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Cited by 565Bipolar Disorder and TreatmentChild and Adolescent Psychosocial and Emotional DevelopmentPersonality Disorders and Psychopathology

Severe Mood Dysregulation, Irritability, and the Diagnostic Boundaries of Bipolar Disorder in Youths

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Leibenluft, Ellen·2011·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2010.10050766PMC PMC3396206
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Abstract

In recent years, increasing numbers of children have been diagnosed with bipolar disorder. In some cases, children with unstable mood clearly meet current diagnostic criteria for bipolar disorder, and in others, the diagnosis is unclear. Severe mood dysregulation is a syndrome defined to capture the symptomatology of children whose diagnostic status with respect to bipolar disorder is uncertain, that is, those who have severe, nonepisodic irritability and the hyperarousal symptoms characteristic of mania but who lack the well-demarcated periods of elevated or irritable mood characteristic of bipolar disorder. Levels of impairment are comparable between youths with bipolar disorder and those with severe mood dysregulation. An emerging literature compares children with severe mood dysregulation and those with bipolar disorder in longitudinal course, family history, and pathophysiology. Longitudinal data in both clinical and community samples indicate that nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood. Data also suggest that youths with severe mood dysregulation have lower familial rates of bipolar disorder than do those with bipolar disorder. While youths in both patient groups have deficits in face emotion labeling and experience more frustration than do normally developing children, the brain mechanisms mediating these pathophysiologic abnormalities appear to differ between the two patient groups. No specific treatment for severe mood dysregulation currently exists, but verification of its identity as a syndrome distinct from bipolar disorder by further research should include treatment trials.

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  • The DSM-5 Childhood and Adolescent Disorders Work Group compared evidence from natural history and treatment studies of classic bipolar disorder versus bipolar disorder diagnosed using nonepisodic irritability as a criterion, and determined that separate disorders based on episodic versus persistent irritability were justified.

    “the DSM-5 Childhood and Adolescent Disorders Work Group compared evidence from natural history and treatment studies of classic bipolar disorder versus bipolar disorder diagnosed using nonepisodic irritability as a criterion, and determined that separate disorders based on episodic versus persistent irritability were justified (45).”

    From The DSM-5: Classification and criteria changes (2013) · cites this paper as [45]

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  • The prevalence of childhood bipolar disorders is growing at an alarming rate.

    “With the prevalence of childhood bipolar disorders growing at an alarming rate”

    From The DSM-5: Classification and criteria changes (2013) · cites this paper as [45]

    In “Diagnosing Bipolar Disorder in Youths: The Controversy” (page not supplied), the paper reports a marked rise in bipolar disorder diagnoses among youths. It explicitly says this could reflect a true prevalence increase, better case identification, or changed diagnostic concepts, so it does not establish that the disorder’s prevalence is growing. (LLM, conf=0.90)

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Authors
Leibenluft, E.
Affiliations
National Institutes of Health (US)
Corresponding author
Leibenluft, Ellen
ORCID
Leibenluft, Ellen
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2011-02
Volume
168
Issue
2
Pages
129-142
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2010.10050766
PMC
PMC3396206
OpenAlex
W2118839664
Semantic Scholar
c64f609f300b8257f6acf9cc1dba5132f3857cd0
Cited by
565
References
102
Citations by year
2026: 20 · 2025: 18 · 2024: 26 · 2023: 24 · 2022: 24 · 2021: 51 · 2020: 27 · 2019: 38 · 2018: 30 · 2017: 37 · 2016: 59 · 2015: 39 · 2014: 47 · 2013: 51 · 2012: 52
FWCI
26.89
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (Z99 MH999999)
  • National Institute of Mental Health (ZIAMH002786)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
severe mood dysregulation, bipolar disorder, children and adolescents, hyperarousal, diagnostic boundaries, familial risk, anxiety, major depressive disorder, frustration, longitudinal course, pathophysiology, treatment
MeSH terms
Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Brain, Cross-Sectional Studies, Depressive Disorder, Diagnosis, Differential, Humans, Irritable Mood, Longitudinal Studies, Neural Pathways, Phenotype, Psychotropic Drugs, Risk Factors, Mood Disorders, Diagnostic and Statistical Manual of Mental Disorders

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