Research Article
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Published Online: 23 March 2016

Disruptive Mood Dysregulation Disorder Symptoms and Association with Oppositional Defiant and Other Disorders in a General Population Child Sample

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


Objective: The new Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) diagnosis, disruptive mood dysregulation disorder (DMDD), has generated appreciable controversy since its inception, primarily in regard to its validity as a distinct disorder from oppositional defiant disorder (ODD). The goal of our study was to determine if the two DSM-5 DMDD symptoms (persistently irritable or angry mood and severe recurrent temper outbursts) occurred independently of other disorders, particularly ODD. Other DSM-5 DMDD criteria were not assessed.
Methods: Maternal ratings of the two DMDD symptoms, clinical diagnosis of ODD using DSM-5 symptom criteria, and psychological problem scores (anxiety, depression, oppositional behavior, conduct disorder, and attention-deficit/hyperactivity disorder [ADHD]) on the Pediatric Behavior Scale were analyzed in a population sample, 6–12 years of age (n = 665).
Results: The prevalence of DMDD symptoms (irritable-angry mood and temper outbursts both rated by mothers as often or very often a problem) was 9%. In all, 92% of children with DMDD symptoms had ODD, and 66% of children with ODD had DMDD symptoms, indicating that it is very unlikely to have DMDD symptoms without ODD, but that ODD can occur without DMDD symptoms. Comorbid psychological problems (anxiety, depression, conduct disorder, and ADHD) in addition to ODD did not increase the risk of having DMDD symptoms beyond that for ODD alone. Only 3% of children with psychological problems other than ODD had DMDD symptoms.
Conclusions: Our general population findings are similar to those for a psychiatric sample, suggesting that DMDD cannot be differentiated from ODD based on symptomatology. Therefore, it is important to assess all DSM criteria and to examine for comorbid psychopathology when considering a diagnosis of DMDD. Our results support the recommendation made by the World Health Organization's International Classification of Diseases, 11th Revision (ICD-11) panel of experts that DMDD symptoms may be more appropriately classified as an ODD specifier than a separate diagnosis.

