The Difference Between Oppositional Defiance (ODD) and DMDD
Children with disruptive mood dysregulation disorder (DMDD) may go through a couple diagnoses, including oppositional defiance disorder (ODD), in the beginning. This is partly because DMDD is a newer disorder, but it also looks like other illnesses--especially ODD. My son's first providers diagnosed him with ODD, and other DMDD parents have told me their kids also started with that diagnosis. There is, however, a subtle difference between the two.
Symptoms of ODD vs. DMDD Symptoms
Oppositional Defiant Disorder (ODD) Symptoms
Yes, the acronym is unfortunate. Whoever named the disorder clearly didn't have a child who might get labeled with it. That's a discussion for another post. For now, though, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, describes ODD as a pattern of three types of behaviors.
- Anger/Irritability -- The child often loses his temper, is easily annoyed or is angry/resentful most of the time.
- Argumentative/Defiant -- The child argues with adults, actively defies or refuses to comply with rules/requests, deliberately annoys people or blames others for his mistakes or misbehavior.
- Vindictiveness -- The child has been vindictive at least twice in the last six months
ODD is a tough label because it's often associated with conduct disorder (i.e. criminal behaviors). While the two can go together, ODD itself does not include criminal behavior. The symptoms can be scary, though, and the criteria include being purposefully annoying. So these kids get a bad rap.
Disruptive Mood Dysregulation Disorder (DMDD) Symptoms
Per the DSM-5, the following are the symptoms of DMDD:
- Severe recurrent temper outbursts that aren't developmentally appropriate. Outbursts result in verbal rages and/or physical aggression towards people and property, and these outbursts are out of proportion to the situation (e.g. my son once destroyed his bedroom and broke his window because we asked him to do homework).
- These outbursts occur three or more times a week.
- Even when not having an outburst, the child is observed as irritable or angry most of the day, nearly every day.
These symptoms have to go on for at least a year before a diagnosis is appropriate and they have to happen in two or more settings (like home and school).
Similarities Between ODD and DMDD
Both disorders involve a consistently angry and disruptive child. Children with ODD may not have explosive rages, but severe cases result in purposeful destruction or assault. Both disorders can involve children blaming their behavior on others or refusing to follow rules.
Things get even more complicated if a child has other disorders. ODD is an impulse control disorder, and my son's attention-deficit/hyperactivity disorder (ADHD) includes a lack of impulse control. DMDD's explosive outbursts look like the outbursts with intermittent explosive disorder (IED; also a poorly chosen acronym). Parsing it out can be confusing to parents.
The Differences Between ODD and DMDD
My son went into his psychiatric hospitalization with diagnoses of ADHD and ODD. After observing him daily, though, his hospital psychiatrist said he wasn't seeing ODD. Yes, the outward behaviors looked similar, but my son had a mood disorder. That's what triggered the behaviors, which is different from ODD.
Children with ODD, he explained, have intent behind their behavior. They want to anger or scare people. Children with DMDD may elicit the same responses from others, but it's not on purpose. In fact, kids with DMDD often feel deeply remorseful after outbursts. Children with ODD generally lack remorse.
The Right Diagnosis Can Change Your Life
The line between ODD and DMDD is an extremely fine one. Our duty as parents, then, is to advocate. If something isn't working, ask what can change. Maybe it's the treatment, or maybe it's the diagnosis. From my own experience with my son, I can say that, sometimes, the right diagnosis makes all the difference.
David, M. (2017, October 23). The Difference Between Oppositional Defiance (ODD) and DMDD, HealthyPlace. Retrieved on 2021, January 17 from https://www.healthyplace.com/blogs/parentingchildwithmentalillness/2017/10/the-difference-between-oppositional-defiance-and-dmdd
Author: Melissa David
HI! I was wondering if someone could help me... My 8 year old daughter was diagnosed with ADHD about a year and a half ago or so. Tried different meds, etc. About 3 months ago was also diagnosed with DMDD. Her Dr. has her on a med that she takes at night and seems to help some?? But wears off quickly. WHen she gets home from school she is a NIGHTMARE 99% of the time. Can't talk to her with out her being angry. She screams, calls herself stupid, says she hates herself, and God hates her and so does everyone else. So heartbreaking. She slams her fists on things, bangs her head into the wall ... We tried "ignoring" we tried hugging her, etc. Not much seems to help. Last weekend she had a friend over who she loves...normally. But it was constant fighting and rudeness from the word go. She screamed that she hated her and wanted her to leave... Which she did...but my daughter cried and screamed the whole time as I took her home, not wanting her to go. However, the next day was 100% different. She only whined once and 0 outbursts... What is the difference??? What causes it??? It is causing a strain between her father and I as well. We live in constant misery from the screaming, hateful outbursts. Her current therapist does not seem to be helping, and will always talk in front of her, when I feel it should be discussed with her out of the room. I think one issue may be her metabolizing her meds so quickly. She is 52" tall and weighs only 44lbs. She is on Ritalin 10mg ER and then has to take a non extended release 5mg pill at lunch. Her PCP will not up it because he feels like she is on enough stuff now and is afraid her sleep will be even worse. (She takes 10mg of Melatonin to get to sleep at night... which still takes about an hour or 2 to work enough for her to wind down)
Have you tried something other than melatonin? I used to give my son melatonin but it seemed to cause him to be irritable the next day. He's been put on a low dose of clonidine ,he still wakes up but seems to get a restful sleep. Also I noticed certain foods trigger him. Like snowballs, slushies, gummies.
