Bella is 9 years old and in the 4th grade. Bella’s mother sought treatment due to increasing disruptive behaviors over the past year, including non-compliance, physical aggression toward peers, and frequent behavioral meltdowns which resembled the temper tantrums of a much younger child. Tantrums included screaming, yelling, slamming doors, and crying. Bella and her mother both noted that it was difficult for Bella to “move on” when something angered her. She also noted that Bella had an underlying irritable mood, manifesting as Bella appearing “cranky” most of the time and the family feeling they needed to “walk on eggshells” to avoid upset. At school, at least one phone call home per week was being placed due to Bella’s refusal to comply or sometimes to even speak to her teacher for days at a time. Bella and her mother noted that Bella was generally well-liked by peers and teachers, given that she was hardworking and funny, yet her current disruptive behaviors were causing significant interference in making new friends and meeting academic goals.

Concept Map Information

1. What is the Main diagnosis for Mary Rose?

2. What are the Key symptoms?

3. What differential diagnoses did you consider and why?

4. What is your treatment recommendation and why?

5. What is the Prognosis?

SOLUTION

1. Main Diagnosis:

Disruptive Mood Dysregulation Disorder (DMDD) (DSM-5)

DMDD is characterized by severe temper outbursts that are out of proportion to the situation and a persistently irritable or angry mood between outbursts, occurring in children between the ages of 6 and 18.

Rationale:

• Bella is 9 years old, within the diagnostic age range.

• She displays severe, recurrent temper outbursts (screaming, slamming doors, crying) inconsistent with her developmental level.

• Her irritable, cranky mood is present most of the day, nearly every day, across settings (home and school).

• Symptoms have been present for over a year and cause impairment socially and academically.

---

2. Key Symptoms:

• Frequent temper outbursts (yelling, crying, aggression)

• Persistent irritable or cranky mood

• Low frustration tolerance; difficulty “moving on” from anger

• Noncompliance and refusal to speak or engage at school

• Aggression toward peers

• Significant impairment in friendships and academics

• Family tension (“walking on eggshells”)

---

3. Differential Diagnoses Considered:

---

4. Treatment Recommendation:

Multimodal Approach:

a) Psychotherapy:

• Cognitive Behavioral Therapy (CBT): To help Bella develop emotion regulation, coping strategies, and frustration tolerance

• Parent Management Training (PMT): To equip her mother with tools to manage behaviors and reduce reinforcement of tantrums

• School-based interventions: 504 or IEP accommodations (breaks, emotion check-ins, behavior chart)

b) Medication (if symptoms persist or worsen):

• SSRIs (e.g., fluoxetine) if irritability/mood symptoms are impairing

• Stimulants or atypical antipsychotics may be considered with severe aggression, but only after careful evaluation

c) Collaborative Care:

• Coordination between therapist, school counselor, teacher, and parent to ensure consistent behavioral strategies

Rationale:
DMDD responds best to CBT and parent training, not mood stabilizers typically used in bipolar disorder. Medications are second-line unless there is significant risk or functional impairment.

---

5. Prognosis:

• Moderate to Good, with early intervention.

• Prognosis improves with:

  • Consistent behavioral therapy

  • Supportive home and school environments

  • Emotional skill-building

• Children with DMDD are at higher risk of developing depression or anxiety in adolescence if left untreated.

The post Disruptive Mood Dysregulation Disorder (DMDD) appeared first on Skilled Papers.