Having “severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation” at least three times a week: If this is your child, she or he could be a candidate for Disruptive Mood Dysregulation Disorder (DMDD), a controversial new psychiatric disorder that has been proposed for inclusion in the new DSM-5, the fifth revision of the Diagnostic Statistical Manual of the American Psychiatric Association (APA).
I suspect I’m not the only parent who is frowning at what sounds like tantrums, meltdowns and outbursts being turned into a psychiatric diagnosis. Nail-biting, excessive use of the internet and grieving are all candidates to be included in the next edition of the DSM, which is to be published in 2013. Once again, it seems that the psychiatrists are “medicalizing” and “pathologizing” any and potentially all sorts of behaviors.
DMDD As a Replacement For Childhood Bipolar Disorder?
The reason the APA is seeking to turn “terrible two” sort of tantrumming into a diagnosis has to do with the rise in the past decade in the diagnosis of childhood bipolar disorder in the U.S. Bipolar disorder is “extremely” rarely diagnosed in children elsewhere and, as the APA’s DSM-5 Childhood and Adolescent Disorders Work Group itself says, introducing DMDD is intended to be a sort of corrective measure.
DMDD as a “replacement” for childhood bipolar disorder would have implications for treatment. Bipolar disorder is treated with atypical antipsychotic medication and/or mood stabilizers and the long-term effects of these medications on still-developing children are not fully known.
The “Deeply Flawed” Concept of DMDD
David Axelrod and his colleagues studied 706 children aged 6-12 who had been assessed for emotional or behavior problems and compared those who would meet the new criteria for DMDD versus those who would not. What they found was that, in all these children, DMDD “could not be delimited from oppositional defiant disorder and conduct disorder.” That is, DMDD did not seem that much different than two other disorders which, as Wired points out, are themselves “wildly overused” and too often “used to justify medication for Kids Who Just Won’t Listen.”
Even more, while DMDD would be classified as a “Mood Dysregulation Disorder” in the “Depressive Disorder” section of the DSM-5, the researchers found that DMDD was “not associated with current, future-onset, or parental history of mood or anxiety disorders.”
A Personal Perspective About the DSM, Psychiatric Diagnoses and Tantrums
My now-teenage son, Charlie, does have an actual in-the-DSM diagnosis, autism (and “severe” enough that his diagnosis is not going to be affected by the proposed revisions to what an “autism spectrum disorder” is in the DSM-5), that requires highly specialized treatment with anti-psychotics and mood stabilizers under the care of a pediatric neurologist. (We haven’t had too much success taking Charlie to child psychiatrists — why is material for another post!).
I’ve certainly seen my share of “severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation” but Charlie is on the severer end of the autism spectrum. At 15 1/2 years old, he can still have some quite intense “behavior storms.”
All of this has made me extremely sympathetic to any parent with a child having a tantrum and especially firework-y ones in public places. But I have also learned that there are plenty of strategies, “positive behavior supports” and other tricks in the parenting tool kit not only to soothe tantrums, but to prevent them. These have played a huge role in helping Charlie not have “outbursts,” alongside and beyond medication.
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