I'm curious as to those of you managing life with these diagnoses, how do you deal with the never-ending blame leveled at mothers by pop psychology and pop culture?
I have a 42-year-old daughter who was labeled ODD as a child, and who has teetered on the edge many times in her adult life. She became involved with someone recently who seems to have convinced her that I had been the cause of all her problems, that there was no way her issues didn't stem from neglect, emotional invalidation and abuse from her mother.
Our life-long struggle to manage her anger and frustration was derailed and the accusations of my responsibility for her emotions and difficulties exploded.
I went with her to counseling for five months and listened to many hours of negative and aggressive emotions, without any connection to specific actions or even memories to explain why her feelings were my fault.
I would never claim to be a perfect parent, and yet even while I struggled with my own issues, I provided a stable, loving, and consistent home environment until she left home in anger at 17 and married a dominating much older man not long after she turned 18.
It seems social media is full of therapists and bloggers who lay all the blame for mental health issues on horrific, unloving, and emotionally bereft mothers.
It is the most excruciating experience to know that most people believe what she now says, without question. Less than five years ago she repeatedly said that I "believed in her too much" and now we no longer speak.
I don't have a strategy to adjust to this reality. I keep thinking I should write a book, but when I think about what to say, all I can think is that we tried so hard. It turns into a list of "this is what we did" and it seems self-serving somehow.
I really just want to scream and scream and scream into the abyss... why? why? why?
This thread is very helpful, I was wondering if anyone has successfully been treated for DMDD and what was prescribed?
Well i commented on 8-25-18 about raising my grandson cause my daughter passed away (his mom) and on the 25 they said he was adhd and dmdd well today they said he is dmdd and odd and put him on a med. And said meds dont alaways help. And he also seen his case worker and family partner, and he was in the room while we were talking about certain things and how and what to do when he acts up and what not to do ,well neless to say when we got home he started testing me and pushing my last nerve, i am at my wits in here,what i am asking is there books on this or other resources and does it ever get better he is 81/2 years old thanks
I’ve noticed that, as my son gets older, he’s able to grasp more ideas and skills. He still struggles (we’re kinda in a downward spiral right now) but it’s a different struggle than when he was 8. Facebook has several DMDD support groups worth searching for. There’s some information floating on the internet. DMDD is pretty new, though, so there’s not as much out there as you’d find on ADHD (or even ODD).
Thank you for the response. She has an appointment coming up which is why I was researching and came across you blog. I started reading through them from the beginning(I think) and was just in tears. I try to explain to people what's going on and they just don't get it. Several of your post could have been word for word situations we have had. It just really helped to know someone else knows what it's like. It's not just us dealing with these situations. You try to explain and people think "oh, so she threw a tantrum", but it is so much more than that, and she can't control it once it gets to that level. And you can't predict/prevent/avoid everything that may upset them.
I would love to hear how you & your daughter are doing. I'm in the exact same place right now. I just found this blog this morning (up at 4am because I can't sleep worrying about my daughter). They are testing her in Nov and I just found out this is what her Dr is thinking. As I'm reading about it, every thing is my life. I'm dealing with friends & family that think she's just a spoiled brat and we just let her get away with everything. I've found that medication helps her and she even admits that she feels better on it but she has stopped taking it. My husband and I have tried everything to get her to start it again but it's a solid No. It's a help to find other families that are dealing with the same thing.
I believe my child has been misdiagnosed. You mention that the right diagnosis makes all the difference. My question is what have the suggested treatment wise for a DMDD diagnosis. My daughter is diagnosed as far as I know with depressive disorder and general anxiety disorder. They have also mentioned bipolar, but that has not been diagnosed officially. The more I research, the more I believe she really has DMDD.
Hi, Sara! The tough thing about DMDD is that it’s a very new diagnosis. I’ve run into child and family therapists who haven’t even heard of it yet despite working with kids for years. Because it’s new, there’s also no “go to” treatment for it. In general, it looks a lot like the treatment recommended for childhood bipolar disorder and ODD. Therapy, high level school supports, and any in-home behavior assistance is helpful. Medication-wise, it seems common to go with mood stabilizers or medications that will take the edge off the aggression that comes with DMDD. My son initially had the depression disorder diagnosis, too, and took anti-depressants, and it didn’t seem to make a dent in his mood. If your daughter doesnt already have a psychiatrist, I’d set up an appt ASAP. If she does, talk to that person about DMDD and let them know if you don’t feel depression treatment is getting at whatever’s going on with your daughter. Keep in mind, she could actually have bipolar disorder or something else may be going on, too. Whatever the case, what matters is the status quo isn’t working and the psychiatrist needs to know. Your her best advocate! Doctors sometimes don’t listen the best to us, but we need to be very clear about what symptoms we’re seeing and what we feel may be missing. Hopefully your doctor hears you out!
Thank you for your blog this made me feel so much better. My son was hospitalised last year and was diagnosed odd. The day of discharge I. Called his psychiatrist who I never knew while he was hospitalised and told I disagree and that it was so much more than that not to mention both his father and I are bipolar but she dismissed me so my son was sent home with no meds and an odd diagnosis. Things got even worse and a month later my son was hospitalised again but this time I was able to get special permission from our insurance company to pay for a hospital in mass. There my son was diagnosed dmdd and ADHD. We left with meds and a diagnosis. With that diagnosis we were able to get him on another medication and things are so much better, I don't cry at night anymore. The first hospital wouldn't listen to anything I had to say but the second one did and I am forever grateful. It's so nice knowing I'm not alone
With dmdd they typically prescribe antipsychotic or antiseizure meds. Both help, it just depends on the child.