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

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?

Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature

Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6–1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.

Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders

Disruptive behaviour disorders (DBDs)—which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder—are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre–post-evaluation of the curriculum showed improved knowledge in participants.