Diagnosing disruptive mood dysregulation disorder: Integrating semi-structured and unstructured interviews

The newest iteration of the Diagnostic and Statistical Manual–fifth edition (DSM-5), is the first to include the diagnosis of disruptive mood dysregulation disorder (DMDD). The assessment and diagnosis of psychopathology in children are complicated, particularly for mood disorders. Practice can be guided by the use of well-validated instruments. However, as this is a new diagnosis existing instruments have not yet been evaluated for the diagnosis of DMDD. This study seeks to provide a method for using existing structured interview instruments to assess for this contemporary diagnosis. The Children’s Interview for Psychiatric Syndromes (ChIPS) and the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) are reviewed and existing items consistent with a diagnosis of DMDD are identified. Finally, a case is presented using both measures and applying the theoretical items identified to illustrate how one might use these measures to assess DMDD. Limitations and future directions are discussed.

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Demographic Differences in Disruptive Mood Dysregulation Disorder Symptoms in ADHD, Autism, and General Population Samples

Journal of Attention Disorders ◽

10.1177/1087054716664409 ◽

2016 ◽

Vol 23 (8) ◽

pp. 849-858 ◽

Cited By ~ 11

Author(s):

Susan D. Mayes ◽

Susan L. Calhoun ◽

James G. Waxmonsky ◽

Cari Kokotovich ◽

Raman Baweja ◽

...

Keyword(s):

General Population ◽

School Age Children ◽

Demographic Differences ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Disruptive Mood Dysregulation Disorder ◽

Oppositional Defiant ◽

Almost All ◽

New Diagnosis ◽

Mood Dysregulation

Objective: Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disruptive mood dysregulation disorder (DMDD) is a controversial new diagnosis. No studies have investigated DMDD symptoms (irritable-angry mood and temper outbursts) and demographics in general population and psychiatric samples. Method: Maternal ratings of DMDD symptoms and diagnoses, age, gender, IQ, race, and parent occupation were analyzed in general population ( n = 665, 6-12 years) and psychiatric samples ( n = 2,256, 2-16 years). Results: Percentage of school-age children with DMDD symptoms were 9% general population, 12% ADHD-I, 39% ADHD-C, and 43% autism. Male, nonprofessional parent, and autism with IQ > 80 were associated with increasing DMDD symptoms, but demographics together explained only 2% to 3% of the DMDD score variance. Conclusion: Demographics contributed little to the presence of DMDD symptoms in all groups, whereas oppositional defiant disorder (ODD) explained most of the variance. Almost all children with DMDD symptoms had ODD suggesting that DMDD may not be distinct from ODD.

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Introduction

Irritability in Pediatric Psychopathology ◽

10.1093/med-psych/9780190846800.003.0001 ◽

2019 ◽

pp. 1-8

Author(s):

Amy Krain Roy ◽

Melissa A. Brotman ◽

Ellen Leibenluft

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Health Evaluation ◽

Behavioral Correlates ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Disruptive Mood Dysregulation Disorder ◽

Dsm 5 ◽

Assessment And Treatment ◽

New Diagnosis

Pediatric irritability is one of the most common reasons for mental health evaluation and treatment. Irritability is transdiagnostic; while it is the hallmark symptom of disruptive mood dysregulation disorder, a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it also appears in the diagnostic criteria for several mood, anxiety, and behavioral disorders and is a common correlate in others. The past 15 years have witnessed a rise in clinical neuroscience studies of pediatric irritability, resulting in significant advances in our understanding of its neural, genetic, psychophysiological, and behavioral correlates. These advances are detailed in the chapters in this volume. There is a particular focus on the implications of these findings for assessment and treatment of irritable youth, along with suggestions for further research.

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Validity of proposed DSM-5 diagnostic criteria for nicotine use disorder: results from 734 Israeli lifetime smokers

Psychological Medicine ◽

10.1017/s0033291712002954 ◽

2013 ◽

Vol 43 (10) ◽

pp. 2179-2190 ◽

Cited By ~ 6

Author(s):

D. Shmulewitz ◽

M. M. Wall ◽

E. Aharonovich ◽

B. Spivak ◽

A. Weizman ◽

...

Keyword(s):

Operating Characteristic ◽

Latent Trait ◽

Structured Interview ◽

Characteristic Analysis ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Other Substances ◽

