Temper Tantrums Are a New Psychiatric Disorder?

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

In addition, one study has found that the concept of DMDD itself is “deeply flawed.”

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.

Neuroskeptic dubs DMDD the “the new ‘mood disorder’ that isn’t one.” I think it’s fair to say, the DSM’s working group would do well to consider Axelrod’s study and also Neuroskeptic‘s post.


Related Care2 Coverage

Nail Biting As A Psychiatric Disorder?

Does Someone You Know Have Internet Use Disorder?

Will New Diagnostic Criteria End the “Autism Epidemic”?


Photo by LizaWasHere


Janet B.
Janet B4 years ago

Alex....before vaccines.....all kids have, and had tantrums......it is called not getting their way........

Janet B.
Janet B4 years ago


Kayleigh Harter
Kayleigh Harter4 years ago

Oh, for god's sake. I am so sick of every little thing being labeled a disorder. What's next, nose picking?

News flash, parents: All children throw tantrums sometimes. The severity and frequency of those tantrums depends on a number of factors--the age and maturity level of the child, the situation that triggered said tantrum, the child's personality, and how you, AS A PARENT, react to said tantrum. There is no magical cure that will make your kids behave; you have to take responsibility and TEACH them what is and is not acceptable behavior. Don't get me wrong, I know that neurological and behavioral disorders are "a real thing", but just because a kid has a tantrum (or even frequent tantrums) doesn't mean he/she has a disorder. It worries me how eager many parents and therapists are to pump kids full of medication just because their behavior is less than ideal.

Kathy Perez
Kathy Johnson5 years ago

My son will be 3 in April and has thrown MAYBE 3 tantrums in his life. Luckily. We just ignore them

Amber Martingale
Angela Roquemore5 years ago

No kidding, Jessica L. AS I say in my caption for the Facebook copy of this article: "HORSE HOCKEY! THEY'RE JUST SPOIED, UNDISCIPLINED BRATS!"

Sarah Hill
Sarah Hill5 years ago

All children throw temper tantrums. You just need to learn how best to deal with yours, and how best to react. With mine I just ignored them and didn't give them the reaction they were looking for.

Anna M.
A M5 years ago

Always new ways to overmedicate...

John B.
John B5 years ago

Thanks Kristina for the excellent summation of the new proposal by the APA.

Myriam G.
Myriam G5 years ago

Thanks, Kristina, food for thought...

Alex H.
Alex H5 years ago

Over the last twenty years,I have got really sick of hearing the expression "The Terrible Two's",a supposedly normal right of passage for two year olds to progress onwards in life.These tantrums and embarassingly unreasonable behaviours are NOT normal.My parents told me that my sister and I never manifested with temper tantrums so what has changed?.In my opinion,the overload of neurotoxins(mercury derivatives,aluminium,formaldehyde>>) being injected into babies and children via 20 vaccines before the age of five,is the major cause along with the fact that parents are toxic and passing on to their children a host of chemicals,which lodge in tissues,cells etc disrupting brain and other development?!Sadly,all these"neuro-syndromes"have spawned a whole new set of "industries" and lucrative pharmaceutical products.People are now dispensable to greed and profit,and the suffering of families and ruining of lives just doesn't seem to figure in the equation.What a world!!!