The New "Mood Disorder" That Isn't One

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The storied history of "Disruptive Mood Dysregulation Disorder (DMDD)", a controversial new child psychiatric disorder proposed for inclusion in the new DSM-5 manual, continues.

If DSM-5 is officially published (it's due in 2013), kids will be deemed DMDD if they show

severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.

At least three times a week. Would giving that label be helpful?

Pittsburg psychiatrists David Axelson and colleagues have just shown that the DMDD concept is deeply flawed. They took a large sample of kids assessed for emotional or behavior problems, and compared those who would meet the new DMDD criteria, to those who wouldn't.

"DMDD" turned out not to be correlated with anxiety or mood symptoms in either the child or their parents - rather unusual for a so-called 'Mood Dysregulation Disorder' which is found in the 'Depressive Disorder' section of the DSM-5.

However, DMDD was correlated with - and in fact "could not be delimited from" - two existing disorders, "Conduct Disorder" and "Oppositional Defiant Disorder". It wasn't even a more severe form of those disorders, it was pretty much the same thing.

So, DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?

Well, the back-story is that in the past ten years, many American kids and even toddlers have got diagnosed with 'child bipolar disorder' - a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn't even achieve this dubious goal.

The possibility of just going to back to the days when psychiatrists didn't diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.

Axelson D, et al (2012). Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the Longitudinal Assessment of Manic Symptoms study. The Journal of Clinical Psychiatry, 73 (10), 1342-50 PMID: 23140653