Condition

DMDD (disruptive mood dysregulation disorder)

also known as disruptive mood dysregulation disorder

Medically reviewed by the Shrinkopedia editorial team, led by Shariq Refai, MD, MBA, FAPA.

8 min read · 1,701 words

Medically reviewed . Reviewed by a board-certified psychiatrist before publication.
Sourced from primary literature . DSM-5-TR, NICE, the American Psychiatric Association, the NIMH, Cochrane, peer-reviewed research.
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Quick answer

> "Disruptive mood dysregulation disorder is a childhood condition marked by severe, frequent temper outbursts and a persistently irritable or angry mood between them. It was added to the DSM in 2013." (Shrinktionary's definition)

DMDD describes kids who aren't just having a rough patch. They explode several times a week, and in between they're grumpy, snappy, and on edge most of the day. It lasts a year or more and shows up at home, at school, and with friends. The diagnosis was created partly to stop chronically irritable children from being labeled with bipolar disorder, which is a different condition with a different course. Treatment borrows from what works for related problems: parent training, therapy, and sometimes medication.

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Symptoms and key features

Under DSM-5-TR, DMDD requires:

severe temper outbursts, in words or actions, far out of proportion to the situation and to the child's age
outbursts about three or more times a week on average
an irritable or angry mood most of the day, nearly every day, between outbursts, noticeable to others
symptoms for 12 months or longer, without a break of three months or more
symptoms in at least two settings (home, school, peers) and severe in at least one
first diagnosed between ages 6 and 18, with symptoms starting before age 10

What it looks like

A nine-year-old is asked to turn off a video game. She throws the controller, screams for twenty minutes, and kicks a hole in her bedroom door. The next day it happens over the wrong cereal. Her teacher describes her as "always on the edge of losing it," and she's been sent to the office four times this month. Her parents say the part that wears them down isn't the explosions. It's the constant crankiness in between, like living with a thundercloud.

Many families describe walking on eggshells. Siblings get hurt or learn to hide. Friendships fall apart because other kids get scared or tired of it. The child often feels terrible afterward and can't explain why it happened.

What people often confuse this with

Bipolar disorder. Mania comes in distinct episodes: days of elevated or irritable mood, less need for sleep, racing thoughts, and big changes from the child's usual self. DMDD is steady, chronic irritability. Long-term research by Leibenluft found that chronic irritability in youth is linked to later anxiety and depression, not bipolar disorder.

Oppositional defiant disorder. ODD centers on arguing, defiance, and rule-breaking with authority. Kids with ODD can be irritable, but DMDD's outbursts are more severe and the mood between them is more constantly angry.

ADHD. ADHD brings impulsivity and frustration, and the two often occur together. ADHD alone doesn't usually include a persistently angry mood.

Normal tantrums. Toddlers and preschoolers melt down a lot. That's why DMDD isn't diagnosed before age 6.

Depression or anxiety. In children, depression and anxiety can show up as irritability. A good evaluation looks for them.

Reality check

Myth: DMDD is just bad parenting.

Parenting shapes how outbursts play out, but DMDD is a recognized condition, and loving, skilled parents have children with it.

Myth: DMDD is childhood bipolar disorder under a new name.

The research points the other way. Chronic irritability tends to lead toward anxiety and depression, not mania.

Myth: They'll grow out of it, so there's no need to do anything.

Symptoms often ease with age, but years of explosions can cost a child friendships, schooling, and self-esteem along the way. Treatment is worth it.

What research says

It's uncommon after early childhood. A community study by Copeland and colleagues found three-month prevalence of DMDD criteria ranged from 0.8 to 3.3 percent across three samples, highest in preschoolers.
It rarely comes alone. In the same study, DMDD co-occurred with another psychiatric disorder 62 to 92 percent of the time. Affected kids had more social problems, school suspensions, and service use.
It predicts anxiety and depression. NIMH notes children with DMDD are more likely to develop anxiety and depression later.
Treatment trials are few. The citalopram trial had 49 participants. Larger studies are underway.

When to seek care, and when it's urgent

Talk to a pediatrician or child mental health clinician when outbursts happen most weeks, a bad mood hangs around most days, and it's getting in the way of school, friendships, or family life. A good first step is keeping a short log for two weeks: what happened before each outburst, how long it lasted, and how the day went.

It's urgent when a child is hurting themselves or others, talks about wanting to die, or can't be kept safe at home. Call or text 988 in the US, or call 911 in an emergency.

What we know and what we don't know

What we know

DMDD requires severe outbursts about three times a week plus a persistently irritable mood for at least a year, across settings.
It often occurs with ADHD, anxiety, and other conditions.
Chronic irritability in children is linked to later anxiety and depression.

What we don't know

What causes it.
Which treatments work best. Only a handful of DMDD-specific trials exist.
How best to help teenagers whose symptoms continue into adulthood.

Questions people ask

Why was DMDD created?

In the 2000s, more and more children were being diagnosed with bipolar disorder, many of them kids whose main problem was constant irritability and explosive outbursts rather than clear manic episodes. DMDD was added to the DSM in 2013 to give those children a more accurate diagnosis.

Can adults have DMDD?

It's diagnosed only between ages 6 and 18. Adults with long-standing anger and outbursts might be evaluated for intermittent explosive disorder, depression, or other conditions.

Does DMDD go away?

Symptoms often lessen with age. Many kids with DMDD go on to have anxiety or depression, so ongoing care and check-ins make sense.

Is medication necessary?

