Life with Disruptive Mood Dysregulation Disorder (DMDD)
Most people don't know what life with disruptive mood dysregulation disorder (DMDD) is like. But if your child is perpetually angry and irritable or you walk on eggshells for fear of triggering terrifying outbursts, these behaviors may point to disruptive mood dysregulation disorder, a childhood mood disorder that can lead a child and his or her parents on a scary and frustrating journey.
The Complex Road to a DMDD Diagnosis
Diagnosing a child is hard. I'm a licensed mental health provider and I didn't even know DMDD existed. (In my defense, I work with adults, and DMDD is pretty new. See the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition changes). One problem is that disorders like DMDD include symptoms found in many other disorders. Children may get misdiagnosed with countless other things before making it to DMDD. They may have multiple disorders happening at once, so DMDD gets missed because professionals stopped looking after the first diagnosis. My own son's journey took years.
Disruptive Mood Dysregulation Disorder and ADHD
There is no debate my son has attention-deficit/hyperactivity disorder (ADHD). Look up ADHD diagnostic criteria, and there might as well be a picture of him next to it. Stimulants and behavior modification weren't getting at everything, though, and ADHD didn't quite capture his intense moods.
For awhile, the doctors thought it was just depression. He exhibited many of the childhood symptoms: irritability, sleep difficulties, and suicidal thoughts (Recognizing Symptoms of Depression in Teens and Children). They also diagnosed him with anxiety. This is common: both depression and anxiety are seen in kids with DMDD and ADHD. He still holds the anxiety diagnosis.
The biggest problem, though, was anger. My son was angry when he was depressed. He was angry when he wasn't. He was angry at home and school. Anything could trigger outbursts that ended with our house in shambles. The outburst that got him hospitalized happened in the car, seemingly triggered when my daughter started humming. My son started screaming, unbuckled himself, and began assaulting the both of us. He didn't stop until we were in the Emergency Room and security guards isolated him in a back room. To this day, he doesn't remember having that outburst or why it happened.
DMDD and Oppositional Defiant Disorder
By the time he was hospitalized, my son had already been labeled with oppositional defiant disorder (ODD). The main indicator was his interactions with authority. His outbursts tended to happen in response to teachers or parents. It never happened with other kids.
What a psychiatrist at the hospital pointed at, though, was the intent behind his defiance. Kids with ODD deliberately defy or annoy others. My son's intent wasn't to deliberately hurt anybody. He suffered from rigid thinking, anxiety, and an inability to control his emotions. In fact, he usually felt deep remorse and shame after coming out of his rages. He's not a defiant kid. He's a dysregulated one.
Treating Disruptive Mood Dysregulation Disorder
One thing that pointed to my son's DMDD was medication. It's a weird system when the way to confirm a diagnosis is to see if the treatment works, but that's what happened. The psychiatrist put my son on a mood stabilizer, and there was an immediate effect. As a mental health professional, I knew the side effects of the medication they prescribed. I was scared. However, the effects absolutely outweighed my fears. We have moments of peace at home now. Outbursts do happen, but they're fewer and less intense. Even better: my son seems capable of feeling content.
Life with DMDD is complicated. You have to work closely with doctors, schools, and family when dealing with a disorder this intense and intricate. It's the only way to get it diagnosed appropriately. It's the only way to manage it, and it's the only way to keep from being overcome by it.
David, M. (2017, May 1). Life with Disruptive Mood Dysregulation Disorder (DMDD), HealthyPlace. Retrieved on 2019, June 23 from https://www.healthyplace.com/blogs/parentingchildwithmentalillness/2017/05/walking-on-eggshells-life-with-disruptive-mood-dysregulation-disorder
Author: Melissa David
He made great strides in Elementary but as Middle school expected more independence and organization of him, he began a downward spiral of defiance and outbursts. The school focused on minimizing the amount of disruption he has causing the class, they moved him to classes that had less structure so he could "learn" independent working and organizational skills. The reduced workload mentally board him resulting in him working down to expectations and mimicking behaviors of other disruptive children in order to get attention.
He is now in his 1st year of Junior High (8th grade) and as expected with the onset of puberty came ramped up behaviors. He is now my height and 1/2 a foot taller than my wife. He has the intellect of of one slightly above his age in raw knowledge, but due to a late start in school and socialization before being placed in foster care, he is behind his peers in reading, a choppy writing style and common place ideas (metaphors, inferences, etc.).
Emotionally he is around 3 years behind his peers. We tried to have the school hold him back in 1st grade so he would be developmentally better able to handle environmental situations and peer interactions, but to no avail.
We face the same situation now. The school is focusing on his organization and record keeping of assignment rather than making sure the work GETS Home. We can make sure he does it and that it leaves the house with him, but we can't make him bring it home or turn it in. (The grades he gets for the work that he has passed in are A's & B's)
It's the oppositional defiance behavior that has him refusing meet the organizational goals they ask of him. At this point we knew this was beyond us and therapy alone.
The Medications help... to a point, but he is still having almost daily outbursts with teachers and has tried to use his size to intimidate my wife.
He wants to do the same things with the same freedoms of other teenagers. But we don't honestly trust him to maintain control with out one of us around for more than an hour or two.
If you are willing to share, I am so curious about which medication he is on, the adjustment period and the different side effects he encountered. Thank you
It is good to know that we are not in this alone. Now to get the school to understand his diagnosis so they to can better serve him and help in school.
Or at nite