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Commentary: Concerns Regarding the Inclusion of Temper Dysregulation Disorder With Dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

David A. Axelson, MD; Boris Birmaher, MD; Robert L. Findling, MD; Mary A. Fristad, PhD; Robert A. Kowatch, MD; Eric A. Youngstrom, PhD; L. Eugene Arnold, MD, MEd; Benjamin I. Goldstein, MD, PhD; Tina R. Goldstein, PhD; Kiki D. Chang, MD; Melissa P. DelBello, MD; Neal D. Ryan, MD; and Rasim S. Diler, MD

Published: May 3, 2011

Article Abstract

The authors strongly oppose including temper dysregulation disorder with dysphoria (TDD) as an official diagnosis in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The primary justification for the inclusion of this new diagnostic category is to have an alternate diagnosis for youths with severe, chronic irritability who may be currently diagnosed with bipolar disorder. However, the TDD diagnosis, as it is currently conceived, introduces problems of its own. The diagnosis of TDD rests on 2 primary criteria: recurrent severe temper outbursts and chronically irritable and/or sad mood. Because temper outbursts are a behavioral manifestation of irritable mood, the diagnosis of TDD as it is currently proposed, can be fulfilled with the presence of a single symptom, making it unlikely to be categorically distinct from oppositional defiant disorder, for example. Scientific support for the TDD diagnosis is limited, and most of it has emerged from a single research group. In the case of TDD, most of the studies that have a bearing on children with TDD have focused an overlapping but distinct population of youths with severe mood dysregulation (SMD). The research on SMD is groundbreaking, and it demonstrates that a subgroup of youths with severe, chronic irritability does not have bipolar disorder, but it is insufficient to justify the inclusion of TDD, a new diagnostic category, in the DSM-5.

Volume: 72

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