Eur Child Adolesc Psychiatry

DOI 10.1007/s00787-015-0789-y

LETTER TO THE EDITOR

Disruptive mood dysregulation disorder in ICD‑11: a new

disorder or ODD with a specifier for chronic irritability?
K. C. Runions1 · R. M. Stewart2 · J. Moore2 · Y. Martinez Ladino2 · P. Rao2 ·
F. D. Zepf2,3 

Received: 21 September 2015 / Accepted: 22 October 2015

© Springer-Verlag Berlin Heidelberg 2015

To the Editor, important aspect in the light of the ongoing discussion on

DMDD and ODD. ODD as a diagnostic category has been
We read the article by Mulraney et al. entitled “Comor-
around for many years, but DMDD as a diagnosis is new.
bidity and correlates of disruptive mood dysregulation
However, this does not mean that ODD is either correct or
disorder in 6–8‐year‐old children with ADHD” [1] with
ideal as a diagnostic category, and that it does not need any
great interest. In the study covered in this particular arti-
further revision.
cle, the authors aimed to explore the impact of the new
Indeed, there may yet be unintentional benefits of the
DSM-V diagnosis disruptive mood dysregulation disorder
controversy over DMDD. There is reason to believe the
(DMDD) in children aged 6–8 years with attention-deficit/
current conceptualisation of ODD conflates two commonly
hyperactivity disorder (ADHD), and with a focus on related
co-occurring but distinct phenotypes, irritability and non-
comorbid psychiatric disorders and how DMDD can affect
compliance/oppositional behaviours. Studied as distinct
functioning in daily life. We would like to congratulate the
phenomena, these constructs, respectively, show prospec-
authors on their very important paper.
tive associations with depressive/anxiety problems, and
As stated by the authors, there was a significant diag-
with conduct disorder and ADHD [3–5]. We believe that
nostic overlap of DMDD with oppositional defiant disor-
these findings suggest that both the disorders, DMDD and
der (ODD); and using a proxy DMDD diagnosis contain-
ODD, require an equal amount of scrutiny as diagnostic
ing items from the ODD module of the DISC-IV likely
categories as regards their validity.
impacted such comorbidity patterns. Mulraney et al. [1]
Another relevant related area is the issue of hierarchy in
suggest that the DSM-5 developers might instead have pro-
diagnosis. As the authors have pointed out, DSM-5 man-
posed a diagnostic specifier regarding chronic irritability to
dates a preferential diagnosis of DMDD over ODD, when
the ODD diagnosis, a proposal also recently forwarded for
features of both are deemed to be present. This could,
the ICD-11 [2].
potentially, be construed as meaning that DMDD is a more
While we agree with Mulraney and colleagues [1] and
severe form of ODD. But there are no empirical data, to
acknowledge that their results are of clinical importance,
date, to suggest that this is the case. Further research is
we would like to highlight one further and in our view
therefore needed to clarify constructs that constitute valid
individual diagnostic categories as well as potential over-
* F. D. Zepf lap between categories. At this stage it is not possible to
florian.zepf@uwa.edu.au determine in advance which of the different views on this
1 important clinical topic is correct.
Telethon Kids Institute, Perth, Australia
2
As reflected in the US National Institute of Men-
Department of Child and Adolescent Psychiatry,
tal Health Research Domain Criteria Initiative, a close
The University of Western Australia, 35 Stirling Highway
(M561), Crawley, Perth, WA 6840, Australia examination of particular constructs in mental illness may
3 fruitfully inform better taxonomies and diagnoses [6]. We
Specialised Child and Adolescent Mental Health Services
(CAMHS), Department of Health in Western Australia, believe the controversy over DMDD, and in particular its
Perth, WA, Australia phenotypic overlap with ODD, may be an impetus for a

13

close examination of the constructs of angry and irritable
mood as distinct from argumentative and defiant behav-
iours and vindictiveness. Research examining the distinct
developmental trajectories of these symptom domains, and
their sensitivity to genetics, epigenetic markers, biomark-
ers, and social correlates, may provide a clearer picture
of clinical and behavioral phenotypes as well as possible
related subtypes, the underlying mechanisms, aetiology
and, most importantly, treatment avenues [7].
Acknowledgements  The research leading to these results is funded
by the European Union’s Seventh Framework Programme (FP7/2007–
2013) under Grant Agreement No 602407. The funding sources had
no role in the writing of the manuscript or the decision to submit it for
publication. There was no payment received by any of the authors to
write this article by a pharmaceutical company or other agency. The
corresponding author, FDZ, had final responsibility for the decision
to submit the publication, and all co-authors agreed with this and the
final version of the manuscript.
Complaince with ethical standards  conduct problems and mood dysregulation among children with
Conflict of interest  FDZ was the recipient of an unrestricted award
donated by the American Psychiatric Association, the American Psy-
chiatric Institute for Research and Education, and AstraZeneca (Young
Minds in Psychiatry Award). He has also received research support
from the German Federal Ministry for Economics and Technology, the
European Union, the German Society for Social Pediatrics and Adoles-
cent Medicine, the Paul and Ursula Klein Foundation, the Dr. August
Scheidel Foundation, the IZKF Fund of the University Hospital of
RWTH Aachen University, and a travel stipend donated by the Glaxo-
SmithKline Foundation. He is the recipient of an unrestricted educa-
tional grant, travel support and speaker honoraria by Shire Pharmaceu-
ticals, Germany. In addition, he has received support from the Raine
13
Eur Child Adolesc Psychiatry
Foundation for Medical Research (Raine Visiting Professorship), and
editorial fees from Co-Action Publishing (Sweden). The other authors
have nothing to report or to disclose.
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