Not always. Parent training and therapy come first for many families. Medication is considered when outbursts are severe or when ADHD or anxiety is part of the picture.

How can I handle an outburst in the moment?

Stay as calm as you can, keep your words few, and make sure everyone's safe. Save the talking and consequences for later, when everyone's settled. A clinician can help you build a plan that fits your child.

How it's diagnosed

A child psychiatrist, psychologist, or pediatrician diagnoses DMDD after a detailed history from parents, the child, and usually the school. Rating scales and school reports help show whether symptoms happen across settings. The clinician checks the timeline carefully: a child whose irritability started last month after a move is in a different situation from one who's been like this for years.

DSM-5-TR sets some rules about overlap. DMDD can't be diagnosed alongside oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder. If a child meets criteria for both DMDD and ODD, only DMDD is diagnosed.

Why it happens

The causes aren't known. NIMH says researchers are studying environmental, social, and biological factors. In Leibenluft's review, chronically irritable children had more trouble labeling emotions on faces and reacted to frustration more strongly than other kids, which fits what parents see when a small disappointment sets off a big explosion. Stress at home can make outbursts harder to manage. That isn't the same as saying parents caused it.

Treatment

Because DMDD is new, NIMH notes that few treatments have been studied specifically for it. Most care borrows from what helps ADHD, ODD, and anxiety.

Parent training. Parents learn to predict triggers, stay calm during outbursts, reward calm behavior consistently, and use clear, predictable consequences. It sounds simple. It's hard work, and it helps.

Therapy for the child. CBT adapted for irritability teaches the child to notice anger rising, tolerate frustration, and try another response. Some programs add exposure to frustration in small, manageable doses.

Medication. No medication is approved specifically for DMDD. Stimulants are often used when ADHD is also present. A small randomized trial by Towbin and colleagues found that adding the SSRI citalopram to a stimulant led to more responders than stimulant plus placebo (35 percent versus 6 percent), though functional impairment didn't differ between groups. Antipsychotics are sometimes used for severe aggression, with real side effect tradeoffs.

School support. A 504 plan or IEP can give the child a place to cool down and a consistent approach across teachers.

Sources

National Institute of Mental Health. Disruptive Mood Dysregulation Disorder (DMDD).
Copeland WE, Angold A, Costello EJ, Egger H. Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. American Journal of Psychiatry. 2013;170(2):173-179.
Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of Psychiatry. 2011;168(2):129-142.
Towbin K, Vidal-Ribas P, Brotman MA, et al. A double-blind randomized placebo-controlled trial of citalopram adjunctive to stimulant medication in youth with chronic severe irritability. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(3):350-361.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.

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How to cite this page

Short: DMDD (disruptive mood dysregulation disorder). Shrinkopedia, medically reviewed by Shariq Refai, MD, MBA. https://shrinkopedia.com/conditions/disruptive-mood-dysregulation-disorder/
APA: Shrinkopedia. (2026, September 24). DMDD (disruptive mood dysregulation disorder). Medically reviewed by Shariq Refai, MD, MBA. https://shrinkopedia.com/conditions/disruptive-mood-dysregulation-disorder/
MLA: "DMDD (disruptive mood dysregulation disorder)." Shrinkopedia, 24 Sept. 2026, https://shrinkopedia.com/conditions/disruptive-mood-dysregulation-disorder/.

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Medical disclaimer

Shrinkopedia is for education, not medical advice. It can't diagnose your child, and it isn't a substitute for care from a licensed clinician.

If you're in crisis or thinking about harming yourself, call or text 988 in the US to reach the Suicide and Crisis Lifeline, or call 911.

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Editorial guidance

When evaluation may help

Reading a reference is not the same thing as being evaluated. If what you just read matches your own experience closely, if the pattern has been getting in the way of work, relationships, or daily life, or if you have questions that only a clinician who knows your situation can answer, a professional evaluation is a reasonable next step. Reading forward without seeking evaluation is also a reasonable choice for many people. There isn't one right answer.

A few honest options, presented in no particular order:

Your primary care doctor. Often the fastest way to begin. A family doctor or internist can do an initial screen, rule out medical contributors, and refer you to a psychiatrist or therapist if that's the right next step. This is the entry point most people already have.
A therapist through Psychology Today or your insurance panel. Search Psychology Today by location and specialty, or call the member services number on your insurance card and ask for the in-network therapists near you. Look for someone trained in the treatments Shrinkopedia describes for dmdd (disruptive mood dysregulation disorder).
A psychiatrist. If medication is likely to be part of the picture, or the situation is complex, a psychiatrist is the clinician to see. Wait times are often long, so book earlier rather than later. Ask about telepsychiatry if in-person options are limited where you live.
shrinkMD if telepsychiatry fits. Disclosure: shrinkMD is an independent multistate telepsychiatry practice founded by Shariq Refai, MD, MBA, who is also the medical editor of Shrinkopedia. Shrinkopedia takes no referral or affiliate commission for care. We name shrinkMD here because it is transparently one option, not because we recommend it above other qualified clinicians. shrinkMD provides adult outpatient psychiatric evaluation, medication management, and follow-up care through secure virtual appointments. If it fits your situation, you can start care at shrinkMD. Other qualified psychiatrists in your area or through your health plan will do this same work.
If you are in crisis or thinking about harming yourself. Call or text 988 in the US, 24 hours a day, to reach the Suicide and Crisis Lifeline. Call 911 or go to an emergency room for immediate danger. This is not the moment to search for a new psychiatrist.

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