Adult Diagnostic and Functional Outcomes of DSM-5 Disruptive Mood Dysregulation Disorder

Abstract

Objective Disruptive mood dysregulation disorder is a new disorder for DSM-5 that is uncommon and frequently co-occurs with other psychiatric disorders. Here, we test whether meeting diagnostic criteria for this disorder in childhood predicts adult diagnostic and functional outcomes. Methods In a prospective, population-based study, subjects were assessed with structured interviews up to 6 times in childhood and adolescence (ages 10 to 16; 5336 observations of 1420 subjects) for symptoms of disruptive mood dysregulation disorder and 3 times in young adulthood (ages 19, 21, and 24-26; 3215 observations of 1273 subjects) for psychiatric and functional outcomes (health, risky/illegal behavior, financial/educational and social functioning). Results Young adults with a history of childhood disruptive mood dysregulation disorders had elevated rates of anxiety and depression and were more likely to meet criteria for more than one adult disorder as compared to controls with no history of childhood psychiatric problems (noncases) or subjects meeting criteria for psychiatric disorders other than disruptive mood dysregulation disorder in childhood/adolescence (psychiatric controls). Participants with a history of disruptive mood dysregulation disorder also were more likely to have adverse health outcomes, be impoverished, have reported police contact, and have low educational attainment as adults compared to either psychiatric or noncase controls. Conclusions The long-term prognosis of children with disruptive mood dysregulation disorder cases is one of pervasive impaired functioning that in many cases is worse than that of other childhood psychiatric cases.

Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

“…The core symptoms of DMDD may be expressed behaviorally but the condition is considered to be a mood-based disorder and follow-up studies indicate a high risk for internalizing disorders [5,6]. Given the recent conceptualization of DMDD, research published to date primarily consists of re-analysis of existing datasets using a DMDD proxy, where almost all symptoms of DMDD can be identified using questions from the ODD and major depressive disorder modules of structured diagnostic interviews.…”

“…Given the recent conceptualization of DMDD, research published to date primarily consists of re-analysis of existing datasets using a DMDD proxy, where almost all symptoms of DMDD can be identified using questions from the ODD and major depressive disorder modules of structured diagnostic interviews. Using this approach, community prevalence estimates of DMDD range from 0.8 to 3.3 % in adolescents [5,7] to 8.2 % in 6-year-old children [8]. DMDD is considerably more common in clinical samples (e.g., inpatients, clinically referred patients) with reported prevalence rates of 26-31 % [9,10].…”

“…DMDD has been associated with poor parent mental health [9,11], low levels of parental support [8], and high levels of parental hostility [8]. Children with DMDD are reported to be severely impaired, and receive low ratings of social and global functioning [5,7,8]. Children who meet criteria for DMDD are also at high risk for poor long-term outcomes including multiple psychiatric diagnoses, poor educational attainment, engagement in illegal activities, and impoverishment (as defined by the U.S. Census Bureau based on income and family size) [5].…”

“…Children with DMDD are reported to be severely impaired, and receive low ratings of social and global functioning [5,7,8]. Children who meet criteria for DMDD are also at high risk for poor long-term outcomes including multiple psychiatric diagnoses, poor educational attainment, engagement in illegal activities, and impoverishment (as defined by the U.S. Census Bureau based on income and family size) [5]. There is some evidence that these impairments and risks are conferred by DMDD status independently i.e., they persist after controlling for comorbid ODD, depression, anxiety, and ADHD [7,8].…”

Stability of Disruptive Mood Dysregulation Disorder Symptoms (Irritable-Angry Mood and Temper Outbursts) Throughout Childhood and Adolescence in a General Population Sample

“…Irritability has been investigated in some studies, but this has been confounded by other symptoms, as most diagnostic interview schedules and behavior rating scales used in research combine irritability with symptoms of oppositional defiant disorder (ODD) or depression in one item or prompt. For example, Copeland et al (2013Copeland et al ( , 2014 analyzed "negative mood" (defined as "depressed, sad, irritable, or angry mood or low frustration threshold," 2013, p. 174), which differs from DMDD because of its inclusion of sadness and depression as symptoms. Similarly, Leibenluft et al (2006) studied "chronic irritability" which was the total score on the Diagnostic Interview Schedule for Children home and school items "arguing a lot" and "temper tantrums."…”