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Focus on Childhood and Adolescent Mental Health

Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study

David Axelson, MD; Robert L. Findling, MD, MBA; Mary A. Fristad, PhD, ABPP; Robert A. Kowatch, MD, PhD; Eric A. Youngstrom, PhD; Sarah McCue Horwitz, PhD; L. Eugene Arnold, MD; Thomas W. Frazier, PhD; Neal Ryan, MD; Christine Demeter, MA; Mary Kay Gill, MSN; Jessica C. Hauser-Harrington, PhD; Judith Depew; Shawn M. Kennedy, MA; Brittany A. Gron, BS; Brieana M. Rowles, MA; and Boris Birmaher, MD

Published: October 15, 2012

Article Abstract

Objective: To examine the proposed disruptive mood dysregulation disorder (DMDD) diagnosis in a child psychiatric outpatient population. Evaluation of DMDD included 4 domains: clinical phenomenology, delimitation from other diagnoses, longitudinal stability, and association with parental psychiatric disorders.

Method: Data were obtained from 706 children aged 6-12 years who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study (sample was accrued from November 2005 to November 2008). DSM-IV criteria were used, and assessments, which included diagnostic, symptomatic, and functional measures, were performed at intake and at 12 and 24 months of follow-up. For the current post hoc analyses, a retrospective diagnosis of DMDD was constructed using items from the K-SADS-PL-W, a version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which resulted in criteria closely matching the proposed DSM-5 criteria for DMDD.

Results: At intake, 26% of participants met the operational DMDD criteria. DMDD+ vs DMDD- participants had higher rates of oppositional defiant disorder (relative risk [RR]=3.9, P<.0001) and conduct disorder (RR=4.5, P<.0001). On multivariate analysis, DMDD+ participants had higher rates of and more severe symptoms of oppositional defiant disorder (rate and symptom severity P values <.0001) and conduct disorder (rate, P<.0001; symptom severity, P=.01), but did not differ in the rates of mood, anxiety, or attention-deficit/hyperactivity disorders or in severity of inattentive, hyperactive, manic, depressive, or anxiety symptoms. Most of the participants with oppositional defiant disorder (58%) or conduct disorder (61%) met DMDD criteria, but those who were DMDD+ vs DMDD- did not differ in diagnostic comorbidity, symptom severity, or functional impairment. Over 2-year follow-up, 40% of the LAMS sample met DMDD criteria at least once, but 52% of these participants met criteria at only 1 assessment. DMDD was not associated with new onset of mood or anxiety disorders or with parental psychiatric history.

Conclusions: In this clinical sample, DMDD could not be delimited from oppositional defiant disorder and conduct disorder, had limited diagnostic stability, and was not associated with current, future-onset, or parental history of mood or anxiety disorders. These findings raise concerns about the diagnostic utility of DMDD in clinical populations.

J Clin Psychiatry 2012;73(10):1342-1350

Submitted: January 26, 2012; accepted August 1, 2012(doi:10.4088/JCP.12m07674).

Corresponding author: David Axelson, MD, Western Psychiatric Institute and Clinic, 3811 O’ Hara St, Pittsburgh, PA 15213 (axelsonda@upmc.edu).

Volume: 73

Quick Links: Bipolar Disorder , Mood Disorders

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