Concerns Regarding the Inclusion of Temper Dysregulation Disorder With Dysphoria in the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition: (Commentary)
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Article Abstract The authors strongly oppose including temper dysregulation disorder with dysphoria (TDD) as an official diagnosis in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The primary justification for the inclusion of this new diagnostic category is to have an alternate diagnosis for youths with severe, chronic irritability who may be currently diagnosed with bipolar disorder. However, the TDD diagnosis, as it is currently conceived, introduces problems of its own. The diagnosis of TDD rests on 2 primary criteria: recurrent severe temper outbursts and chronically irritable and/or sad mood. Because temper outbursts are a behavioral manifestation of irritable mood, the diagnosis of TDD as it is currently proposed, can be fulfilled with the presence of a single symptom, making it unlikely to be categorically distinct from oppositional defiant disorder, for example. Scientific support for the TDD diagnosis is limited, and most of it has emerged from a single research group. In the case of TDD, most of the studies that have a bearing on children with TDD have focused an overlapping but distinct population of youths with severe mood dysregulation (SMD). The research on SMD is groundbreaking, and it demonstrates that a subgroup of youths with severe, chronic irritability does not have bipolar disorder, but it is insufficient to justify the inclusion of TDD, a new diagnostic category, in the DSM-5.
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There is now far greater consensus in the field that the diagnosis of BD in children and adolescents should be made based on the same set of symptoms as applied to adults.
“In contrast to the controversies of as recently as a decade ago, there is now far greater consensus in the field that, although there are developmental differences in the manner in which symptoms manifest themselves, the actual diagnosis of BD in children and adolescents should be made based on the same set of symptoms as applied to adults.563”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [563]
In the paper’s main text (page unavailable), the authors urge rigorous application of current criteria for manic, mixed, and hypomanic episodes in youth, while recommending attention to developmental issues. This supports the diagnostic approach attributed to them, but the paper does not establish that there is now far greater consensus across the field than a decade earlier; it says substantial diagnostic controversies remain. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies in clinical and community samples have found that 70-100% of children with DMDD have symptoms that meet the diagnostic requirements for ODD.
“Studies in clinical and community samples have found that 70-100% of children with DMDD have symptoms that meet the diagnostic requirements for ODD 77,79-82 , suggesting that the irritability and behavioural symptom dimensions of ODD are not separable into different disorders 31,78 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [80]
The discussion of TDD and ODD quotes analyses of community-based and clinic-based samples finding that essentially all youths meeting TDD criteria also meet ODD criteria. This supports substantial diagnostic overlap, but the paper does not report the claimed 70–100% range for children with DMDD. (LLM, conf=0.85)
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- Authors
- Axelson, D. A., Birmaher, B., Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., Arnold, L. E., Goldstein, B. I., Goldstein, T. R., Chang, K. D., DelBello, M. P., Ryan, N. D., & Diler, R. S.
- Affiliations
- University of Pittsburgh (US)
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2011-05-03
- Volume
- 72
- Issue
- 09
- Pages
- 1257-1262
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC3581329
- OpenAlex
- W1505053248
- Cited by
- 62
- References
- 14
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 4 · 2014: 9 · 2013: 11 · 2012: 8
- FWCI
- 9.99
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Purdue University
- Purdue Pharma
- Sunnybrook Foundation
- National Institutes of Health (5r01mh073967-10)
- National Institute of Mental Health (R01MH073801, R01-MH073967, R01MH073816, R01MH073953)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- DSM-5, diagnostic criteria, irritability, temper outbursts, severe mood dysregulation, bipolar disorder, oppositional defiant disorder, children and adolescents, psychiatric diagnosis
- MeSH terms
- Adolescent, Affective Symptoms, Child, Humans, Temperament, Antimanic Agents, Diagnostic and Statistical Manual of Mental Disorders, Emotional Intelligence
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