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 with DMDD experience significant problems at home, at school, and often with peers. They also tend to require mental health care services, including doctor visits and sometimes hospitalization. Additionally, these children are at an increased risk of developing anxiety and depression in the future.

DMDD can be treated. If you are concerned that your child may have DMDD, talk to your child’s pediatrician or health care provider.

Children or adolescents with DMDD experience:

• Severe temper outbursts (verbal or behavioral), on average, 3 or more times per week
• Outbursts and tantrums that have been happening regularly for at least 12 months
• Chronically irritable or angry mood most of the day, nearly every day
• Trouble functioning due to irritability in more than one place, such as at home, at school, or with peers

Youth with DMDD are diagnosed between the ages of 6 and 10. To be diagnosed with DMDD, a child must have experienced symptoms steadily for 12 or more months.

Over time, as children grow and develop, the symptoms of DMDD may change. For example, an adolescent or young adult with DMDD may experience fewer tantrums, but they may begin to exhibit symptoms of depression or anxiety. For this reason, treatment may change over time, too.

Children with DMDD may have trouble in school and difficulty maintaining healthy relationships with family or peers. They also may have a hard time in social settings or participating in activities such as team sports. If you think your child has DMDD, seeking a diagnosis and treatment is essential.

If you think your child may be experiencing symptoms of DMDD, talk to your child’s health care provider. Describe your child’s behavior, and report what you have observed and learned from talking with others, such as their teacher or counselor.

An evaluation by your child’s health care provider can help clarify problems underlying your child’s behavior, and the provider may recommend next steps. You can also ask your health care provider for a referral to a mental health professional with experience working with children and adolescents. DMDD symptoms also can occur at the same time as other disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety disorders. An accurate diagnosis is vital for effective treatment.

To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), or visit the SAMHSA online treatment locator .

DMDD is a relatively new disorder; few DMDD-specific treatment studies have been conducted. Current treatments are primarily based on what has been helpful for other childhood disorders associated with irritability, such as ADHD, oppositional defiant disorder, and anxiety disorders.

Treatment for DMDD generally includes certain types of psychotherapy (sometimes called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later. However, at times, providers recommend that children receive both psychotherapy and medication at the start of their treatment.

NIMH is funding studies focused on improving these treatments and identifying new treatments specifically for DMDD. Parents or caregivers should work closely with their child’s health care provider to make treatment decisions that are best for their child.

Psychotherapies

Cognitive behavioral therapy (CBT) targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. Researchers at NIMH are also using CBT to help children increase their ability to tolerate frustration without having an outburst. This therapy teaches coping skills for controlling anger and ways to identify and relabel the distorted perceptions that contribute to outbursts.

Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to temper outbursts and working ahead to avert them. Training also emphasizes the importance of predictable and consistent responses to a child’s outbursts and rewards for positive behavior.

Learn more about psychotherapy.

Medications

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD. However, health care providers may prescribe certain medications—such as stimulants, antidepressants, and atypical antipsychotics—to help relieve your child’s DMDD symptoms.

All medications have side effects. Monitor and report your child’s side effects and review the medications frequently with your child’s health care provider. Visit the FDA website for the most up-to-date information on medications, side effects, and warnings.

• Stimulants are often used to treat ADHD, and research suggests that stimulant medications also may decrease irritability in youth with DMDD.
• Antidepressants are sometimes used to treat irritability and mood problems that children with DMDD may experience. One small study suggests that citalopram (a serotonin reuptake inhibitor antidepressant), combined with the stimulant methylphenidate, may 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. The FDA has approved these medications for treating irritability associated with autism, and they are sometimes used to treat DMDD. However, because these medications can cause unwanted side effects, they’re usually only tried when other approaches haven’t worked.

What is DMDD?

Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience ongoing irritability, anger and frequent, intense temper outbursts. Many children go through periods of moodiness, but children with DMDD experience severe symptoms and often have significant problems at home and school. They may also struggle to interact with peers.

DMDD can be treated. If you are concerned that your child may have DMDD, talk to your child’s pediatrician or health care provider.

What are the signs and symptoms of DMDD?

Children and adolescents with DMDD experience:

• Severe temper outbursts (verbal or behavioral), on 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
• Trouble functioning due to irritability in more than one place, such as at home, at school, or with peers

Youth with DMDD are typically diagnosed between the ages of 6 and 10. To be diagnosed with DMDD, a child must have experienced symptoms steadily for 12 or more months.

What are the risk factors of DMDD?

It is not clear how widespread DMDD is in the general population, and the exact causes of DMDD are not clear. Researchers are exploring risk factors and brain mechanisms of this disorder.

How is DMDD treated?

DMDD is a relatively new disorder and few DMDD-specific treatment studies have been conducted. Treatment is often based on what has been helpful for other childhood disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and anxiety disorders.

Treatment for DMDD generally includes certain types of psychotherapy (also called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later if needed. However, in some cases, providers recommend that children receive both psychotherapy and medication at the start of their treatment. Parents or caregivers should work closely with their child's health care provider to make treatment decisions that are best for their child.

The National Institute of Mental Health (NIMH) is currently funding studies focused on further improving these treatments and identifying new treatments to address irritability and temper outbursts.

Psychotherapies

Cognitive behavioral therapy (CBT) targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. Researchers are also using CBT to help children increase their ability to tolerate frustration without having an outburst. This therapy teaches coping skills for controlling anger and ways to identify and relabel the distorted perceptions that contribute to outbursts.

Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to temper outbursts and working ahead to avert them. Training also emphasizes the importance of predictable and consistent responses to a child’s outbursts and rewards for positive behavior.

Medications

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD. However, health care providers may prescribe certain medications—such as stimulants, antidepressants, and atypical antipsychotics—to help relieve a child’s DMDD symptoms.

• Stimulants are often used to treat 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 small study suggests that the antidepressant citalopram (a serotonin reuptake inhibitor antidepressant), combined with the stimulant methylphenidate, may 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. The FDA has approved these medications for treating irritability associated with autism, and they are sometimes used to treat DMDD. However, because these medications can cause unwanted side effects, they’re usually only tried when other approaches have not worked.

All medications have side effects. Monitor and report your child's side effects and review the medications frequently with your child's health care provider. Visit the FDA website for most up-to-date information on medications, side effects, and warnings.

How can I find a clinical trial for DMDD?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for your child.