Research Article
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Published Online: 23 March 2016

Disruptive Mood Dysregulation Disorder in a Community Mental Health Clinic: Prevalence, Comorbidity and Correlates

Publication: Journal of Child and Adolescent Psychopharmacology
Volume 26, Issue Number 2


Objective: The revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) added a new diagnosis of disruptive mood dysregulation disorder (DMDD) to depressive disorders. This study examines the prevalence, comorbidity, and correlates of the new disorder, with a particular focus on its overlap with oppositional defiant disorder (ODD), with which DMDD shares core symptoms.
Methods: Data were obtained from 597 youth 6–18 years of age who participated in a systematic assessment of symptoms offered to all intakes at a community mental health center (sample accrued from July 2003 to March 2008). Assessment included diagnostic, symptomatic, and functional measures. DMDD was diagnosed using a post-hoc definition from item-level ratings on the Schedule for Affective Disorders and Schizophrenia for School-Age Children that closely matches the DSM-5 definition. Caregivers rated youth on the Child Behavior Checklist.
Results: Approximately 31% of youth met the operational definition of DMDD, and 40% had Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnoses of ODD. Youth with DMDD almost always had ODD (odds ratio [OR] = 53.84) and displayed higher rates of comorbidity with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder than youth without DMDD. Caregivers of youth with DMDD reported more symptoms of aggressive behavior, rule-breaking, social problems, anxiety/depression, attention problems, and thought problems than all other youth without DMDD. Compared with youth with ODD, youth with DMDD were not significantly different in terms of categorical or dimensional approaches to comorbidity and impairment.
Conclusions: The new diagnosis of DMDD might be common in community mental health clinics. Youth with DMDD displayed more severe symptoms and poorer functioning than youth without DMDD. However, DMDD almost entirely overlaps with ODD and youth with DMDD were not significantly different than youth with ODD. These findings raise concerns about the potentially confusing effects of using DMDD in clinical settings, particularly given that DSM-5 groups DMDD with depressive disorders, but ODD remains a disruptive behavior disorder, potentially changing the decision-making framework that clinicians use to select treatments.

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Published In

cover image Journal of Child and Adolescent Psychopharmacology
Journal of Child and Adolescent Psychopharmacology
Volume 26Issue Number 2March 2016
Pages: 123 - 130
PubMed: 26745325


Published online: 23 March 2016
Published in print: March 2016
Published ahead of print: 8 January 2016


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Andrew J. Freeman, PhD
Department of Psychology, University of Nevada, Las Vegas, Nevada.
Eric A. Youngstrom, PhD
Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jennifer K. Youngstrom, PhD
Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Robert L Findling, MD, MBA
Bloomberg Children's Center, Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland.


Address correspondence to:Andrew J. Freeman, PhDDepartment of PsychologyUniversity of Nevada, Las Vegas4505 S. Maryland ParkwayLas Vegas, NV 89154-5030E-mail: [email protected]


Dr. Freeman and Dr. J. Youngstrom have no financial conflicts of interest to disclose. Dr. E. Youngstrom has received funding from the National Institute of Mental Health (NIMH) and has consulted with Otsuka and Lundbeck about assessment. Dr. Findling receives or has received research support, acted as a consultant for, and/or served on a speaker's bureau for Alcobra, American Academy of Child & Adolescent Psychiatry, American Physician Institute, American Psychiatric Press, AstraZeneca, Bracket, Bristol-Myers Squibb, CogCubed, Cognition Group, Coronado Biosciences, Dana Foundation, Elsevier, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson and Johnson, Jubilant Clinsys, KemPharm, Lilly, Lundbeck, Merck, National Institutes of Health (NIH), Neurim, Novartis, Noven, Otsuka, Oxford University Press, Pfizer, Physicians Postgraduate Press, Purdue, Rhodes Pharmaceuticals, Roche, Sage, Shire, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, and WebMD.

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