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. 2021 Feb;60(2):286-295.
doi: 10.1016/j.jaac.2019.12.008. Epub 2020 Jan 29.

Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization

Paola Paganella Laporte  1 , Alicia Matijasevich  2 , Tiago N Munhoz  3 , Iná S Santos  4 , Aluísio J D Barros  4 , Daniel Samuel Pine  5 , Luis Augusto Rohde  6 , Ellen Leibenluft  5 , Giovanni Abrahão Salum  6
Affiliations

Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization

Paola Paganella Laporte et al. J Am Acad Child Adolesc Psychiatry. 2021 Feb.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Acad Child Adolesc Psychiatry. 2021 Jun;60(6):789. doi: 10.1016/j.jaac.2021.03.013. Epub 2021 Apr 28. J Am Acad Child Adolesc Psychiatry. 2021. PMID: 33962828

Abstract

Objective: To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community.

Method: Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology.

Results: At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%.

Conclusion: Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.

Keywords: child/adolescent; developmental psychopathology; disruptive mood dysregulation disorder; irritability; temper outbursts.

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Figures

FIGURE 1
FIGURE 1
Symptomatic and Syndromic Thresholds and Clinical Operationalizations
FIGURE 2
FIGURE 2. Symptomatic Threshold for Each Irritable Mood and Outbursts Item in the Confirmatory Factor Analysis
Note: (A) Irritable mood. (B) Outbursts.
See this image and copyright information in PMC

Comment in

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