Ever since the days of Hippocrates, frustrated parents have been labeling their kids as “Bipolar.” Of course, it hasn’t always been called that. Like the Devil, it has gone by many names. The word “Melancholy” derives from the Ancient Greek, a general term for depression and related mental disorders. In the 19th century, the French called it “La Folie Circulaire,” which translates to “circular insanity.” In the 20th century, it was called “Manic-Depressive Disorder.” It then morphed into “Bipolar Disorder” Types 1 and 2, along with “Cyclothymia,” which is its long term, low-grade cousin.
Those are inappropriate labels to apply to children, but poorly-trained therapists and doctors do it all the time. Bipolar Disorder is far more likely to develop in adulthood, and there’s way more to it than mood swings and foul tempers. It is serious. It is debilitating. And it is often misdiagnosed.
Children don’t have as firm a grasp on their emotions as do their adult counterparts, and that’s one of several reasons why so many children present as emotionally unstable. Consider a typical two-year-old. They are giggling one minute, sobbing hysterically the next. But the mood swings you see in a two-year-old are usually normal and perhaps even necessary for proper development. But what if they’re still struggling with these issues when they are 7? Or 10? Or 14? Is that the same thing?
Disruptive Mood Dysregulation Disorder.
In 2013, The American Psychiatric Association (APA) revised its mental health Bible and added several “new” disorders, some fraught with controversy. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is what clinicians use to assess and diagnose clients with mental health, developmental, and substance abuse disorders. Bipolar Disorder is in there, a serious diagnosis usually reserved for adults. This doesn’t mean that kids don’t present with behaviors associated with Bipolar. However, it should mean that clinicians use a diagnose that is more appropriate for kids. Enter Disruptive Mood Dysregulation Disorder.
If there is such a thing as a “hot” new diagnosis in mental health, it is Disruptive Mood Dysregulation Disorder (DMDD). While classified (incorrectly, I believe) as a “Depressive Disorder,” DMDD is basically bipolar for children. While nobody likes to place labels on kids, the emergence of DMDD as a recognized disorder allows clinicians to provide appropriate treatment for kids who have repeated tantrums, verbal and/or physical aggression, and a persistent angry or irritable mood. This is not Bipolar Disorder. It may look like Bipolar Disorder, but there are key differences that separate the two.
How DMDD is different from Bipolar Disorder?
Several key features distinguish DMDD from Bipolar Disorder. Bipolar can be a lifelong affliction, and is episodic in nature. DMDD is persistent, but does not manifest with severe mania (i.e., incredible energy, sleeplessness). Bipolar often leads to psychosis (delusions, hallucinations); DMDD does not. Grandiose thinking and elevated mood are typical with Bipolar; these symptoms are not present with DMDD. Severe tantrums are a feature of DMDD; this feature is absent from Bipolar.
In reality, Bipolar is rare, and almost never afflicts people under 18 years of age. These two disorders are similar, but only on a superficial level.
What Parents Can Do
If you suspect that your child suffers from DMDD, enlist the services of a licensed clinician who specializes in the diagnosis and treatment of children and adolescents. Your regular primary care physician is just not qualified to do this. You need to see a specialist. Anyone can Google the diagnostic criteria for any known mental illness, but it takes a trained clinician to confirm the existence of an actual disorder. Humans are not just a collection of symptoms.
Children are not adults. This is especially true when it comes to mental health diagnoses. Children are still navigating various developmental stages and learning how to regulate their moods and emotions in ways that are appropriate for their age. Tantrums in children are to be expected, but a pattern of severe tantrums is a cause for concern. DMDD at least gives a name to a condition that many parents and clinicians already know exists and it provides a criterion-based framework for proper diagnosis and treatment.