Comparing the DSM-5 construct of Disruptive Mood Dysregulation Disorder and ICD-10 Mixed Disorder of Emotion and Conduct in the UK Longitudinal Assessment of Manic Symptoms (UK-LAMS) Study

Abstract

It is important to understand new diagnostic entities in classifications of psychopathology such as the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (code F34.8) construct of Disruptive Mood Dysregulation Disorder (DMDD) and to compare it with possible equivalent disorders in other classificatory systems such as the International Classification of Diseases-10 (ICD-10), which has a category that superficially appears similar, that is, Mixed Disorder of Emotion and Conduct (MDEC) (code F92). In this study, the United Kingdom (UK) arm (UK-LAMS) of the US National Institute of Mental Health (NIMH) supported Longitudinal Assessment of Manic Symptoms (LAMS) multi-site study was used to evaluate and retrospectively construct DMDD and MDEC diagnoses in order to compare them and understand the conditions they co-occur with, in order to improve the clinical understanding. In particular, the phenomenology of UK-LAMS participants (n = 117) was used to determine whether DMDD is a unique entity within the DSM-5. The findings showed that 24 of 68 participants with either DMDD or MDEC (35.3%) fulfilled both diagnostic criteria for DMDD and MDEC, suggesting that these entities do contain overlapping features, particularly symptoms relating to Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD), Attention Deficit Hyperactivity Disorder (ADHD)/Hyperkinetic Disorder (HKD) and/or an anxiety disorder. The data also showed that most of the participants who met DMDD criteria also fulfilled the diagnostic criteria for ODD/CD, ADHD, followed by an anxiety disorder. In this context, this raises the issue whether DMDD is a unique construct or whether the symptomology for DMDD can be better explained as a specifier for ODD/CD and ADHD. Unlike DMDD, MDEC clearly specifies that the label should only be used if emotional and conduct disorders co-exist.

Attention deficit hyperactivity disorder and comorbidity: A review of literature

“…ADHD and externalizing disorders: Common externalizing disorders comorbid with ADHD include ODD and Conduct disorder (CD). Newer diagnostic categories like Disruptive Mood Dysregulation Disorder (DMDD) and Intermittent Explosive Disorder (IED) have also been shown to exist comorbidly with ADHD[31,32]. It is demonstrated that 30%-50% children with ADHD also fulfill criteria for CD or ODD.…”

“…Disruptive mood dysregulation disorder and IED: Sagar-Ouriaghli et al[31] thus postulated that DMDD appears to be an alternative way of describing the presence of ODD/CD with either anxiety or ADHD. Symptoms of aggression, anger and impulsivity are also seen in IED and high rate of comorbidity are reported in literature.…”

Affective dysregulation: a transdiagnostic research concept between ADHD, aggressive behavior conditions and borderline personality traits

“…Although aggression, impulsivity, and irritability are dealt with in many research articles (for ECAP see Refs. [6][7][8][9][10][11]), a key problem is to assess these complex behaviors in terms of indication and choice of appropriate interventions as well as individual prognosis.…”