Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience persistent irritability and anger and frequent, intense temper outbursts. Many children go through periods of moodiness, but children with DMDD experience severe symptoms and often have significant problems at home and school. They may also struggle to interact with peers. While there is no treatment specifically for DMDD, researchers are working to improve existing treatment options and identify possible new treatments.
Signs and symptoms
Children and adolescents with DMDD experience:
- Severe temper outbursts (verbal or behavioral), on average, three or more times per week
- Outbursts and tantrums that have been ongoing for at least 12 months
- Chronically irritable or angry mood most of the day, nearly every day
- Trouble functioning due to irritability in more than one setting, such as at home, at school, or with peers
Youth with DMDD are typically diagnosed between the ages of 6 and 10. To be diagnosed with DMDD, a child must have experienced symptoms steadily for 12 or more months.
It is not clear how widespread DMDD is in the general population, and the exact causes of DMDD are not clear. Researchers are exploring risk factors and brain mechanisms of this disorder.
Treatment and therapies
Relatively few DMDD-specific treatment studies have been conducted to date. Treatment is often based on what has been helpful for other disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and anxiety disorders.
Treatment for DMDD generally includes certain types of psychotherapy (also called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later if needed. However, in some cases, providers recommend that children receive both psychotherapy and medication at the start of their treatment. Parents or caregivers should work closely with their child's health care provider to make treatment decisions that are best for their child.
The National Institute of Mental Health (NIMH) is currently funding studies focused on further improving these treatments and identifying new treatments to address irritability and temper outbursts.
Cognitive behavioral therapy (CBT) targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. CBT for anger and disruptive behavior focuses on changing maladaptive thoughts. Researchers are also using CBT to help children increase their ability to tolerate frustration without having an outburst. This therapy teaches coping skills for controlling anger and ways to identify and re-label the distorted perceptions that contribute to outbursts.
Dialectical behavior therapy for children (DBT-C) teaches children skills that may help them regulate their emotions and avoid extreme or prolonged outbursts. In DBT-C, the clinician helps children learn skills that can help with regulating their moods and emotions.
Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert it. Training also focuses on the importance of predictable and consistent responses to a child’s outbursts and rewards for positive behavior.
Currently, no medications are approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD. However, health care providers may prescribe certain medications—such as stimulants, antidepressants, and atypical antipsychotics—to help relieve a child’s DMDD symptoms.
- Stimulants are often used to treat ADHD, and research suggests that stimulant medications also may decrease irritability in youth.
- Antidepressants are sometimes used to treat irritability and mood problems children with DMDD may experience. One study suggests that the antidepressant citalopram, combined with the stimulant methylphenidate, can decrease irritability in youth with DMDD. Please note: Antidepressants may increase suicidal thoughts and behaviors in youth, who should be monitored closely by their health care provider.
- Certain atypical antipsychotic medications are used to treat children with irritability, severe outbursts, or aggression. FDA has approved these medications for the treatment of irritability associated with autism, and they are sometimes used to treat DMDD, too. However, due to the side effects associated with these medications, they are often used only when other approaches have not been successful.
All medications have side effects. Monitor and report your child's side effects and review the medications frequently with your child's health care provider. Visit FDA’s website for the latest warnings, patient medication guides, and information on newly approved medications.
Join a study
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Clinical trials aim to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for your child.
To learn more or find a study, visit:
- NIMH’s Clinical Trials webpage: Information about participating in clinical trials
- Clinicaltrials.gov: Current Studies on DMDD: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
- Join a Study: Children – DMDD: List of NIMH studies being conducted on the NIH Campus in Bethesda, MD
Free fact sheets
- Disruptive Mood Dysregulation Disorder: The Basics: This fact sheet provides information about DMDD, including a description of the condition, signs and symptoms, how it is diagnosed, treatment options, and tips for parents and caregivers. Also available en español.
- Severe Irritability in Youth: Dr. Melissa Brotman, Assistant Clinical Investigator in the NIMH Emotion and Development Branch, discusses NIMH research on irritability in children.
- Depression in Adolescents: Mechanisms and Treatment of a Global Health Concern and Mechanism-based Treatments for Irritability in Youth: Dr. Melissa Brotman, Assistant Clinical Investigator in the NIMH Emotion and Development Branch, describes NIMH research on treatments for DMDD. Her presentation starts at approximately minute 30 of the video.
- Disruptive Mood Dysregulation Disorder: Dr. Ellen Leibenluft, Senior Investigator and Chief of the NIMH Emotion and Development Branch, explains the history of DMDD.
- Irritability in Children: Dr. Ellen Leibenluft, Senior Investigator and Chief of the NIMH Emotion and Development Branch, discusses research on irritability in children.
- Severe Irritability and DMDD in Youth: NIMH child and adolescent psychiatrist Dr. Kenneth Towbin discusses NIMH research on childhood severe irritability and disruptive mood dysregulation.
Research and statistics
- Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine)
Last Reviewed: January 2023
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.