Differential Diagnosis Between Disruptive Mood Dysregulation Disorder and other Conduct/Behavioral Disorders

DMDD IED CD ODD

• Severe recurrent temper • Behavioral outbursts as a failure • Repetitive and persistent pattern • Angry or irritable mood
outbursts due to frustration to control aggressive impulses of exploitative behavior • Loss of temper
• Verbal rages • Rapid onset • Aggression toward others • Easily annoyed
• Physical aggression • Temper tantrums or verbal • Bullies, threatens, or intimidates • Argues with authority or adults
• 3+ times weekly arguments • Initiates physical fights, possibly • Defies or refuses to comply
• Persistent, non-episodic • Physical aggression toward with a weapon • Deliberately annoys others
irritability between rages others, animals, or property • Physically cruel to people or • Blames others for misbehavior
• No periods of significant changes • May or may not results in animals • Can be spiteful or vindictive
from baseline mood (i.e., mania, damage or injury • Actions gain an objective • Behavior occurs more than
goal-directed behavior, • Expression grossly out of • May involve theft while engaged developmentally appropriate
worsening of symptoms with proportion to provocation in a confrontation • Behavior occurs in social context,
remission) • Outbursts are not premeditated, • May involve forced sexual activity that is, through interaction with
• Present in multiple settings nor do they achieve an objective • Deliberate destruction of others
• Diagnosed after age 6 and before • History of emotional trauma property or fire setting • Behavior negatively affects social,
age 10 for the first time increase risk • Breaking and entering, lies to educational, or familial
• Low frustration tolerance • May have abnormalities in the obtain things (con) functioning
• Poor peer and familial brain (i.e., serotonin, amygdala) • Violation of rules, school truancy, • May be confined to only one
relationships • Provoked by a broad array of running away setting in mild cases
• Problems succeeding in school frustrations • Causes impairment in functioning • Low frustration tolerance
• Leads to MDD and GAD later in • No symptoms of mood • Harsh, inconsistent, or neglectful
life dysregulation or disturbance parenting common
The key differences to note between these disorders fall into several categories: mood disturbance, persistence v. intermittent, premeditation v. impulsive,
and broad v. specific triggers. Many of these disorders can co-occur with ADHD, but not exclusively within a MDD or panic episode. Also note that DMDD was
created with the primary purpose of differentiating childhood Bipolar Disorder from irritability. DMDD is more associated with later MDD and GAD than BPD.

DMDD IED CD ODD Another important distinction is the concept of cyclic versus non-episodic.
Mood Disturbance X X In disorders such as Bipolar, behavior and mood changes occur without
Persistent X X X provocation and on a seemingly random cycle. Disorders such as DMDD,
Intermittent X ODD, and IED show provoked behaviors due to frustration of social or some
Premeditative X other stimulus. When making the diagnosis, pay close attention to the
Impulsive X X X
temporal dimension of behavior and mood problems.
Broad Triggers X X
Specific Triggers X