Mood Dysregulation Disorder

Mood dysregulation disorder (MDD) is a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts. The symptoms of MDD go beyond a “bad mood.” MDD symptoms are severe. Youth who have MDD experience significant problems at home, at school, and often with peers. They also tend to have high rates of health care service use, hospitalization, and school suspension, and they are more likely to develop other mood disorders.

MDD can be treated. If you are concerned that your child may have MDD, talk to your child’s pediatrician or health care provider.

What are the signs and symptoms of MDD –

Children or adolescents with MDD experience:

· Severe temper outbursts (verbal or behavioral), on average, three or more times per week

· Outbursts and tantrums that have been ongoing for at least 12 months

· Chronically irritable or angry mood most of the day, nearly every day

· Trouble functioning due to irritability in more than one place (at home, at school, and with peers)

Youth with MDD are diagnosed between the ages of 15 and 25. To be diagnosed with MDD, a child must have experienced symptoms steadily for 12 or more months.

Over time, as children grow and develop, the symptoms of MDD may change. For example, an adolescent or young adult with MDD may experience fewer tantrums, but they begin to exhibit symptoms of depression or anxiety. For these reasons, treatment may change over time, too.

Children with MDD may have trouble in school and experience difficulty maintaining healthy relationships with family or peers. They also may have a hard time in social settings or participating in activities such as team sports. If you think your child has MDD, it is essential to seek a diagnosis and treatment.

How is MDD diagnosed –

If you think your child may be experiencing symptoms of MDD, talk to your child’s health care provider. Describe your child’s behavior, and report what you have observed and learned from talking with others, such as a teacher or school counselor. An evaluation by your child’s health care provider can help clarify problems that may be underlying your child’s behavior, and the provider may recommend the next steps.

You also can ask your health care provider for a referral to a mental health professional who has experience working with children and adolescents. MDD symptoms also can occur at the same time as other disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety disorders. An accurate diagnosis is vital for effective treatment.

For more information about diagnosis and treatment of children and tips for talking to your health care provider, check out NIMH’s fact sheets, Children and Mental Health and Tips for Talking With Your Healthcare Provider.

How is MDD treated –

MDD is a newly classified disorder, and few MDD-specific treatment studies have been conducted to date. Current treatments are primarily based on research focused on other childhood disorders associated with irritability (such as anxiety and ADHD). Fortunately, many of these treatments also work for MDD. NIMH is currently funding studies focused on further improving these treatments and identifying new treatments specifically for MDD. It is important for parents or caregivers to work closely with their child’s doctor to make treatment decisions that are best for their child.

Treatment for MDD generally includes certain types of psychotherapy (“talk therapy”) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later. However, at times, providers recommend that children receive both psychotherapy and medication at the start of their treatment.

Psychotherapies –

Cognitive behavioral therapy (CBT) is used to help children and adolescents learn how to cope with thoughts and feelings that contribute to their feeling depressed or anxious. CBT for anxiety often includes exposing the child to situations that make them anxious so that they can learn to respond to those situations better. Clinicians can use similar techniques to teach children to increase their ability to tolerate frustration without having an outburst. This therapy also teaches coping skills for controlling anger and ways to identify and re-label the distorted perceptions that contribute to outbursts.

Researchers also are studying the use of dialectical behavior therapy for children (DBT-C) with MDD. This type of therapy may help children learn to regulate their emotions and avoid extreme or prolonged outbursts. In DBT-C, the clinician helps children learn skills that can help with regulating their moods and emotions.

It can be effective to combine therapy for the child or adolescent with parent training. Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert it. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior.

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