New Classification for DSM: TDD/DMDD?
In April of 2010, the American Psychiatric Association (“APA”) announced the proposed changes for the next edition of the Diagnostic and Statistical Manual: the DSM 5. Among the changes was the proposed classification of Temper Dysregulation Disorder with Dysphoria (TDD) which is now called Disruptive Mood Dysregulation Disorder (DMDD).
Authors of the proposal concluded that, since some children satisfy the criteria currently established for bipolar disorder, and since episodic mania of specified minimal duration has always been a criteria of bipolar disorder, children who experience chronic or frequent irritability and/or temper outbursts constitute a different disorder. Therefore, they propose that DMDD will serve as a corrective action and diagnostic home for those children.
JBRF sponsored investigators have expressed grave concern over the direct and indirect consequences of the new proposal. In their strong opinion, it is a proposal which does not venture out of old ideas but merely restores internal consistency with previously defined DSM diagnoses –a point which is, in fact, one of the primary justifications given by the authors for the new classification. DMDD is not supported by any meaningful or compelling new evidence-based knowledge and therefore does not bring us any closer to a validated condition which would provide a path to effective and reliable treatment. In fact, JBRF-sponsored investigators believe that it confers greater risk to these children as the new classification shifts them to a treatment regimen which they believe is contraindicated and will hasten onset and/or increase suicidal behavior.
During the public comment period that followed the announcement, JBRF submitted a substantial and detailed objection to the proposal. We never received any response or inquiry in return.
JBRF is not the only entity concerned about the new classification. A statement by the National Association on Mental Illness (NAMI) echoes a frequently expressed concern that the limited scope of research that created the new classification and the lack of clinical guidelines it offers render inclusion of the classification as premature. A search of the internet will reveal other research-based concern.
Apart from the serious clinical concerns expressed from professionals and research institutions, there was also a groundswell in the advocacy community against the proposed name of the new classification. It was perceived to have a negative connotation which would only serve to perpetuate stigma.
After weighing all of the responses, the APA has only acted in regard to the name change. As mentioned above, TDD became DMDD. All criteria, justification and rational have remained unchanged.
Most of the response submitted to APA by JBRF is re-printed in this section of the site. Please bear in mind that it was written prior to the name change. Consequently, all references to the new classification refer to it by its original name: Temper Dysregulation Disorder with Dysphoria or TDD.
