Disruptive mood dysregulation disorder DSM V

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Is anyone else worried about this?

I am all for it for those who have been incorrectly labeled as bi-polar, and are being treated incorrectly; but I am afraid that it might exacerbate a push to medicate Auties and Aspies for behavioral issues.

I know some need meds, so I am not trying to start a flame war or anything. I am mainly worried about a stronger push for those who choose not to medicate.

I too wonder if this will be handled poorly. There is the criteria for persistentant negativity between outbursts. It is suppossed to replace overdiagnosing Bipolar in children who as adult seem to outgrow the symptoms or develop depression or anxiety rather than Bipolar. I worry that it will be applied to meltdowns as seen in children with Autism. However, it should not replace the Autism diagnosis. I think it will also be used in place of Mood Disorder, NOS which is often used nowadays for children with mood regulation difficulties.

Is there anything in there do you know to prevent a dual diagnosis?

So far as I can tell, it can't be dually diagnosed with other mood disorders such as Bipolar and Major Depressive Disorder. It can be dually diagnosed with ADHD, ODD. I can't remember if it can be dually diagnosed with anxiety disorders, and I am not sure but figure it can be dually diagnosed with ASD.

Well the thing is, that me a person with Bipolar, I was getting a bit concerned finding out the huge overdiagnosis of children with Bipolar disorder. Those children have emotional outburts and can't controll them. Very often they are treated with moodstabalizers, atypical antipsychotics and other stuff and that with a very young age. My opinion is, that very often this is not necessery and they end up developing other conditions while getting older and just in some cases Bipolar.
There are cases of Bipolar from a very young age or even so young as kindergarten, but actually they are very rare.

I started developing Bipolar as a teenager and it needed until resently, years and years later to even get a Bipolar suspicion and to get identified correctly. Some years ago shrinks believed you have to be an adult to have Bipolar.
Now we know a lot more about it and start recognizing it in younger ppl and very often "overdx" it.
Bipolar disorder, is one ot those disorders that is very difficult to dx correctly and very often it takes years to figure out if it's Bipolar or not. But some shrinks seem to love dx like this. They can get overdx so easily.
Actually Bipolar disorder is this disorder that is the most over AND underdx disorder, at least that's what leading Bipolar experts believe.

So, it made sence seperating those children with temper tandrums from childhood Bipolar disorder.
But yes, I also worry, that children with ASD and also "normal" children then they have difficult times end up with this new label.

So it's a bit a mixed blessing.

I also heared that this diagnosis is for children between the age of 6 and 10. So I wonder what happens when those children turn 11?
Is this true?

Not able to focus well right now, but I think that Table E.3.2 on page 7 on this article seems to say that pervasive developmental disorder is exclusionary.

http://iacapap.org/wp-content/uploads/E ... 072012.pdf

My question is...if this is supposed to replace misdiagnosing kids with bipolar (supposedly because the pharmacological response to bipolar is potentially harmful), would it lead to more kids with ASD being medicated? I'm not sure....What is the proposed "treatment" of Mood Dysregulation Disorder? Are they saying it is something that kids will grow out of? If so, are the interventions primarily behavioral?

I didn't pay much attention to this among all of the DSM hullabaloo because neither of my kids tend to have dysphoric moods in general (although both can have outbursts when overstimulated).

I don't really get this and here it says you have to be between 7 and 17 and with onset before the age of 12. So, the best is to wait for the final version, but the age thing makes more sence.
Also it says that it excludes PDD, schizophrenia, schizoaffective, PTSD and other stuff. But I don't understand this graphic very well.



Well, if it really excludes ASD than not, but it is like this with all diagnosis that exclude, in the end many ppl end up with both diagnosis anyway...



So far I understand it, this is a mixed group and some of those children will turn out having depression, anxiety, personality disorders and some even with bipolar or other stuff and some will outgrow it. So, we have to wait and see.
How I understand it, it's more a: "we don't know what else to dx"-category.
Propably some of those children will also end up medicated, but with meds that makes more sence and not with bipolar meds on kids who don't even have it. But that's just what I think the shrinks will do.

I guess I have a bigger issue with this (and with the current diagnosis of ODD, and sometimes with bipolar.)

