Explainer Link Copied 01.26.24

Does My Kid Have Disruptive Mood Dysregulation Disorder?

Or is TikTok lying again? BySarah Wheeler, PhD

Shutterstock / Wondermind

If you’re a parent who spends any time on TikTok, you know that the algorithm is very good at serving you content that spikes your curiosity and concerns. So when you see videos about a "new" mental health condition that causes big outbursts and bad moods in kids, you take notice. 

We're talking about DMDD or disruptive mood dysregulation disorder, a relatively new and often misunderstood diagnosis that’s getting buzz on social media. TikTok videos with #DMDD have more than 26 million views so far, with many parents saying these videos have given them a sense of relief. “Omg I have been dealing with this since my son was 6 years old and no one took me seriously,” one of them wrote. “The doctor said he just sounds like a spoiled child crying.” 

That experience tracks, says child and family therapist Amanda Campbell, LMFT. For starters, in 2013 DMDD was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which means it’s fairly new in the mental health space. So, “If you don't have a lot of experience with ‘badly behaved children,’” she explains, “you think [that behavior is] bad parenting or a bad kid.” 

For a lot of parents, content about this complex and serious mood disorder sounds eerily familiar—and that can be a stressful experience. I get it. But, of course, TikTok isn't exactly the best place to get more info on it. With that in mind, here’s what you need to know about what this disorder is and what—other than scrolling—you should do if you’re worried your kid has it. Let’s get into it. 

What is DMDD? 

DMDD is a type of depressive disorder that shows up in kids, though how many kids it impacts is still pretty fuzzy, per the DSM-5-TR (the latest edition of the DSM-5) Before early 2013, children who had trouble regulating their emotions were often misdiagnosed with pediatric bipolar disorder. So researchers developed DMDD to accurately diagnose children who struggle to manage their feelings on a regular basis. 

That struggle isn’t the same as the occasional meltdown. According to the DSM-5-TR, kids with DMDD have verbal rages (see: screaming) and/or get physical with other people or things. And what really makes this different from your run-of-the-mill outburst is that it happens a lot (an estimated three times a week for at least a year), in various situations like school or home or at a friend’s house, and the reaction is much more intense than what you’d expect to see in that situation or in a kid that age.

Those last two points can be hard to gauge; it’s true. Though all children can have big feelings about things that adults find NBD, when an 8-year-old has a meltdown over a thing they’re very used to (like putting on shoes) and their response looks more like a 2- or 3-year-old’s, something could be up. 

“These are really quick and really big,” explains Campbell, who treats patients with DMDD. “A child might have a big explosion at a parent for not cutting the crusts off a sandwich,” she adds. In kids who don’t have DMDD, Campbell explains, a kid’s anger response will shorten as they get older and they’ll learn to accept some kind of re-engagement after they’ve come down from the peak of their outburst. They’ll also be able to grasp an understanding of the harm their reaction caused, says Campbell. But that’s not really the case with this depressive disorder. 

Between outbursts, kids with DMDD tend to be consistently irritable "most of the day, nearly every day, and [it’s] observable by others," according to the DSM-5-TR. This is not just your standard crankiness. “This ongoing irritability is a key differentiator from other disorders,” says psychiatrist Bradley Engwall, MD, an associate clinical professor of psychiatry at the University of California, San Francisco. For kids with DMDD, “nothing feels right,” adds Campbell. 

Kids and teens between the ages of 6 to 18 can be diagnosed with DMDD as long as symptoms started before age 10, according to the DSM-5-TR. 

What causes DMDD?

At the root of all of this is something called self-regulation, or the ability to soothe yourself or develop coping skills in the face of distress. We all follow a self-regulation learning curve: As toddlers, we often lose it from the most surprising and seemingly small triggers, but we naturally get better at keeping things in check. Children with DMDD really struggle to help themselves feel better even as they get older, and that’s why they are so easily upset. When life is irritating, they have few defenses to weather it. 

But the reason why kids with DMDD struggle with this isn’t clear. Like many newer childhood psychiatric disorders, there isn’t a ton of research on what specifically causes DMDD. That said, kids who have a family history of depression may be more at risk for DMDD, per the DSM-5-TR. A child’s environment might up their chances for DMDD too. Things like abuse, neglect, or early childhood traumas are associated with the disorder, according to the DSM-5-TR. That’s not to say that every kid who has DMDD has terrible parents, but those situations can make it more likely that a kid develops this condition. 

What should you do if you think your kid has DMDD? 

First, if you’re on TikTok, log off. This disorder is so nuanced that even parents going through it and the experts who treat it can’t sum up the condition in a two-minute video, unfortunately. Plus, many mental health pros are just starting to understand and diagnose DMDD. “It can't be understated how complex evaluations for DMDD can be,” says Dr. Engwall. That’s why it’s so important to get one.

A range of professionals who specialize in child mental health can diagnose DMDD in children. So the thing that’s most important to look for in a mental health pro is experience differentiating DMDD from other disorders, like autism spectrum disorder, bipolar disorder, oppositional defiant disorder, or anxiety. 

During an eval for DMDD, Campbell asks parents lots of probing questions about the nature of tantrums, where and when they happen, and whether kids also have symptoms of autism, such as extreme fixations. Sometimes, to get a better sense of what’s going on, a practitioner will also observe kids in and out of the office, says Campbell. 

During this process, the most helpful thing you can do is be incredibly honest. Because it’s not acceptable in our society for kids to act out, especially in intense ways, lots of parents minimize their kids' outbursts, says Campbell. Despite the shame you might feel, it’s so helpful to be upfront about what’s going on. When you are, your kid is more likely to get the care they may need.

That help can come in many forms. Though there’s no one medication approved for treating DMDD, there are a few that can treat the irritability and dysregulation that comes with DMDD (including stimulants, antidepressants, and atypical antipsychotic medications).

But children and families can also benefit from understanding their own emotional regulation and how it impacts the people around them, says Dr. Engwall. Therapy can support the whole family system in coping with the challenges that come with this condition, which is huge. And a professional can teach you tools for helping your child keep their cool—and staying grounded while you do it, Campbell explains. “These kids go from 0 to 60 really fast, and parents themselves get dysregulated as a result,” she adds.

Even if your kid doesn’t have DMDD, if their outbursts or day-to-day frustration worry you, you and your child could also benefit from a mental health assist, says Dr. Engwall. “Traumatic events, family distress, adjusting to the quickly shifting social dynamics often experienced at this age and/or a sensitivity to surging hormones may contribute to such symptoms,” he explains. In other words, you don’t need a diagnosis to seek support.