4 TPC Digest Gregory T. Hatchett Treatment Planning Strategies for Youth With Disruptive Mood Dysregulation Disorder | TPC Digest Read full article and references: Hatchett, G. T. (2022). Treatment planning strategies for youth with disruptive mood dysregulation disorder. The Professional Counselor, 12(1), 36–48. doi: 10.15241/gth.12.1.36 Disruptive mood dysregulation disorder (DMDD) was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 to reduce the overdiagnosis of bipolar disorder in children and adolescents who exhibited non-episodic irritability and frequent temper outbursts. DMDD was originally derived from research on severe emotional dysregulation (SMD), a proposed research phenotype developed by researchers at the National Institute of Mental Health. Though DMDD and SMD are not interchangeable, research on SMD was used to justify inclusion of DMDD in the DSM-5. At the time of the DSM-5’s publication, very little research had actually been conducted on the specific criteria and correlates of DMDD. Thus, to some extent, DMDD was included as an experimental diagnostic category in the DSM-5. This was a controversial decision in 2013, and one that continues to be so in the present. Researchers have expressed concerns that DMDD cannot be reliably differentiated from other childhood-onset disorders, most notably oppositional defiant disorder (ODD). According to DSM-5 decisional rules, a diagnosis of DMDD automatically overrules a diagnosis of ODD, so both diagnoses may not be given concurrently. Some experts are concerned that this decisional rule may prevent counselors and other clinicians from targeting attitudinal and behavioral concerns that nearly always accompany a diagnosis of DMDD. Because of this, other diagnostic options have been presented, such as allowing the two diagnoses to be made concurrently. The 11th edition of the International Classification of Diseases (ICD-11) took a different route to this diagnostic controversy. In the ICD-11, clinicians can diagnose ODD with or without chronic irritabilityanger, allowing both oppositional behavior and emotional dysregulation to be recognized under a single diagnosis. Parallel to the concerns surrounding the diagnostic validity of DMDD, there continues to be a lack of evidence-based treatment strategies for working with children and adolescents who meet the diagnostic criteria for DMDD. Researchers have reported some clinical efficacy for the following interventions: psychostimulants for comorbid attention-deficit/ hyperactivity disorder, mood stabilizers, dialectical behavior therapy, interpersonal psychotherapy, and cognitive behavioral therapy. However, there are not any medications with FDA approval for youth with DMDD, nor are there any psychosocial interventions that have been deemed empirically supported. In the absence of a stronger evidence base specific to DMDD, many experts have recommended that clinicians use evidence-based treatment strategies for ODD and other disorders that are commonly comorbid with DMDD. This article explores the diagnostic controversies surrounding DMDD, presents strategies for facilitating accurate assessment and diagnosis, and reviews treatment strategies that hold promise in working with youth who fit this challenging diagnostic profile. At the end of the article, there are suggestions for future research and a recommendation as to how counselors can play a role in prevention efforts. Gregory T. Hatchett, PhD, NCC, LPCC-S, is a professor at Northern Kentucky University. Correspondence may be addressed to Gregory T. Hatchett, MEP 211, Highland Heights, KY 41099, hatchettg@nku.edu.
RkJQdWJsaXNoZXIy NDU5MTM1