Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, Colorado.
San Diego State University, and San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology.
J Am Acad Child Adolesc Psychiatry. 2021 Feb;60(2):216-218. doi: 10.1016/j.jaac.2020.12.019. Epub 2020 Dec 21.
Disruptive mood dysregulation disorder (DMDD) is a novel diagnosis emerging from a continuing discourse on the best diagnostic home for children with severe, chronic irritability. DMDD emerged from a research diagnosis that was developed to test the hypothesis that severe, chronic irritability is a developmental phenotype of pediatric bipolar disorder. That is, such irritability is a phenomenon that emerges prior to a hypo/manic episode that defines bipolar disorder. For many, such irritability in conjunction with attention-deficit/hyperactivity disorder (ADHD) symptoms had been treated as a prodrome of bipolar disorder. Although this line of research did not establish a deterministic association between the DMDD syndrome and later bipolar disorder, it did provide guidance for assessing the risk of irritability for later bipolar disorder. Among the outcomes was the introduction of DMDD as a new diagnosis in DSM-5. It is defined by 2 core symptoms-temper outbursts and irritable/angry mood-the 2 major features of irritability. However, what qualifies as DMDD-level irritable mood and temper outbursts is unclear, and, unlike other mood disorders, no ancillary symptom criteria are available to establish a diagnosis of DMDD. Through the example of the relationship between DMDD and ODD, we will illustrate the clinical impact of this lack of clarity and describe the current efforts to establish a developmentally sensitive clinical nosology for irritability.
破坏性心境失调障碍（DMDD）是一种新的诊断，源于对患有严重、慢性易怒的儿童最佳诊断归宿的持续讨论。DMDD 是从一种研究诊断中出现的，该诊断旨在测试严重、慢性易怒是否是儿童双相情感障碍的发育表型的假设。也就是说，这种易怒是在定义双相情感障碍的轻躁狂/躁狂发作之前出现的现象。对于许多人来说，这种易怒加上注意力缺陷多动障碍（ADHD）症状，被视为双相情感障碍的前驱症状。尽管这一研究并未确定 DMDD 综合征与后来的双相情感障碍之间存在必然联系，但它确实为评估易怒症后来发生双相情感障碍的风险提供了指导。其中的结果之一是在 DSM-5 中引入了 DMDD 作为一种新的诊断。它由 2 个核心症状——发脾气和易激惹/愤怒情绪——即易怒的 2 个主要特征来定义。然而，什么样的情绪才算 DMDD 水平的易怒和发脾气并不明确，而且与其他心境障碍不同，没有辅助症状标准可用于确定 DMDD 的诊断。通过 DMDD 与对立违抗性障碍（ODD）之间的关系示例，我们将说明这种不明确性对临床的影响，并描述目前为建立易激惹的发展敏感临床分类学所做的努力。
