DMDD – A New Classification for DSM
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. Action taken regarding bipolar disorder in children has become one of the primary shifts proposed for the new edition. It has also become one of the major controversies.
The APA accepted for inclusion the new classification of Disruptive Mood Dysregulation Disorder (DMDD) as a more appropriate diagnostic category for many of the children who would have previously received a diagnosis of Bipolar Disorder- Not Otherwise Specified (BP-NOS) (see What is Juvenile Bipolar Disorder).
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.
The primary and strongest justification for inclusion, as the authors themselves state, is that it restores consistency, or reliability, with previously defined DSM diagnoses. Since reliability, rather than validity, is the stated intention of this and previous DSM editions, (see What is the DSM and Obstacles Created by Language) it is not too surprising that the proposal was ultimately accepted.
During the public comment period that followed the announcement, JBRF submitted a substantial and detailed objection to the proposal but do not believe that our research or opinions were seriously considered. (The remaining postings in this section come from that response.)
JBRF-sponsored investigators expressed grave concern over the direct and indirect consequences of the new proposal. It is a proposal which does not venture out of old ideas. Its lack of meaningful or compelling evidence-based knowledge will not bring us any closer to a path which will provide 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.
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. Prior to and post release of the new manual there has been substantial concern expressed by leading voices in the field of psychiatry as to the lack of science underlying new DSM 5 classifications. (see the tab NIMH; Research Trends)
After weighing all of the professional and public comments submitted in response to the open comment period prior to adoption, the only adjustment that was made by the APA to the proposed classification was to change its name from the original proposal of Temper Dysregulation Disorder to DMDD. All the criteria, justification and rational have remained unchanged.