[3] Treatments include medication to manage mood symptoms as well as individual and family therapy to address emotional regulation skills.

[3] In other words, it is important to discern between general irritability and tantrums that can be episodic and common in pediatric patients and the easy provocation and extreme anger expressions of threatening to kill, throwing things, or attacking someone, as seen in DMDD.

For instance, a child with DMDD can become extremely upset or emotional to the point of intense temper outbursts with yelling or hitting after being asked by a parent to stop playing and complete their homework.

Young children between 3 and 8 years old present with somatic complaints (e.g., stomach aches), irritability, anxiety, general behavioral problems, and less of the typical sadness commonly seen in adults.

[3] In general, though, examining the comorbidity of SUDs in DMDD is important as it may be linked to self-medication for underlying mood disorders or trauma.

More specifically, these studies have used behavioral, neurocognitive, and physiologic measures that include functional magnetic resonance imaging (fMRI), event-related potentials (ERPs), and magnetoencephalography.

[5][8] In general, studies have shown that there are four major dysregulated domains that cause dysfunction, primarily in distress levels with frustrating tasks and emotional labeling.

[6] Compared to children with bipolar disorder and ADHD, fMRI studies suggest that under-activity of the amygdala, the brain area that plays a role in the interpretation and expression of emotions and novel stimuli, is associated with the dysregulation seen in DMDD.

[18] The hypoactivity of the amygdala and the early attention process deficits mirror those found in depression and ADHD, respectively, partially explaining the comorbidity with these disorders.

[8] The DSM-5 includes several additional diagnostic criteria which describe the duration, setting, and onset of the disorder that must be met to make a diagnosis.

[19][20] A summary of the criteria is as follows: Criterion A requires severe and recurrent outbursts that manifest as verbal and/or behavioral rage that are grossly out of proportion (by intensity or duration) to the situation.

Criterion I states that there should never have been a period of more than 1 day where symptoms for mania or hypomania are met (except duration), but this excludes moments of mood elevation due to a very positive experience or upcoming event.

[21] Usually, a professional will use a semistructured interviews to elicit the "irritability" as caused by feelings of anger or crankiness or the child being easily annoyed.

[4][8] Thus far, National Institute of Mental Health (NIMH) research group has used versions of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children to conduct interviews and diagnose DMDD by the DSM-5 criteria.

[22] Both conditions can commonly cause dangerous behavior, suicidal ideation or attempts, and severe aggression, possibly requiring psychiatric hospitalization.

[19] On the other hand, bipolar disorder in children is characterized by distinct manic or hypomanic episodes usually lasting a few days, or a few weeks at most, that usually can be differentiated from baseline behavior.

[3] While individuals with bipolar disorder typically display symptoms for the first time as teenagers and young adults, DMDD is usually diagnosed between the ages of 6 and 10.

[3][20][25] The initial creation of the DMDD diagnosis in the DSM-5 was with the intended purpose of addressing the over-diagnosis of bipolar disorder in children.

[28] The creation of DMDD as a specific diagnosis in the DSM-5 was intended, in large part, to prevent the misdiagnosis of bipolar disorder in children, with hopes of avoiding medication mismanagement in younger mental health patients.

[7][21] Recent trends have shifted toward prescription of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), and stimulants (e.g., methylphenidate) for patients with DMDD.

[5] Stimulant and antidepressant medications are prescribed both for their treatment of DMDD symptoms and in cases of comorbid ADHD and depressive disorders.

Although contingency management can be helpful for ADHD and ODD symptoms, it does not seem to reduce the most salient features of DMDD, namely, irritability and anger.

[6] Instead, some evidence suggests that cognitive behavioral therapy (CBT) may be an effective treatment, especially in adolescents, in that it teaches children with DMDD how to handle the thoughts and feelings that causing depressed or anxious moods.

[5][31] Epidemiological studies show that approximately 3.2% of children in the community have chronic problems with irritability and temper, the essential features of DMDD.

[6] In the 1990s, clinicians started to observe a group of children displaying distinctive symptoms, including hyperactivity, irritability, and severe temper outbursts.

In the October 2016 edition of the Shanghai Archives of Psychiatry, Jun Chen et al. outlined in their paper that, prior to the inception of DMDD, children exhibiting signs of persistent and intense irritability were commonly diagnosed with bipolar disorder.

[32][33] However, this diagnostic practice faced controversy among experts due to the incongruence of symptoms with the established criteria for bipolar disorder.

Consequently, many children were subjected to overmedication and over-diagnosis, highlighting the need for a more precise and suitable framework to address their mental health challenges.