Article

Prevalence, Comorbidity, and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder

American Journal of Psychiatry (Impact Factor: 12.3). 02/2013; 170(2):173-9. DOI: 10.1176/appi.ajp.2012.12010132
Source: PubMed

ABSTRACT

Objective:
No empirical studies on the DSM-5 proposed disruptive mood dysregulation disorder have yet been published. This study estimated prevalence, comorbidity, and correlates of this proposed disorder in the community.

Method:
Prevalence rates were estimated using data from three community studies involving 7,881 observations of 3,258 participants from 2 to 17 years old. Disruptive mood dysregulation disorder was diagnosed using structured psychiatric interviews.

Results:
Three-month prevalence rates for meeting criteria for disruptive mood dysregulation disorder ranged from 0.8% to 3.3%, with the highest rate in preschoolers. Rates dropped slightly with the strict application of the exclusion criterion, but they were largely unaffected by the application of onset and duration criteria. Disruptive mood dysregulation co-occurred with all common psychiatric disorders. The highest levels of co-occurrence were with depressive disorders (odds ratios between 9.9 and 23.5) and oppositional defiant disorder (odds ratios between 52.9 and 103.0). Disruptive mood dysregulation occurred with another disorder 62%-92% of the time, and it occurred with both an emotional and a behavioral disorder 32%-68% of the time. Affected children displayed elevated rates of social impairments, school suspension, service use, and poverty.

Conclusions:
Disruptive mood dysregulation disorder is relatively uncommon after early childhood, frequently co-occurs with other psychiatric disorders, and meets common standards for psychiatric "caseness." This disorder identifies children with severe levels of both emotional and behavioral dysregulation.

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Available from: Helen Egger, Sep 29, 2015
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    • "Nevertheless, having the diagnosis at age six increased a child's risk for persistent DMDD. Similarly, cross-sectional data on the rates of DMDD across childhood (Copeland et al., 2013)and longitudinal data on normative irritability across childhood (Wiggins et al., 2014)demonstrate similar decreases in irritability after early childhood. In the only other study examining the stability of SMD and DMDD, Deveney and colleagues (2015) reported that in a clinical sample, 48.7% and 39.5% of youth (ages 7-17) with SMD continued to meet criteria for SMD at two-and four-year follow-ups, respectively. "
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    ABSTRACT: Background: Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. Method: A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. Results: DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. Conclusions: Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.
    Full-text · Article · Jan 2016 · Psychological Medicine
    • "D isruptive mood dysregulation disorder (DMDD), recently introduced in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed.'s (DSM-5) section on childhood and adolescent disorders, is characterized by a pervasive sad, irritable, or angry mood, occurring nearly every day, and punctuated by developmentally inappropriate temper outbursts that are grossly out of proportion to the immediate situation (American Psychiatric Association 2013). Its inclusion is intended to identify youth who show impaired mood and temper regulation across development, and distinguish them from youth who exhibit early manifestations of bipolar spectrum disorders (Copeland et al, 2013, 2014). This addition to the DSM-5 has preliminary support from both clinical and large longitudinal community samples suggesting that schoolage DMDD and chronic irritability predict higher levels of anxiety and depression, but not bipolar disorder, during later points in development (Copeland et al. 2014; Deveney et al. 2014). "
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    ABSTRACT: Objective: Reward-processing abnormalities are thought to be a key feature of various psychiatric disorders and may also play a role in disruptive mood dysregulation disorder (DMDD), a new diagnosis in DSM-5. In the current study, we used event-related potentials (ERP) sensitive to monetary gains (i.e., the reward positivity [RewP]) and losses (i.e., the N200) to examine associations between symptoms of DMDD during early childhood and later reward processing during preadolescence. Methods: To assess early emerging DMDD symptoms in a large longitudinal community sample (n=373) of 3-year old children, we administered a diagnostic interview, Preschool Age Psychiatric Assessment (PAPA) with parents. At a later assessment, ∼6 years later, children completed a monetary reward task while an electroencephalogram (EEG) was recorded. Children's lifetime history of psychopathology was also assessed at that time using Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with the child and parent. Results: Multiple regression analyses revealed that age 3 DMDD symptoms predicted an enhanced RewP to monetary rewards in preadolescence. This association is independent of demographics and lifetime history of symptoms of depression, any anxiety disorder, attention-deficit disorder, oppositional defiant disorder, or conduct disorder Conclusions: Early manifestations of DMDD in children as young as 3 years old predicted enhanced reward processing later in development. These findings add to the growing corpus of literature on the pathophysiology of DMDD, and underscore the predictive validity of preschool DMDD on a neural level.
    No preview · Article · Jan 2016 · Journal of Child and Adolescent Psychopharmacology
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    • "This observation informed the inclusion of Disruptive Mood Dysregulation Disorder in DSM 5.0 to capture children with persistent negative mood coupled with frequent behavioral outbursts (40). This disorder seems to do a good job of accounting for severe, non-episodic irritability (41), but still leaves questions about the more general of irritability in common childhood psychiatric disorders. "
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    ABSTRACT: Objective: Comorbidity between psychiatric disorders is common, but pairwise associations between two disorders may be explained by the presence of other diagnoses that are associated with both disorders or “indirect” comorbidity. Materials and Methods: Comorbidities of common childhood psychiatric disorders were tested in three community samples of children ages 6–17 (8931 observations of 2965 subjects). Psychiatric disorder status in all three samples was assessed with the Child and Adolescent Psychiatric Assessment. Indirect comorbidity was defined as A-B associations that decreased from significance to non-significance after adjusting for other disorders. Results: All tested childhood psychiatric disorders were positively associated in bivariate analyses. After adjusting for comorbidities, many associations involving a behavioral disorder and an emotional disorder were attenuated suggesting indirect comorbidity. Generalized anxiety and depressive disorders displayed a very high level of overlap (adjusted OR = 37.9). All analyses were rerun with depressive disorders grouped with generalized anxiety disorder in a single “distress disorders” category. In these revised models, all associations between and emotional disorder and a behavior disorder met our criteria for indirect comorbidity except for the association of oppositional defiant disorder with distress disorders (OR = 11.3). Follow-up analyses suggested that the indirect associations were primarily accounted for by oppositional defiant disorder and the distress disorder category. There was little evidence of either sex differences or differences by developmental period. Conclusion: After accounting for the overlap between depressive disorders with generalized anxiety disorder, direct comorbidity between emotional and behavioral disorders was uncommon. When there was evidence of indirect comorbidity, ODD, and distress disorders were the key intermediary diagnoses accounting for the apparent associations.
    Full-text · Article · Nov 2013 · Frontiers in Psychiatry
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