My concern is less that kids might be misdiagnosed, and more about what sometimes happens when there is a diagnosis. Landon Bryce did this video about wandering that expresses my concerns about kids who get a diagnosis for having outbursts or other behavioral issues: http://thautcast.com/drupal5/content/ac ... -wandering

Basically, as Mr. Bryce says, one of the things that can happen with a diagnosis is that they consider symptoms a part of the diagnosed person, and therefore something to ignore (and medicate away.) With kids who have communication disorders (whether that plays out in actual speech or in pragmatics) it means that caregivers are less inclined to do detective work to find out why these behaviors are there.

That scares me. DS used to have a whole collection of scary defiant behaviors - but after finding out everything he was struggling with and figuring out appropriate supports, they are nearly gone. The first suggestion we got from the school (without a medical background) was to medicate him. I can't imagine what would have happened if we hadn't held firm - but in all likelihood he'd be an adult with a severe undiagnosed pragmatic speech delay.

This is not to say I am against medication, just that we need to be careful that a child's actual needs are being met as much as possible before we start down that road, and that these diagnoses do not exclude careful examination of behaviors and an attempt to find out why they are there.

Unfortunately in our immediate gratification-based society, it seems like fewer and fewer people want to uncover the root cause of problems. They just want to make them go away, even if it is only a superficial fix.

Well the thing is that Bipolar means that you have moodswing with no real reason if you will. It is more neuropsychiatric like epilepsy. Also the experience is that behavioural therapy helps up to some degree, but wouldn't stopp it. Bipolar is mainly treated with meds.

So, but the problem beginns if you take children with temper tandrums and dx them with Bipolar. What happens is that noone really will look for the reasons of this tantrums anymore, because of this lable and that's also the thing. That's why it's important to use the label carefull. In my case it took years to even get a suspicion and some shrinks just give this label to children after seeing them once or twice.
I also don't really understand what temper tamdrums have to do with Bipolar?
I mean, ppl with Bipolar tend more often to temper tandrums, but beside that Bipolar has mainly to do with mania and depression and when you are dx with that shrinks will of course starting to treat that!

I don't have too much knowledge with the label ODD, but so far I'm informed most of the time it means that you have an underlying disorder. Personally for me ODD and DMDD are mainly behavioural out of diff. reasons and they need mainly behavioural therapy and not meds.
I'm also no fan from this idea giving young children meds IF there is another solution.

Of course, sadly, as soon as you are dx with something very often ppl start to believe somehow, that your personality is this disorder.

That isn't exactly my understanding of Bipolar disorder. While the mood swings may not be "in sync" or directly related to what is happening around you, isn't one of the treatments to look for patterns and find potential triggers that may set off a mood swing? (e.g. lack of sleep, stress, change of seasons.) This is what concerns me about medicating any psychiatric, psychological or neurological disorder - medication is often critical (especially, I understand, with bipolar disorder,) but you can't depend expressly on medication to make things better.

Even with schizophrenia, which we don't seem to have tools for other than medication, patients do best in some kind of group therapy that helps them stay on track with meds and keep up their quality of life.

Actually there is a huge connection between Bipolar and epilepsy. Many meds that work for epilepsy also work for bipolar.
A friend of mine has a rare neurological disorder that goes along in her case with approx. 200 seizures per year. Also she once tryed psychotherapy, because things like "lack of sleep" and so on also affect epilepsy. But that doesn't make epilepsy a psychological condition...!
What I meant was - I should have specified myself- that Bipolar isn't caused by behavioural issues in the first place.



What you claim here is highly controversal.
I was listening to a lecture from the Yale University in psychology the other day, even they believe that you can't primarily treat schizophrenia with psychotherapy.

Last edited by Raziel on 28 Jan 2013, 10:41 am, edited 1 time in total.

You misunderstood - what I meant was that, without the additional support of therapy, many schizophrenics do not successfully keep up their medication as they should, nor do they manage to keep up a good quality of life. For the best results in this and many instances where meds are involved, a combination of meds and the indicated therapy for the condition produces the best result.

Also, I don't know that anyone is saying any of these disorders are caused by behavioral issues. I'm just trying to say that if there are behavioral issues, it is important to find out the underlying reason for the behavior.

IMO, offering medication under the assumption that meds alone will solve the problem is a very serious mistake - and I believe this to be a fairly common occurrence (since it happened to us, and I've heard this happen to many other people.)

Well I just know, we talk at cross-purposes.

Sounds like an umbrella category filled with poor operational definitions to me. Almost any Axis-I disorder could, at some point in time, be described as "dysruptive mood dysregulation." Way to hit another homerun, DSM-5.

Well, at least I'm too old for it!