Clinical Guidance: Severe Mood Dysregulation in Childhood
Children with severe mood dysregulation, characterized by chronic severe irritability, can be distinguished from those with childhood bipolar disorder, characterized by distinct episodes of hypomania, irritability, or depression. Those with severe mood dysregulation are more likely to develop adult unipolar depression and anxiety, whereas those with childhood bipolar disorder continue on to adult bipolar disorder. Family history of bipolar disorder is increased in parents of children with bipolar disorder, and there are pathophysiological differences between the two childhood disorders, according to Leibenluft (p. 129). Accurate estimates of relative prevalence and recommended treatment for severe mood dysregulation have not been achieved, but the condition has been recommended as a new DSM-5 diagnosis, which will facilitate further work. Parental perspectives on mood disorders in children are the subject of a new book by Judith Warner, reviewed by Rosenbaum in this issue (p. 214). Warner concludes that allegations of the overmedication of children overlook the severity of the behavioral symptoms manifested by the children whose families seek help.