Children with DMDD show severe and recurrent temper outbursts three or more times per week. These outbursts can be verbal or behavioral. Verbal outbursts often are described by observers as "rages", "fits", or "tantrums". Children may scream, yell, and cry for excessively long periods of time, sometimes with little provocation. Physical outbursts may be directed toward people or property. Children may throw objects; hit, slap, or bite others; destroy toys or furniture; or otherwise act in a harmful or destructive manner. Children with DMDD also display persistently irritable or angry<unk>  that is observable by others. Parents, teachers, and classmates describe these children as habitually angry, touchy, grouchy, or easily "set off". Unlike the irritability that can be a symptom of other childhood<unk> s, such as ODD, anxiety<unk> s, and major depressive<unk> , the irritability displayed by children with DMDD is not episodic or situation-dependent. In DMDD, the irritability or anger is severe and is shown most of the day, nearly every day in multiple settings, lasting for one or more years. The DSM-5 includes several additional diagnostic criteria which describe the duration, setting, and onset of the<unk> : the outbursts must be present for at least 12 months and occur in at least two settings (e.g. home and school), and it must be severe in at least one setting. Symptoms appear before the age of 10, and diagnosis must be made between ages 6 and 18. Comorbidity The core features of DMDD—temper outbursts and chronic irritability—are sometimes seen in children and adolescents with other psychiatric conditions. Differentiating DMDD from these other conditions can be difficult. Three<unk> s that most closely resemble DMDD are attention deficit hyperactivity<unk>  (ADHD), oppositional defiant<unk>  (ODD), and bipolar<unk>  in children. ADHD ADHD is a neurodevelopmental<unk>  characterized by problems with inattention and/or hyperactivity-impulsivity. ODD ODD is a<unk>  behavior<unk>  characterized by oppositional, defiant, and sometimes hostile actions directed towards others. Bipolar<unk>  One of the main differences between DMDD and bipolar<unk>  is that the irritability and anger outbursts associated with DMDD are not episodic; symptoms of DMDD are chronic and displayed constantly on an almost daily basis. On the other hand, bipolar<unk>  is characterized by distinct manic or hypomanic episodes usually lasting a few days, or a few weeks at most, that parents should be able to differentiate from their child's typical<unk>  and behavior in between episodes. The DSM precludes a dual diagnosis of DMDD and bipolar<unk> . Bipolar<unk>  alone should be used for youths who show classic symptoms of episodic mania or hypomania. Prior to adolescence, DMDD is much more common than bipolar<unk> . Most children with DMDD see a decrease in symptoms as they enter adulthood, whereas individuals with bipolar<unk>  typically display symptoms for the first time as teenagers and young adults. Children with DMDD are more at risk for developing major depressive<unk>  or generalized anxiety<unk>  when they're older rather than bipolar<unk> .
Disruptive mood dysregulation disorder
Atypical depression
Personality disorder not otherwise specified
Mixed anxiety–depressive disorder
Internalizing disorder
Externalizing disorder
Bipolar I disorder
Transference neurosis