I have to open-up this discussion with just a few sentences about a new disorder outlined in DSM-V. I had not been keeping-up with all of the changes so this one caught me a little by surprise. The diagnosis is “Disruptive Mood Dysregulation Disorder.” What is interesting is every time I write about it, the computer spell-check systems marks dysregulation as the color RED. This usually means that the system does not recognize this word in our culture. If you are getting a copy of this book you will certainly be ahead of the mark because many of my colleagues (social workers and primary care physicians, etc.) may not be this cutting edge. A young person with this disorder is probably going to be seen as a problem inmost settings. The diagnosis requires severe and recurrent temper outburst. You may say this is the normal teenager nowadays, however the diagnostic criteria is a little more specific. Let’s just look at the DSM-V criteria for this disorder:
Disruptive Mood Dysregulation Disorder DSM- V Criteria for Diagnosis Code 296.99
1.Sever recurrent temper outbursts manifested verbally (an example would be verbal rages) and/ or behaviorally (e.g. physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation provocation.
2.The temper outburst are inconsistent with the developmental level.
3.The temper outbursts occur, on average three or more times per week.
4.The mood between temper outburst is persistently irritable or angry most of the day, nearly everyday, and is observable by others (e.g., parents, teachers, peers)
5.Criteria A-D have been present for 12 or months. Through out that time, the individual has not had a period lasting 3 or more consecutive months with all of the symptoms in Criteria 1-4)
6.Criteria 1 and 4 are present in at least two of three settings (i.e, at home, at school, with peers) and at are sever in at least one of these
.7.The diagnosis should not be made for the first time before age 6 years or after age 18 years.
8.By history or observation, the age at onset of criteria 1-5 is before 10 years.
9.Three has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. NOTE: Developmentally appropriate mood elevation such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
10.The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g, autism spectrum disorder, post traumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthmia]). NOTE: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, through it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive and substance use disorders and oppositional defiant disorder should not only be given diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
11.The symptoms are not attributed to the physiological effects of a substance or to another medical or neurological condition.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Copyright 2013 American Psychiatric Association
I am sure that this may prove to be one of out more controversial diagnosis, but it really saves us from just throwing all children into the category of Bipolar Illness prematurely. After all, there are very specific criteria for now Bipolar Disorders and Mood Disorders that the DSM-V now separated. No longer are the Bipolar Disorders included in the same chapter as the Depressive Disorders. I agree with this novel and different approach to the illnesses, because it set of disorders although similar can be very different in phenomenology. This new disorder n children usually present between 6 and 18 and the clinician has to be sure that he or she does a thorough bio-psycho-social-spiritual work-up prior to developing a treatment plan. If you don’t have the skill, license or credential to deal with true psychopathology, after you recognize what you believe that you may be observing, please refer the youth to the appropriate medical medical personnel. I would always start with a physician because other medical illnesses may need to be initially ruled-out before the decision that this illness is a garden-variety mental illness with no physiological illnesses underlying or causing the presentation of symptoms. (i.e. seizures, stroke or brain tumors)
Now before moving on to the discussion about other mood disorders, I feel that it is prudent to take just a few minutes to start you to thinking about suicide in the teenage and adolescent population. You may be familiar with statements like, ” I hate you mom!’ “Your ruining my life?” or ” I can’t wait to get out of your house!” These statements are made freely and can sometimes hurt adults when they are made. However, you have to stand back and look at it from a broader perspective. There just may be something else going on with the young person. Being a teenager, if you can recall, is surely one of the most interesting times of your life, but it can also be the scariest time. The teen world consists of constant peer pressure and curiosity about sex, drugs, and alcohol. With this, your teen can display questionable behavior that is not entirely their fault.
Well, it is not real easy to figure out who you are as a teenage person or youth, especially when you are mentally unstable due to symptoms of anxiety, depression and or suicidal ideation. The scenario is usually more common in girls than boys, as it accepted in our culture that girls mature faster than boys. This is both physically and emotionally. In my practice, I see mood disorder much more frequently in adolescent females than males. However, I do more oftentimes see more aggression in the males. It is important for me to mention that, I treat a very diverse population and in some families the girls are becoming more aggressive and actually fight just as quickly as the boys in the same family. We also accept the fact that girls do attempt suicide more frequently than girls but boys are usually more successful at carrying out the act. However, in either case if verbalized directly to you, this should be considered a medical emergency and the appropriate actions must be taken immediately. It is also important to note that usually when mental illness presents in adolescence, it becomes a life long problem. According to the U.S. Centers for Disease Control and Prevention, suicide is the third leading cause of death of young persons between the age of 10 and 24. This should let you know that this is now a very serious problem in America.
I am sure that you may be asking, “What can I do to help with this problem?” Here are a couple of simple recommendations that I would suggest to you. 1) Know your limitations. When this issues becomes a little more than just small gossip or boy/girl trouble, refer the troubled teen to the appropriately credential health care provider. Sometimes starting with the pediatrician is good, but don’t just sit on a cry from a youth. 2) In your environment weather home, church or youth group encourage open dialogue and the expression of feelings. Sometimes a good old fashion rap session can be helpful. 3) Finally, sometimes just listen. You may or may not have the answer to the question or issues. Just stand back and take sometime to listen. Feel free to appropriately use techniques that you are skilled in if so trained. However, do not attempt psychotherapy if you are not appropriately trained or credentialed this can be very dangerous and lead to an adverse outcome in your organization. Leave the deep-thought psychotherapy and processing to those that are trained. I can’t help but emphasize this fact.
I hope this information has been helpful. When you get a chance check out my most recent book Am I In A Bad Relationship. This book is definitely a great read and will open your eyes and force you to examine all of your family and friends relationships.