Utility of DMDD diagnosis in child psychiatric patients questioned

By Andrew Czyzewski

In children admitted to a psychiatric unit with serious behavioral problems, use of the new diagnosis concept of disruptive mood dysregulation disorder (DMDD) may go some way to reducing diagnoses of bipolar disorder, research shows.

However, this was largely dependent on whether parent report or observation was used and the researchers say the "overall utility of the DMDD diagnosis remains to be seen."

Study co-author Gabrielle Carlson (Stony Brook University Medical Center, New York, USA) and colleagues note that the frequency of bipolar disorder diagnoses in children has risen dramatically in recent decades. This is a potential concern since it carries with it a lifetime of exposure to medication.

As a result, the DSM-V committee has been debating returning bipolar I disorder to the more narrow phenotype, and, at least in children, relabeling and expanding the definition of severe mood dysregulation into a proposed condition, DMDD.

In the current study Carlson et al tested the implementation of DMDD in 82 children aged 5-12 years who were admitted to a university hospital children's inpatient psychiatric unit.

Based on interviews with the children and their parents, 25 (30.5%) children met the criteria for DMDD defined as having both severe irritability and superimposed explosive outbursts that had been occurring several times a week, after excluding diagnoses of mood, psychosis, developmental disorder, or post-traumatic stress disorder.

By contrast, observation by clinicians found only 13 (15.9%) children with definite DMDD, owing partly to the detection of other disorders that precluded DMDD.

In all, 46 (56%) children showed evidence of manic symptoms, from parent reports and were thus considered to be at possible risk for being diagnosed with bipolar disorder.

Of these 46 children, 21 (45.7%) met criteria for DMDD by parent-report, though only eight (17.4%) did when observed on the inpatient unit.

Thus, at most, 21 children from a total of 82 might have avoided false-positive diagnosis of bipolar disorder.

While the majority of children with DMDD had comorbid attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) - the converse was not true. As such, Carlson et al say "it is not clear whether DMDD is a distinct condition."

"The likelihood is that if DMDD criteria are strictly followed, this alternative condition would not provide a better diagnostic home for the majority of children, somewhat defeating its raison d'etre," they conclude in Bipolar Disorders.

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