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Achenbach TM: Child Behavior Checklist. Burlington, VT: University of Vermont Department of Psychiatry; 1991.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
Arnold LE, Vitiello B, McDougle C, Scahill L, Shah B, Gonzalez NM, Chaung S, Davies M, Hollway J, Aman MG, Cronin P, Koenig K, Kohn AE, McMahon DJ, Tierney E: Parent-defined target symptoms respond to risperidone in RUPP autism study: Customer approach to clinical trials. J Am Acad Child Adoles Psychiatry 42:1443–1450, 2003.
Axelson DA, Findling RL, Fristad MA, Kowatch RA, Youngstrom EA, Horwitz SM, Arnold LE, Frazier TW, Ryan N, Demeter C, Gill MK, Hauser–Harrington JC, Depew J, Kennedy SM, Gron BA, Rowles BM, Birmaher B: Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the longitudinal assessment of manic symptoms study. J Clin Psychiatry 73:1342–1350, 2012.
Bixler EO, Vgontzas AN, Lin H-M, Calhoun S, Vela-Bueno A, Fedok F, Vlasic V, Graff G: Sleep disordered breathing in children in a general population sample: Prevalence and risk factors. Sleep 32:731–736, 2009.
Burke JD: An affective dimension within oppositional defiant disorder symptoms among boys: Personality and psychopathology outcomes into early adulthood. J Child Psychol Psychiatry 53:1176–1183, 2012.
Conrad AL, Richman L, Lindgren S, Nopoulos P: Biological and environmental predictors of behavioral sequelae in children born preterm. Pediatr 125:e83–e89, 2010.
Copeland WE, Angold A, Costello EJ, Egger H: Prevalence, comorbidity and correlates of DSM-5 proposed disruptive mood dysregulation disorder. Am J Psychiatry 170:173–179, 2013.
Copeland WE, Shanahan L, Egger H, Arnold A, Costello EJ: Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. Am J Psychiatry 171:668–674, 2014.
Dougherty LR, Smith VC, Bufferd SJ, Carlson GA, Stringaris A, Leibenluft E, Klein DN: DSM-5 disruptive mood dysregulation disorder: Correlates and predictors in young children. Psychol Med 44:2339–2350, 2014.
Eyberg SM, Nelson M, Boggs SR: Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. J Clin Child Adoles Psychol 37:215–237, 2008.
Fernandez de la Cruz L, Simonoff E, McGough JJ, Halperin JM, Arnold LE, Stringaris A: Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: Results from the Multimodal Treatment Study of Children with ADHD. J Am Acad Child Adoles Psychiatry 54:62–70.e3, 2015.
Gordon M: The Gordon Diagnostic System. DeWitt, NY: Gordon Systems; 1983.
Leadbeater BJ, Homel J: Irritable and defiant sub-dimensions of ODD: Their stability and prediction of internalizing symptoms and conduct problems from adolescence to young adulthood. J Abnorm Child Psychol 43:407–421, 2015.
Leibenluft E, Uher R, Rutter M: Disruptive mood dysregulation with dysphoria disorder: A proposal for ICD-11. World Psychiatry 11 Suppl. 1:77–81, 2012.
Lindgren SD, Koeppl GK: Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale. In: Advances in behavioral assessment of children and families. Edited by Prinz R.J. Greenwich, CT: JAI; 1987; pp 57–90.
Lochman JE, Evans SC, Burke JD, Roberts MC, Fite PJ, Reed GM, de la Pena FR, Matthys W, Ezpeleta L, Siddiqui S, Garralda ME: An empirically based alternative to DSM-5's disruptive mood dysregulation disorder for ICD-11. World Psychiatry 14:30–33, 2015.
Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, Aman MG: A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry 48:1110–1119, 2009.
Matson JL: Aggression and tantrums in children with autism: A review of behavioral treatments and maintaining variables. J Mental Health Res Intell Disab 2:169–187, 2009.
Mattison RE, Mayes SD: Relationship between learning disability, executive function, and psychopathology in children with ADHD. J Atten Disord 16:138–146, 2012.
Mayes SD, Calhoun SL: Impact of IQ, age, SES, gender, and race on autistic symptoms. Res Autism Spectrum Disord 5:749–757, 2011.
Mayes SD, Calhoun SL: Symptoms of autism in young children and correspondence with the DSM. Infants Young Childr 12:90–97, 1999.
Mayes SD, Calhoun SL, Aggarwal R, Baker C, Mathapati S, Anderson R, Petersen C: Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical children. Res Autism Spectrum Disord 6:1–10, 2012a.
Mayes SD, Calhoun SL, Baweja R, Mahr F: Suicide ideation and attempts in children with psychiatric disorders, and typical development. J Crisis Intervent Suicide Prev 36:55–60, 2015a.
Mayes SD, Calhoun SL, Baweja R, Mahr F, Feldman L, Syed E, Gorman AA, Montaner J, Annapareddy J, Gupta N, Bello A, Siddiqui F: Suicide ideation and attempts are associated with co-occurring oppositional defiant disorder and sadness in children and adolescents with ADHD. J Psychopathol Behav Assess 37: 244–282, 2015b.
Mayes SD, Calhoun SL, Mayes RD, Molitoris S: Autism and ADHD: Overlapping and discriminating symptoms. Res Autism Spectrum Disord 6:277–285, 2012b.
Mayes SD, Calhoun SL, Murray MJ, Ahuja M, Smith LA: Anxiety, depression, and irritability in children with autism relative to children with other neuropsychiatric disorders and typical development. Res Autism Spectrum Disord 5:474–485, 2011.
Mayes SD, Gordon M, Calhoun SL, Bixler EO: Long-term temporal stability of measured inattention and impulsivity in typical and referred children. J Atten Disord 18:23–30, 2014.
Mayes SD, Mathiowetz C. Kokotovich C, Waxmonsky J, Baweja R, Calhoun SL, Bixler EO: Stability of irritable-angry mood and temper outbursts throughout childhood and adolescence in a general population sample. J Abnormal Child Psychol 2015c [Epub ahead of print].
Nichols S, Mahoney EM, Sirois PA, Bordeaux JD, Stehbens JA, Loveland KA, Amodei N: HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: Results from the Hemophilia Growth and Development Study. J Pediatr Psychol 25:545–556, 2000.
Owen R, Sikich L, Marcus RN, Corey–Lisle P, Manos G, McQuade RD, Carson WH, Findling RL: Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics 124:1533–1540, 2009.
Regier DA, Narrow WE, Clarke DE, Kraemer HC, Kuramoto SI, Kuhl EA, Kupfer DJ: DSM-5 field trials in the United States and Canada, part II: Test-retest reliability of selected categorical diagnoses. Am J Psychiatry 170:59–70, 2013.
Roy AK, Lopes V, Klein RG: Disruptive mood dysregulation disorder: A new diagnostic approach to chronic irritability in youth. Am J Psychiatry 171: 918–924, 2014.
Safer DJ: Irritable mood and the Diagnostic and Statistical Manual of Mental Disorders. Child Adolesc Psychiatry Ment Health 3:35–39, 2009.
Shea S, Turgay A, Carroll A, Schulz M, Orlik H, Smith I, Dunbar F: Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 114:e634–e641, 2004.
Stringaris A: Irritability in children and adolescents: A challenge for DSM-5. Eur Child Adolesc Psychiatry 20:61–66, 2011.
Stringaris A, Goodman R: Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. J Am Acad Child Adolesc Psychiatry 48:404–412, 2009.
Waxmonsky JG, Pelham WE, Gnagy E, Cummings MR, O'Connor B, Majumdar A, Verley J, Hoffman MT, Massetti GA, Burrows–MacLean L, Fabiano GA, Waschbusch DA, Chako A, Arnold FW, Walker KS, Garefino AC, Robb JA: The efficacy and tolerability of methylphenidate and behavior modification in children with ADHD and severe mood dysregulation. J Child Adolesc Psychopharmacol 18:573–588, 2008.
Waxmonsky JG, Wymbs FA, Pariseau ME, Belin PJ, Waschbusch DA, Babocsai L, Fabiano GA, Akinnusi OO, Haak JL, Pelham WE: A novel group therapy for children with ADHD and severe mood dysregulation. J Attention Disord 17:527–5541, 2013.
Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC: Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New Engl J Med 330:301–307, 1994.

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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: 101 - 106
PubMed: 26745442


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


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    Susan D. Mayes, PhD
    Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
    James D. Waxmonsky, MD
    Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
    Susan L. Calhoun, PhD
    Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
    Edward O. Bixler, PhD
    Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.


    Statistical Consultant: Susan D. Mayes.
    Funding: This study was supported by National Institutes of Health grants RO1 HL063772, MO1 RR10732, and CO6 RRO16499.
    Address correspondence to:James Waxmonsky, MDDepartment of Psychiatry H073Hershey Medical Center500 University DriveHershey, PA 17033E-mail: [email protected]


    Over the past 3 years, Dr. Waxmonsky has received research funding from the National Institutes of Health (NIH), Noven and Shire; served on the advisory board for Noven and Iron Shore pharmaceuticals; and performed continuing medical education (CME) talks funded by Quintiles. Janssen has also donated medication for one of his trials. The other authors have no disclosures to declare.

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