Dsm Iv ◽

Hazardous Use

BackgroundThe fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes aligning nicotine use disorder (NUD) criteria with those for other substances, by including the current DSM fourth edition (DSM-IV) nicotine dependence (ND) criteria, three abuse criteria (neglect roles, hazardous use, interpersonal problems) and craving. Although NUD criteria indicate one latent trait, evidence is lacking on: (1) validity of each criterion; (2) validity of the criteria as a set; (3) comparative validity between DSM-5 NUD and DSM-IV ND criterion sets; and (4) NUD prevalence.MethodNicotine criteria (DSM-IV ND, abuse and craving) and external validators (e.g. smoking soon after awakening, number of cigarettes per day) were assessed with a structured interview in 734 lifetime smokers from an Israeli household sample. Regression analysis evaluated the association between validators and each criterion. Receiver operating characteristic analysis assessed the association of the validators with the DSM-5 NUD set (number of criteria endorsed) and tested whether DSM-5 or DSM-IV provided the most discriminating criterion set. Changes in prevalence were examined.ResultsEach DSM-5 NUD criterion was significantly associated with the validators, with strength of associations similar across the criteria. As a set, DSM-5 criteria were significantly associated with the validators, were significantly more discriminating than DSM-IV ND criteria, and led to increased prevalence of binary NUD (two or more criteria) over ND.ConclusionsAll findings address previous concerns about the DSM-IV nicotine diagnosis and its criteria and support the proposed changes for DSM-5 NUD, which should result in improved diagnosis of nicotine disorders.

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Disruptive Mood Dysregulation Disorder and its Impact on Rates of Bipolar Disorder among Children and Adolescents

Current Psychiatry Research and Reviews ◽

10.2174/2666082216999200909113835 ◽

2021 ◽

Vol 16 (3) ◽

pp. 154-157

Author(s):

Waleed A. Alghamdi

Keyword(s):

Bipolar Disorder ◽

Children And Adolescents ◽

Pediatric Bipolar Disorder ◽

Rapid Rise ◽

Scientific Databases ◽

Disruptive Mood Dysregulation Disorder ◽

Dsm 5 ◽

The Past ◽

The Impact ◽

Mood Dysregulation

Background: In 2013, Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the DSM-5 in part to curb the rapid rise in the rates of bipolar diagnosis among children and adolescents during the decade before the DSM-5 publication. DMDD proved to be a controversial diagnosis for many reasons. Objective: This brief review aims to provide an overview of the DMDD diagnosis and its origins and summarize available data on the impact of the introduction of the DMDD diagnosis on the rates of bipolar disorder among children and adolescents. Methods: Multiple scientific databases were searched using the related terms “DMDD”, “Disruptive Mood Dysregulation”, and “pediatric bipolar disorder” in combination with the terms “diagnosis” and “impact”. The retrieved articles were reviewed carefully. Results: The DMDD diagnosis rates have steadily increased since its introduction. Furthermore, available data show a decrease in the rates of bipolar disorder diagnosis among children and adolescents over the past few years. Conclusion: The very limited available data since 2013 show a decline in the diagnosis of bipolar disorder among children and adolescents. More time and further research are needed to more accurately determine the impact of the DMDD diagnosis on the rates of bipolar disorder in this population.

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Future of Classification in Posttraumatic Stress Disorder

The Oxford Handbook of Traumatic Stress Disorders ◽

10.1093/oxfordhb/9780195399066.013.0005 ◽

2012 ◽

pp. 53-66

Author(s):

Terence M. Keane ◽

Mark W. Miller

Keyword(s):

Posttraumatic Stress Disorder ◽

Mental Disorders ◽

Stress Disorder ◽

Future Directions ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

The Status ◽

History Of ◽

Definition Of

This chapter reviews the status of modifications to the definition of PTSD and proposed changes for DSM-5. We include a brief history of the diagnosis and trace its evolution in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We discuss some of the current controversies related to the definition of PTSD including its location among the anxiety disorders, the utility of Criterion A and its subcomponents, and the factor structure of the symptoms. We review the rationale for the addition of new symptoms and modifications to existing criteria now and conclude with comments on future directions for research on PTSD.

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Examining the effectiveness of the Cultural Formulation Interview with young children: A clinical illustration

Transcultural Psychiatry ◽

10.1177/1363461518780605 ◽

2018 ◽

Vol 57 (4) ◽

pp. 515-524 ◽

Cited By ~ 4

Author(s):

Martin J. La Roche ◽

Jill Betz Bloom

Keyword(s):

Young Children ◽

Structured Interview ◽

Assessment Process ◽

Cultural Formulation ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Interview Format ◽

Cultural Formulation Interview ◽

Clinical Illustration

After years of extensive research, the Cultural Formulation Interview (CFI) was released in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similar to its predecessor, the Outline of the Cultural Formulation (OCF), the CFI aims to refine the psychiatric assessment process by systematically examining cultural factors. However, in contrast to the OCF which employs open-ended questions, the CFI uses a semi-structured interview format. Unfortunately, children and adolescents have only been included in a handful of OCF and CFI studies, which raises questions about their applicability with youth, particularly young children (11 years or younger). In this article, we start examining the usefulness of the CFI with young children and propose recommendations to enhance its benefits by suggesting the development of a supplementary module specifically designed for young children. These ideas are illustrated with the assessment of a 6-year-old boy of Somali descent.

