Bipolar Disorder (BD) and Disruptive Mood Dysregulation Disorder (DMDD) in Children and Teenagers

Many of us are familiar with the ‘up and down’ mood swings of children and teenagers, the rebellious behaviours, the arguments, the tantrums, and the need to be in control and independent. This is normal childhood and we refer to it as ‘going through a phase.’ However, when these behaviours are severe, cause problems, put the child/teenager or others at risk, and appear to be getting worse, not better, then chances are, the child/teenager has a mental disorder.

The challenge is that many mental disorders/illnesses present with these symptoms e.g. ADHD, ODD (oppositional defiant disorder), CD (conduct disorder) BD (bipolar disorder), DMDD (disruptive mood dysregulation disorder) and even some anxiety disorders. To ensure a correct diagnosis is made and an appropriate treatment plan is implemented, it is imperative that the child/teenager receive a thorough physical and cognitive assessment including blood tests. What we are finding, is that many children and teenagers are being diagnosed with more than one mental disorder e.g. bipolar disorder with conduct disorder or ADHD, anxiety disorder and bipolar disorder.

Whilst many of you are likely familiar with the term bipolar disorder (BD), it appears that only a few people know about disruptive mood dysregulation disorder (DMDD). Disruptive mood dysregulation disorder is a newly recognised psychiatric disorder, which has signs and symptoms very similar to bipolar disorder.

Bipolar disorder affects about 1 to 3 percent of children and teenagers. Children/teenagers with BD experience unusual and uncharacteristic mood changes. The mood swings are more extreme and usually accompanied by changes in sleep, energy and cognition. A child/teenager with BD also has an increased likelihood of substance use disorder. Bipolar disorder is categorized into two types:

  • Bipolar I – must have experienced a manic episode and a depressive episode
  • Bipolar II – must have experienced a hypomanic episode and a major depressive episode

Signs and symptoms:

  • Severe mood swings
  • Hyperactive, impulsive, aggressive, socially inappropriate behaviours
  • Risky reckless behaviours
  • Insomnia
  • Confusion and inattention
  • Depression, tearfulness, sadness
  • Irritable
  • Grandiose and inflated view of self and abilities
  • Suicidal thoughts and behaviours

Treatment:

  • Medications e.g. anti anxiety medications, antidepressants
  • Psychotherapy: Talk therapy, family therapy, play therapy, support groups
  • School support and counselling

What can a parent do?

  • Be patient and understanding
  • Keep a mood chart or daily life chart
  • Adhere to treatment plan
  • Help develop
  • Encourage child/teenager to talk, listen and be supportive
  • Share care strategies with friends, family, school
  • Show love

Disruptive mood dysregulation disorder (DMDD) is a newly recognised psychiatric disorder, which has signs and symptoms very similar to bipolar disorder (BD), and usually occurs between the ages of 6 to 18 years old.

The main difference between BD and DMDD is that the irritability and anger outbursts in DMDD are constant and seen on an almost daily basis, compared to BD which are episodic. Also, children/teenagers with DMDD do not experience manic episodes.

DMDD can be severely disturbing and disabling and whilst there is limited research into the disorder, most experts feel that under activity of the amygdala (part of brain associated with interpretation and expression of emotions), and increased activity in the medial frontal gyrus and anterior cingulate cortex (involved in evaluating and processing negative emotions, awareness of one’s own emotional state, and selecting an affective response when angry or upset) is responsible for the deficits.

A child/teenager with DMDD will exhibit the behaviours almost daily and this greatly impacts his/her quality of life and ability to form new relationships and function at home, school, etc. Many parents say, “my child struggles everywhere, everyday.”

Signs and symptoms

  • Severe persistent irritability
  • Extreme outbursts: verbal and behavioural dyscontrol
  • Difficulty processing and responding to negative emotional stimuli and social experiences e.g. unable to interpret social cues, emotional expressions of others
  • Difficulty regulating negative emotions

Some experts believe that if diagnosed early, DMDD is treatable. The aim of treatment is to help the child/teenager to regulate his/her emotions and to try and avoid extreme outbursts. Children with DMDD are at increased risk of developing a depressive disorder or anxiety disorder when they are older rather than bipolar disorder.

Treatment

  • Behavioral therapy
  • Medication: possibly antidepressants, antipsychotics, mood stabilizers
  • Individual/family therapy

What can a parent do?

Caring for a child/teenager with DMDD can be very challenging and upsetting. The constant emotional outbursts are difficult to watch and affects the entire family. The question is: do you discipline or comfort your child/teenager; what can you do?

Talk with child/teenager, help he/she understand why the behaviour is unacceptable and discuss other ways to express emotions

Observe the behaviour and mood changes, record in a journal, identify any triggers or patterns
Be proactive and explain consequences of problem behaviour before the outburst occur. If your child/teenager knows the consequences of the behaviour, he/she may reconsider ‘acting out’
Encourage child/teenager to take a ‘time out’ when feeling overwhelmed, angry, etc.
Any changes in environment can trigger outbursts, establish agreed up routines at home, school, when visiting family, etc.

  • Talk with school, set up routine and plan when outbursts occur
  • Promote healthy diet, exercise, fun activities, family time
  • Ensure self care for yourself, join support group, spend time with friends, partner, plan relaxing activities e.g. massage, lunch out, etc.…
  • Be patient, take a deep breath, be there for your child/teenager and show love always

In my next Blog #11
I will be discussing how to help a child/teenager with a mental disorder
transition back to school

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