Irritability and anger in these minors is one of the most recurrent reasons in psychology clinics and centres. Although these reactions are relatively common in these stages, their chronicity and intensity must be controlled.

When these outbursts are too pronounced and occur too often they can be diagnosed as a Mood Disrupting Disorder . Below we discuss its symptoms and treatment, as well as the controversy surrounding this concept.

What is Mood Disrupting Disorder?

Mood Disrupting Disorder (MDD) is a relatively new term in clinical psychology and psychiatry which refers to a disturbance of a child’s mood . During this the child shows manifestations of chronic irritability and mood states that are disproportionate to the situation.

Although these symptoms can also be seen in a wide variety of psychological disorders in children such as bipolar disorder , oppositional defiant disorder or attention deficit hyperactivity disorder (ADHD), the idea of creating a new concept like that of TDDEA was based on the objective of being able to include tantrums and angry outbursts in the diagnosis.

The incorporation into DSM-V of this new label for child behavior has been widely criticized by both professionals in psychology and pedagogy and by researchers in behavioral sciences. One of these criticisms is the questioning of whether it is really necessary to create more labels for child behaviour , since these tend to create a stigma in the child both on a personal and social level.

On the other hand, the diagnostic criteria do not take into account the family, school or social context of the child , which can have a great influence on his/her mood and behaviour and can be the real cause of these outbursts of anger and rage.

Finally, it has been questioned whether this disorder was substantially different from the others already exposed. However, according to some studies there is a disparity in the aetiology, evolution and neurobiological basis.

Differences with pediatric bipolar disorder

There are many cases of suspected disruptive mood disorders which, because of the similarity in the symptomology of the two conditions, have been diagnosed as pediatric bipolar disorder.

The main difference between the two is that, just as in bipolar disorder the child has well-defined episodes of depressed mood and mania, children diagnosed with TDDEA do not experience these different episodes as precisely or in a limited way.

In bipolarity specific episodes are intermingled with moments of euthymia, while in TDDEA periods of change are much more persistent and random.

Symptomatology of TDDEA

In order to make a satisfactory diagnosis of TDDEA, without burdening the child with unnecessary labels, the fifth volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) describes the diagnostic criteria for this disorder, including its symptoms and exceptions.
These criteria are:

  • Symptoms present in children between 6 and 18 years of age
  • Severe and recurrent outbursts of anger in response to common stressors. These outbursts should be incongruent with the child’s developmental level, the mood between bouts of anger should be irritable or irascible, and the average bout of anger should be at least three times a week.
  • Symptoms begin before age 10.
  • Persistent symptomatology for at least 12 months
  • The symptoms have not disappeared for three or more months in a row .
  • The symptoms must appear in at least two of the following contexts: home, school, social context; being severe in at least one of them.
  • The symptomatology cannot be better explained by any other medical condition, nor by the consumption of any drug or substance.
  • The symptoms do not correspond to the criteria of a manic or hypomanic episode for more than one day.
  • The symptoms do not meet the criteria for a major depressive episode.

It is necessary to specify that this diagnosis cannot be made in any case before the age of 6, since in these stages tantrums and outbursts of anger are common and normative.

On the other hand, the DSM-V specifies the inability of this disorder to occur at the same time as bipolar disorder, oppositional defiant disorder, or intermittent explosive disorder.

Effects and consequences of TDDEA

According to the evaluations and studies in the field of child psychology, it is observed that approximately 80% of children under 6 years of age manifest tantrums in a more or less recurrent manner, becoming severe in only 20% of the cases.

For this anger or aggressiveness to be considered as pathological it must interfere in the child’s daily life, as well as in his/her academic performance and in the daily family dynamics.
As far as the family environment is concerned, this disorder tends to generate a great impotence and feeling of disorientation in the parents of the affected children, since they are unable to manage or control the child’s behaviour and acts; fearing to impose too rigid or on the contrary too lax punishments.

As far as the child is concerned, irascible behaviour ends up affecting his relationship with his peers or equals , who do not understand the reason for his behaviour. In addition, the levels of frustration he feels are so high that his attention span ends up diminishing, making his academic progress difficult.

Treatment

Due to the novelty of the concept, the treatment of TDDEA is still under research and development by clinicians. However, the main protocol for intervention in these cases includes the combination of drugs with psychological therapy.

The medication of choice is usually stimulant drugs or antidepressant medication, while psychotherapy consists of an applied behavioural analysis . In addition, the active role of the parents in the treatment is stressed, as they must learn to manage the changes in the child’s mood in the best possible way.

The pharmacological treatment of disruptive mood disorder is another point for which this condition has received numerous criticisms, questioning the real need to medicate children.