psychotherapy is
considered first, with medication added later.
However, at times, providers recommend that children
How is DMDD diagnosed? receive both psychotherapy and medication at the
start of their treatment.
If you think your child may be experiencing symptoms
of DMDD, talk to your child’s health care provider. Psychotherapies
Describe your child’s behavior, and report what you
have observed and learned from talking with others, Cognitive behavioral therapy (CBT) is used to help
such as a teacher or school counselor. An evaluation children and adolescents learn how to cope with
by your child’s health care provider can help clarify thoughts and feelings that contribute to their feeling
problems that may be underlying your child’s behavior, depressed or anxious. CBT for anxiety often includes
and the provider may recommend the next steps. exposing the child to situations that make them
anxious so that they can learn to respond to those
You also can ask your health care provider for a
situations better. Clinicians can use similar techniques
referral to a mental health professional who has
to teach children to increase their ability to tolerate
experience working with children and adolescents.
frustration without having an outburst. This therapy
DMDD symptoms also can occur at the same time as
also teaches coping skills for controlling anger and
other disorders associated with irritability, such as
ways to identify and re-label the distorted perceptions
attention-deficit/hyperactivity disorder (ADHD) or
that contribute to outbursts.
anxiety disorders. An accurate diagnosis is vital for
effective treatment.
Researchers also are studying the use of dialectical Medications
behavior therapy for children (DBT-C) with DMDD.
This type of therapy may help children learn to Currently, there are no medications approved by the
regulate their emotions and avoid extreme or U.S. Food and Drug Administration (FDA) specifically
prolonged outbursts. In DBT-C, the clinician helps for treating children or adolescents with DMDD.
children learn skills that can help with regulating their However, health care providers may prescribe certain
moods and emotions. medications—such as stimulants, antidepressants,
and atypical antipsychotics—to help relieve your
It can be effective to combine therapy for the child or
child’s DMDD symptoms. All medications have side
adolescent with parent training. Parent training teaches
effects. Monitor and report your child’s side effects
parents or caregivers more effective ways to respond
and review the medications frequently with your
to irritable behavior, such as anticipating events that
child’s health care provider. Visit the FDA website at
might lead a child to have a temper outburst and
www.fda.gov for the most up-to-date information on
working ahead to avert it. Training also focuses on the
medications, side effects, and warnings.
importance of predictability, being consistent with
children, and rewarding positive behavior.

Computer-based training
New approaches currently are being tested to leverage
mobile and computer-based platforms to help address
certain DMDD symptoms in children. However, this
research is in the early stages. After studies are complete,
findings from this line of research may be disseminated
on the NIMH website at www.nimh.nih.gov/news.

Tips for Parents and Caregivers

Being a parent or caregiver for a child or adolescent Find ways to manage your stress. Take practical
with DMDD can be stressful and overwhelming. steps to manage your own stress to avoid the risk
While working on creating a better environment for of negative health effects. For tips, see NIMH’s
the child, you may want to consider the following: 5 Things You Should Know About Stress fact sheet at
Learn as much as you can about the disorder. Talk www.nimh.nih.gov/stress.
to your child’s health care provider or mental health Seek additional support and professional help.
professional. Ask questions about risks, benefits, Parents and caregivers may be able to find resources
and treatment options. You can find additional and encouragement through their local chapter of
information about DMDD (including the latest news, the National Alliance on Mental Illness (www.nami.
videos, and information about clinical trials) on the org/Find-Support), the National Federation of
NIMH website at www.nimh.nih.gov/DMDD. Families for Children’s Mental Health (www.ffcmh.org),
Talk to your child’s teacher, counselor, or school Mental Health America (www.mhanational.org),
psychologist. Together, you may come up with and other organizations.
strategies, plans, and accommodations that can Communicate regularly and effectively with your
help your child thrive in school. For more child’s health care provider. Find tips to help you
information, check out NIMH’s Children and prepare for your child’s visit at www.nimh.nih.gov/
Mental Health fact sheet accessible from the talkingtips. For additional resources, including
Child and Adolescent Mental Health webpage at questions to ask your doctor, visit the Agency for
www.nimh.nih.gov/children. Healthcare Research and Quality website at
www.ahrq.gov/patients-consumers.
• Stimulants are often used in the treatment of
ADHD, and research suggests that stimulant
medications also may decrease irritability in youth.
• Antidepressants are sometimes used to treat
irritability and mood problems that children with
DMDD may experience. One study suggests that
citalopram (a serotonin reuptake inhibitor
antidepressant), when combined with the stimulant
methylphenidate, can decrease irritability in youth
with DMDD. Please note: Antidepressants may
increase suicidal thoughts and behaviors in youth,
who should be monitored closely by their health
care provider.
• Certain atypical antipsychotic medications are
used to treat children with irritability, severe
outbursts, or aggression. FDA has approved these the primary purpose of a clinical trial is to gain new
medications for the treatment of irritability scientific knowledge so that others may be better
associated with autism, and they are sometimes helped in the future.
used to treat DMDD, too. However, due to the side
effects associated with these medications, they are Children are not little adults, yet they are often
often used only when other approaches have not given medicines and treatments that have been
been successful. tested only in adults. There’s a lot of evidence that
children’s developing brains and bodies can respond
Are there clinical trials to medicines and treatments differently than adults’
studying DMDD? brains and bodies respond. The way to get the best
treatments for children is through research designed
NIMH supports a wide range of research, including specifically for them. To find studies being conducted
clinical trials that look at new ways to prevent, detect, at NIMH for children and adolescents, visit Pediatric
or treat diseases and conditions—including DMDD. Studies at www.nimh.nih.gov/joinastudy. To find
Although individuals may benefit from being part a clinical trial near you, visit ClinicalTrials.gov at 
of a clinical trial, participants should be aware that www.clinicaltrials.gov.

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NIH Publication No. 20-MH-8119