Disruptive Mood Dysregulation Disorder (DMDD)

• Disruptive mood dysregulation disorder (DMDD) and major depressive disorder (MDD) are distinct mood disorders with overlapping features, especially in children and adolescents.

Diagnostic Criteria: Disruptive Mood Dysregulation Disorder (DMDD)

• DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.
• Outbursts occur, on average, three or more times per week.
• The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others.
• These symptoms have been present for at least 12 months, and the individual has not had a period lasting more than three consecutive months without the symptoms.
• Symptoms are present in at least two settings (e.g., at home, at school, with peers) and are severe in at least one of these settings.
• The diagnosis should not be made for the first time before age 6 years or after age 18 years.
• By history or observation, the age of onset of the first symptoms must be before 10 years.
• There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for manic or hypomanic episode have been met.
• The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
• The symptoms are not attributable to the physiological effects of a substance or another medical or neurological condition.

Diagnostic Criteria: Major Depressive Disorder (MDD)

• MDD involves a persistent sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.
• Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
  • Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others.
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  • A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The episode is not attributable to the physiological effects of a substance or another medical condition.

Diagnostic Criteria: Premenstrual Dysphoric Disorder (PMDD)

• In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
• One or more of the following symptoms must be present:
  • Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection).
  • Marked irritability or anger or increased interpersonal conflicts.
  • Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  • Marked anxiety, tension, or feelings of being keyed up or on edge.
• One or more of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from above.
  • Decreased interest in usual activities.
  • Subjective difficulty in concentration.
  • Lethargy, easy fatigability, or marked lack of energy.
  • Marked change in appetite, overeating, or specific food cravings.
  • Hypersomnia or insomnia.
  • A sense of being overwhelmed or out of control.
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain.
• The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others.
• The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).
• Criteria A should be confirmed by prospective daily ratings during at least two symptomatic cycles.

Treatment Options: Disruptive Mood Dysregulation Disorder (DMDD)

• Psychotherapy: Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are used to teach coping skills, emotional regulation, and problem-solving strategies.
• Parent Training: To help parents manage their child’s behavior and improve family interactions.
• Medication: Though no medications are specifically approved for DMDD, antidepressants (SSRIs), mood stabilizers, or atypical antipsychotics may be used to manage symptoms such as irritability and aggression.

Treatment Options: Major Depressive Disorder (MDD)

• Psychotherapy: CBT, interpersonal therapy (IPT), and psychodynamic therapy are effective in treating MDD.
• Medication: Antidepressants, such as SSRIs, SNRIs, tricyclic antidepressants, and atypical antidepressants, are commonly prescribed.
• Other Treatments: Electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be considered for severe or treatment-resistant depression.

Treatment Options: Premenstrual Dysphoric Disorder (PMDD)

• Lifestyle Changes: Regular exercise, a healthy diet, and stress reduction techniques can help manage symptoms.
• Medication: SSRIs can be used to treat the mood symptoms of PMDD. Oral contraceptives may also be prescribed to regulate hormonal fluctuations.
• Psychotherapy: CBT can help manage mood symptoms and improve coping skills.

Symptom Comparison

• DMDD: Primarily involves severe irritability, anger, and frequent temper outbursts.
• MDD: Characterized by persistent depressed mood and loss of interest or pleasure.
• PMDD: Mood symptoms are specifically related to the menstrual cycle.

Biological Factors

• DMDD: May involve abnormalities in brain regions that regulate emotions, such as the amygdala and prefrontal cortex. Genetic factors may also play a role.
• MDD: Linked to imbalances in neurotransmitters, such as serotonin, norepinephrine, and dopamine. Genetic vulnerability and environmental stressors contribute to the development of MDD.
• PMDD: Related to hormonal fluctuations, particularly changes in estrogen and progesterone levels.

Co-occurring Conditions

• DMDD: Often co-occurs with ADHD, anxiety disorders, and oppositional defiant disorder.
• MDD: Commonly co-occurs with anxiety disorders, substance use disorders, and personality disorders.
• PMDD: Can co-occur with other mood disorders, such as MDD and anxiety disorders.

Differential Diagnosis

• DMDD vs. MDD: DMDD is characterized by chronic irritability and frequent temper outbursts, while MDD involves discrete depressive episodes.
• DMDD vs. Bipolar Disorder: DMDD does not involve distinct periods of mania or hypomania.
• MDD vs. Bipolar Disorder: MDD does not include any history of manic or hypomanic episodes.
• PMDD vs. MDD: PMDD symptoms are specifically tied to the menstrual cycle, whereas MDD symptoms are more persistent.
• PMDD vs. PMS: PMDD symptoms are more severe and impairing than typical premenstrual syndrome (PMS) symptoms.