Temper Dysregulation Disorder with Dysphoria

Temper Dysregulation Disorder with Dysphoria is a proposed disorder for the new DSM V (THE big mental illness diagnostic manual used by mental health professionals). . T-triple D is supposed to be an alternate diagnosis for kid's with pediatric onset bipolar. There is a lot of controversy regarding whether this is a legit diagnosis or going to be the new over-diagnosed dumping ground (like ADHD and pediatric bipolar have been in the past). Here's some interesting takes: justification, precursor to bipolar?, what happens with misdiagnosis?

I want to read The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children , which I've seen recommended before. It's supposed to be highly applicable. It's on my Amazon Wish List (with a lot of other great books!).

T-triple D can easily describe my kids, but so do their current diagnoses, including the Reactive Attachment Disorder, Complex Post Traumatic Stress Disorder and the Bipolar Disorder. I often think they could also be diagnosed with Oppositional Defiant Disorder. I hear in therapy often that I'm assigning their behaviors overly much to a diagnosis - justifying or blaming Bear's issues with me on RAD for example. I've done a lot of reading and research over the years, but I have more of a generalized knowledge than specialized and sometimes I think people assume I know something I don't so don't always explain things to me. I'm guilty of stopping short of doing all the needed research too, and end up making mistakes like not recognizing side effects of meds or settling for behaviors that could improve with treatment.

I just wish it was like diagnosing diabetes. We know what it is and how to treat it. As long as we follow the rules and with a little luck, then we should do OK. Having more than one diagnosis, the kids' ages and history, different body chemistries... makes it so complicated! I'm just so tired. I want to get it right, but I know there is no such thing.

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Temper Dysregulation Disorder with Dysphoria

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.

1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.


2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation.


3. The responses are inconsistent with developmental level.
   

B. Frequency: The temper outbursts occur, on average, three or more times per week.

C. Mood between temper outbursts:

1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).


2. The negative mood is observable by others (e.g., parents, teachers, peers).

D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.

E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.

F. Chronological age is at least 6 years (or equivalent developmental level).

G. The onset is before age 10 years.

H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences; see pp. XX). Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.

I. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.