The Concept of Bipolar Disorder in Children: A History of the Bipolar Controversy

Carlson, Gabrielle A.; Glovinsky, Ira

doi:10.1016/j.chc.2008.11.003

Cited by 41 publications

(38 citation statements)

References 33 publications

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“…Regardless of how chronic nonepisodic irritability is categorized diagnostically, there is consensus that it can be severely impairing and merits treatments 10,11,13,15. As an alternative to subsuming chronic irritability in children under bipolar disorder, Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5) created the diagnosis, disruptive mood dysregulation disorder (DMDD).…”

Section: Conceptualization Of Disruptive Mood Dysregulation Disordermentioning

confidence: 99%

Disruptive mood dysregulation disorder: current insights

Baweja¹,

Mayes²,

Hameed³

et al. 2016

NDT

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Disruptive mood dysregulation disorder (DMDD) was introduced as a new diagnostic entity under the category of depressive disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It was included in DSM-5 primarily to address concerns about the misdiagnosis and consequent overtreatment of bipolar disorder in children and adolescents. DMDD does provide a home for a large percentage of referred children with severe persistent irritability that did not fit well into any DSM, Fourth Edition (DSM-IV) diagnostic category. However, it has been a controversial addition to the DSM-5 due to lack of published validity studies, leading to questions about its validity as a distinct disorder. In this article, the authors discuss the diagnostic criteria, assessment, epidemiology, criticism of the diagnosis, and pathophysiology, as well as treatment and future directions for DMDD. They also review the literature on severe mood dysregulation, as described by the National Institute of Mental Health, as the scientific support for DMDD is based primarily on studies of severe mood dysregulation.

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Section: Conceptualization Of Disruptive Mood Dysregulation Disordermentioning

confidence: 99%

Disruptive mood dysregulation disorder: current insights

Baweja¹,

Mayes²,

Hameed³

et al. 2016

NDT

View full text Add to dashboard Cite

show abstract

“…The vast majority of such youth, and even some preschoolers, were primarily being treated with mood stabilizers and a new generation of antipsychotic drugs. As a result, there was a raging debate on the prevalence and presentation of pediatric bipolar disorder (Althoff, 2010; Biederman et al, 2004; Carlson and Glovinsky, 2009; Diler et al, 2009; Leibenluft, 2011; Mick et al, 2005). …”

Section: Historical Perspectivesmentioning

confidence: 99%

DSM-5: Disruptive mood dysregulation disorder

Rao

2014

Asian Journal of Psychiatry

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This paper will describe historical perspectives for the introduction of disruptive mood dysregulation disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria for the diagnosis, as well as information on epidemiology, clinical presentation and longitudinal course, pathophysiology, and treatment. The diagnosis of disruptive mood dysregulation disorder requires frequent, persistent, severe temper outbursts out of proportion to the situation and developmental context in combination with persistent, angry/irritable mood between the temper outbursts. Because of the limited available data, the inclusion of this new diagnosis in DSM-5 has been controversial. Regardless of this controversy, it is clear that youth experiencing such symptoms are highly impaired and utilize significant health services. Therefore, we need to expand our efforts to better understand the complex construct of this phenotype in order to improve the assessment, diagnosis and treatment of this condition.

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“…Conversely, some investigators argue that severe outbursts are the primary manifestation of mania in children, thus justifying the diagnosis of bipolar disorder, even in very young children (Wozniak et al 1995;Wilens et al 2003). This diagnostic practice has likely contributed to the 40-fold increase in bipolar diagnoses in children since the late 1990s (Moreno et al 2007;Carlson and Glovinsky 2009). To address this diagnostic controversy, at least in adolescence, Leibenluft et al compared adolescents with distinct manic episodes who fulfilled American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed.…”

mentioning

confidence: 99%

Clinical Features of Young Children Referred for Impairing Temper Outbursts

Roy

Klein

Angelosante

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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Objective: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. Methods: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 nonreferred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. Results: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. Conclusions: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.

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The Concept of Bipolar Disorder in Children: A History of the Bipolar Controversy

Cited by 41 publications

References 33 publications

Disruptive mood dysregulation disorder: current insights

Disruptive mood dysregulation disorder: current insights

DSM-5: Disruptive mood dysregulation disorder

Clinical Features of Young Children Referred for Impairing Temper Outbursts

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