September 17, 2012 - In an recent article in the journal Bipolar Disorders, David Margulies, MD and colleagues from the child inpatient service at Stony Brook University reported the results of a year-long study to determine if the introduction of a newly defined diagnosis of disruptive mood dysregulation disorder (DMDD) in the next edition of the Diagnostic and Statistical Manual (DSM-V) is likely to reduce the rate at which children are inappropriately diagnosed with bipolar disorder. After a systematic examination of the records and behavior of 82 children admitted to the inpatient unit they concluded that the new diagnosis will likely lower the rate at which children are diagnosed with bipolar disorder, although the size of the effect will depend on whether the diagnosis is made solely on the basis of parent-reported symptoms — in which case it is likely to decrease the rate by about half — or on the basis of direct observation of the children’s behavior on inpatient units — in which case the effect is likely to be approximately 17%.
A dramatic increase in the rate at which children are being diagnosed with bipolar disorder prompted the American Psychiatric Association’s DSM-V Work Group to consider tightening the criteria for the diagnosis. The new diagnosis of DMDD is being proposed to account for the children who do not meet the stricter criteria but present with pervasive anger or irritability, explosive behavior and symptoms of hyperarousal, and whose symptoms are not better explained by other disorders.
The authors report that of the 82 children included in the study, 38 were at risk of being diagnosed with bipolar disorders based on symptoms, clinical history and parent reports. Of them, 21 (45.7%) would likely be diagnosed with DMDD if the diagnosis were based solely on parents’ reports, while only 8 (17.4%) of the children would likely be diagnosed with DMDD based on direct observation if the proposed criteria were strictly applied.
They conclude that the utility of the proposed diagnosis of DMDD has yet to be determined. While agreeing that the symptoms of chronic explosiveness and irritability encompassed by the diagnosis are common and important, they worry that the diagnosis of DMDD may prevent children from receiving more appropriate diagnoses if it is used without careful consideration.
Dr. David Margulies is an assistant professor in the Department of Psychiatry and Behavioral Science at Stony Brook University. At the time of the study, he was the Medical Director of the inpatient child psychiatry unit. His co-authors were Sheldon Weintraub, PhD, who recently retired as Clinical Director; Joanne Basile, RN and Paul Grover, RN, senior members of the nursing staff; and Gabrielle Carlson, MD, head of child and adolescent psychiatry. The article, titled “Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children?”, was accepted for publication in Bipolar Disorders March 2012.