In recent years, the number of children diagnosed with bipolar disorder has increased. In fact, it is estimated that between 1 and 2% of children suffer from this problem. However, there are times when the symptoms do not fully correspond to bipolar disorder; in this case, we refer to disruptive mood dysregulation disorder, a new category proposed in DMS-5 to indicate conditions in which irritability predominates.
This is a type of “chronic anger”, a mood that lasts most of the day and causes children to have fits of rage, which can manifest itself in an aggressive way, such as breaking and throwing objects or attacking people around them or harming themselves. This disorder is more common in boys and its course will depend on many factors, including early diagnosis and treatment.
Studies on disruptive mood dysregulation disorder do not reveal a hereditary pattern. In fact, it has been found that only 2.7% of children with this problem have a parent who suffers from a mood disorder.
Symptoms of disruptive mood dysregulation disorder
This disorder can be diagnosed in children or adolescents up to 19 years of age, and is characterized by:
– Severe and recurrent outbursts of anger , which may manifest themselves verbally or behaviorally, and which are considered completely disproportionate to the cause that provoked them. Tantrums and/or aggression, either towards people or property, are common.
– The anger outbursts are not age-appropriate , which means that they are based on an inability to implement the behaviour control mechanisms that a child is expected to have developed by reaching a certain level of maturity. In fact, this diagnosis is inappropriate for children under 6 years of age.
– Anger attacks are frequent and occur, on average, three or more times a week.
– Between fits of anger, the child maintains an irritable and irascible mood , which can be noticed by the people around him.
In terms of time, for a diagnosis of disruptive mood dysregulation disorder to be made, these symptoms must have been present for more than a year, during which time the mood must have been present for at least three consecutive months. In addition, the symptoms must be present in different contexts, such as at home, at school, and with peers.
How does a child with disruptive mood dysregulation disorder behave?
Children with this problem tend to explode in any situation, especially those that generate a feeling of frustration. In this case, they may have tantrums, utter bad words, act violently towards people around them and break or throw things.
He is also visibly irritated; any situation, no matter how trivial, can trigger a disproportionate response, so parents often feel like they are walking on eggshells, as they do not know when the next fit of anger will occur or what will trigger it.
The disorder usually begins before the age of 10, although its symptoms will vary as the child grows. However, it is estimated that approximately half of the children with this problem will continue to suffer from it after years. Even so, the worst prognosis is for children who have shown an irritable temperament from a very young age.
When does irritability become a disorder?
It is estimated that approximately 81% of children under 6 years of age have tantrums. Approximately 20% of these cases develop severe and recurrent episodes of irritability. When does irritability become a psychological disorder?
Typically, as the nervous system matures, the child is able to better manage his or her behavior, learn to deal with frustration, and find a more assertive outlet for negative emotions. However, some children fail to do this, and disruptive mood dysregulation disorder may develop.
In fact, it has been observed that these children have difficulties in recognizing emotions in people’s faces and respond with significant stress to complicated tasks. In practice, these children would have problems recognizing emotions, both their own and those of others, which has been confirmed by magnetic resonance techniques, which have revealed a lower activation of the amygdala during emotion recognition tests.
This inability to recognize the first signs of emotions prevents them from being stopped in time, so frustration and anger increase more and more, leading to fits of rage. We cannot forget that, ultimately, irritability is nothing more than a consequence of the inability to control the mental processes of selective attention, in order to inhibit maladaptive responses to frustration.
Thus, irritability, which may be normal in a 6-year-old child, becomes a disorder when it remains the preferred response of an older child. Furthermore, for irritability to become a psychopathology, it must lead to fits of anger that affect the child’s performance in different areas and profoundly alter the family dynamics.
The consequences of disruptive mood dysregulation disorder
This problem often has significant repercussions on family dynamics. Parents often feel disoriented and helpless, as they are unable to control their child’s impulsiveness. Therefore, it is not unusual for them to lose patience and apply disproportionate punishments, which can end up causing defiant and oppositional behavior. For these families, it is difficult to find a balance, so their daily life often becomes a war without quarter.
The child suffering from this disorder also experiences its consequences. In fact, due to their irritability, relationships with classmates or friends in the neighborhood are often affected. In addition, as they have a low tolerance for stress and frustration, they often have difficulty progressing in school and find it difficult to enjoy school or family activities in which most children participate.
Furthermore, one of the main problems associated with disruptive mood dysregulation disorder is that it has high rates of comorbidity, meaning that it rarely appears alone. In fact, it frequently overlaps with oppositional defiant disorder and attention deficit hyperactivity disorder.
Why is this diagnosis so important?
– Diagnosis gives meaning. When parents are going through a difficult situation with their children, being able to reach a diagnosis suddenly gives them meaning to everything they have experienced; it is the answer to the questions they have been asking themselves for years. It allows them to understand what was happening and, in many cases, it is also a relief because they understand that it was not their fault.
– Access to more appropriate treatment. By including this new entity, children are no longer labelled as bipolar when they are not. This way, they can receive more appropriate treatment and have a greater chance of overcoming the disorder.
References:
APA (2014) Manual Diagnóstico y Estadístico de los Trastornos Mentales. Madrid: Editorial Médica Panamericana.
Leibenluft, E. (2010) Severe Mood Dysregulation, Irritability, and the Diagnostic Boundaries of Bipolar Disorder in Youths. The American Journal of Psychiatry; 168(2): 129-142.
Brotman, M. A. et. Al. (2010) Amygdala Activation During Emotion Processing of Neutral Faces in Children With Severe Mood Dysregulation Versus ADHD or Bipolar Disorder. The American Journal of Psychiatry; 167(1): 61-69.