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Mixed features in major depressive disorder: diagnoses and treatments

CNS Spectrums ◽

10.1017/s1092852917000256 ◽

2017 ◽

Vol 22 (2) ◽

pp. 155-160 ◽

Cited By ~ 5

Author(s):

Trisha Suppes ◽

Michael Ostacher

Keyword(s):

Major Depression ◽

Mood Disorders ◽

Diagnostic System ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Mixed Features ◽

Depression Disorders ◽

First Time ◽

Linear Manner

For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on “mixed states” and the recent literature, which proposes a range of approaches to understanding “mixity.” We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.

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Excoriation Disorder

10.1093/med-psych/9780190052775.003.0004 ◽

2021 ◽

pp. 44-62

Author(s):

Hae-Joon Kim ◽

Kelsey L. Luks ◽

Ana Rabasco ◽

Justyna Jurska ◽

Margaret Andover

Keyword(s):

Mental Disorders ◽

Skin Picking ◽

Future Directions ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Assessment And Treatment ◽

Significant Impairment ◽

Excoriation Disorder ◽

Recent Version

Excoriation disorder, which is characterized by recurrent and impairing skin picking, has been included as a distinct diagnosis in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The move to include excoriation disorder as a separate diagnosis in the DSM-5 was largely due to increasing awareness of its prevalence and the potential for significant impairment and distress. This chapter discusses the nature, clinical presentation, and potential etiological determinants of excoriation disorder. In addition to the nature of symptoms, contemporary approaches to assessment and treatment, including behavioral and pharmacological, are highlighted. The chapter concludes with a discussion of future directions for research.

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Disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in youth at high familial risk of bipolar disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416672727 ◽

2016 ◽

Vol 51 (12) ◽

pp. 1220-1226 ◽

Cited By ~ 2

Author(s):

Tania Perich ◽

Andrew Frankland ◽

Gloria Roberts ◽

Florence Levy ◽

Rhoshel Lenroot ◽

...

Keyword(s):

Bipolar Disorder ◽

High Risk ◽

Familial Risk ◽

Australian Study ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Disruptive Mood Dysregulation Disorder ◽

Severe Mood Dysregulation ◽

Irritable Mood ◽

Mood Dysregulation

Objective: Disruptive mood dysregulation disorder is a newly proposed childhood disorder included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to describe children ⩽18 years of age with chronic irritability/temper outbursts. This study aimed to examine the prevalence of disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in an Australian study of young people at increased familial risk of developing bipolar disorder (‘HR’ group) and controls (‘CON’ group). Methods: A total of 242 12- to 30-year-old HR or CON subjects were administered the severe mood dysregulation module. Of these, 42 were aged ⩽18 years at the time of assessment, with 29 subjects in the HR group and 13 in the CON group. Results: No subjects ⩽18 years – in either group – fulfilled current or lifetime criteria for disruptive mood dysregulation disorder or severe mood dysregulation, the precursor to disruptive mood dysregulation disorder. Similarly, no subjects in either group endorsed the severe mood dysregulation/disruptive mood dysregulation disorder criteria for irritable mood or marked excessive reactivity. One HR participant endorsed three severe mood dysregulation criteria (distractibility, physical restlessness and intrusiveness), while none of the comparison subjects endorsed any criteria. Exploratory studies of the broader 12- to 30-year-old sample similarly found no subjects with severe mood dysregulation/disruptive mood dysregulation disorder in either the HR or CON group and no increased rates of chronic irritability, although significantly more HR subjects reported at least one severe mood dysregulation/disruptive mood dysregulation disorder criterion (likelihood ratio = 6.17; p = 0.013); most of the reported criteria were severe mood dysregulation ‘chronic hyper-arousal’ symptoms. Conclusion: This study comprises one of the few non-US reports on the prevalence of disruptive mood dysregulation disorder and severe mood dysregulation and is the first non-US study of the prevalence of these conditions in a high-risk bipolar disorder sample. The failure to replicate the finding of higher rates of disruptive mood dysregulation disorder and chronic irritability in high-risk offspring suggests that these are not robust precursors of bipolar disorder.

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Is disruptive mood dysregulation disorder a precursor for borderline personality disorder?

Avanços em Medicina ◽

10.52329/avanmed.28 ◽

2021 ◽

pp. 102-103

Author(s):

Hugo André de Lima Martins

Keyword(s):

Bipolar Disorder ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Emotional Instability ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Disruptive Mood Dysregulation Disorder ◽

Borderline Disorder ◽

Mood Dysregulation

Disruptive mood dysregulation disorder in children and adolescents is characterized by chronic irritability, in which outbursts of anger are manifested either verbally or through aggressive behavior. Before the last update of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), many severely irritable children were diagnosed with bipolar disorder. A borderline personality disorder is characterized by emotional instability, episodes of anger, impulsivity, and irritability; therefore, it is often misidentified as bipolar disorder. The behavior of disruptive mood dysregulation disorder resembles many characteristics of borderline, which diagnosis usually occurs in young adulthood. Is disruptive mood dysregulation disorder a precursor for borderline disorder?

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