Disruptive Mood Dysregulation Disorder: Yet Another Setback for Child Psychiatry

Child psychiatry has been on a zealous binge of creating diagnostic fads in recent years with three highly visible examples to its credit – childhood bipolar disorder, ADD and most recently, autism. Now, thanks to a scientific review group, there’s another possible contender, namely, Disruptive Mood Dysregulation Disorder (DMDD) that will be included in DSM-5.

There is no credible research on DMDD; it has been inadequately studied and is a completely untested diagnosis. A conservative prediction is that DMDD will do its part to continue fueling the fire pursuant to the already burgeoning diagnosis of mental disorders in youth – particularly bipolar.

If the aforementioned scientific review group’s intention is for DMDD to serve as a less risky and less stigmatizing replacement for childhood bipolar disorder, this is misguided. This is because DMDD will serve primarily as a diagnostic dumping ground for temperamental, yet normal kids who are going through a developmental stage they will eventually outgrow. The last thing these children need is an ill-defined, nebulous diagnosis hanging like an albatross around their necks.

Assessing and diagnosing mental health conditions in young people can be a menacing proposition. Co-existing conditions are the rule rather than the exception and there is considerable symptom overlap among the diagnoses with childhood onset. Discriminating clinicians understand the importance of taking maturational issues into account, obtain information from collateral sources to confirm their findings and discreetly conduct extensive interviews with the identified child and at least one parent.

It’s true that difficult to manage children are the source of much consternation to parents, teachers and even other kids. As such, eager and overly enthusiastic clinicians often feel pressured to please worried parents by labeling and treating a child – even in instances where it is not yet possible to make a diagnosis or pursue a safe and efficacious treatment. In such instances the mislabeled ill is accompanied by a pill – and too often nowadays the pill is an antipsychotic with its attendant risks of weight gain and metabolic complications. Disturbingly, this psychotropic medication class has clawed its way to $15 billion in annual revenue – achieved mostly through unlabeled use. The inclusion of DMDD in DSM-5 will more than likely be fodder for even more overuse of antipsychotics in children.

If it’s true that pediatric bipolar disorder is avidly overdiagnosed (mounting evidence supports this premise), then the NIMH and the FDA should step up educational campaigns – geared toward clinicians, parents and teachers – that focus on the difficulties inherent to diagnosing youngsters, the need for caution and the importance of employing restraint in the diagnosis and treatment of kids with temperamental outbursts. These agencies should also launch a series of media campaigns which clearly delineate the significant risks associated with the misuse of second-generation antipsychotics.
Laying the groundwork for the likely emergence of a new diagnostic fad ( DMDD) as a way to curtail an old one (BPD) is futile. The childhood bipolar conundrum should be faced head on; offering up DMDD as a new diagnostic alternative is utter foolishness.

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Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.