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Articles   |    
Adult Diagnostic and Functional Outcomes of DSM-5 Disruptive Mood Dysregulation Disorder
William E. Copeland, Ph.D.; Lilly Shanahan, Ph.D.; Helen Egger, M.D.; Adrian Angold, M.R.C.Psych.; E. Jane Costello, Ph.D.
Am J Psychiatry 2014;171:668-674. doi:10.1176/appi.ajp.2014.13091213
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Dr. Shanahan has received grant support from NIMH (MH094605 and MH058144). Dr. Angold has received support from NIMH and the National Institute on Drug Abuse. Dr. Costello has received NIH funding as well as data collection and salary support from 1993 to present. The research presented here was supported by NIMH (MH080230, MH63970, MH63671, MH48085, MH075766), the National Institute on Drug Abuse (DA/MH11301, DA011301, DA016977, DA011301), NARSAD (early career award to Dr. Copeland), and the William T. Grant Foundation.

The authors report no financial relationships with commercial interests.

From the Center for Developmental Epidemiology, Duke University Medical Center, Durham, N.C.; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham; and the University of North Carolina at Chapel Hill.

Address correspondence to Dr. Copeland (william.copeland@duke.edu).

Copyright © 2014 by the American Psychiatric Association

Received September 14, 2013; Revised November 25, 2013; January 09, 2014; Accepted January 16, 2014.

Abstract

Objective  Disruptive mood dysregulation disorder (DMDD) is a new disorder for DSM-5 that is uncommon and frequently co-occurs with other psychiatric disorders. Here, the authors test whether meeting diagnostic criteria for this disorder in childhood predicts adult diagnostic and functional outcomes.

Method  In a prospective, population-based study, individuals were assessed with structured interviews up to six times in childhood and adolescence (ages 10 to 16 years; 5,336 observations of 1,420 youths) for symptoms of DMDD and three times in young adulthood (ages 19, 21, and 24–26 years; 3,215 observations of 1,273 young adults) for psychiatric and functional outcomes (health, risky/illegal behavior, financial/educational functioning, and social functioning).

Results  Young adults with a history of childhood DMDD had elevated rates of anxiety and depression and were more likely to meet criteria for more than one adult disorder relative to comparison subjects with no history of childhood psychiatric disorders (noncases) or individuals meeting criteria for psychiatric disorders other than DMDD in childhood or adolescence (psychiatric comparison subjects). Participants with a history of DMDD were more likely to have adverse health outcomes, be impoverished, have reported police contact, and have low educational attainment as adults compared with either psychiatric or noncase comparison subjects.

Conclusions  The long-term prognosis of children with DMDD is one of pervasive impaired functioning that in many cases is worse than that of other childhood psychiatric disorders.

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FIGURE 1. Means Values for Adult Standardized Outcome Scales by Childhood Diagnostic Statusa

a Negative scores indicate more problems than the mean for the total sample. Asterisks indicate whether the comparison group was statistically different from the disruptive mood dysregulation disorder (DMDD) group (p<0.05). Children with DMDD had worse health outcomes than noncase comparison subjects (means ratio=2.8; 95% CI=1.8–2.1, p<0.001) and psychiatric comparison subjects (means ratio=1.6; 95% CI=1.0–2.5, p=0.04). DMDD case subjects had higher levels of all other outcomes compared with noncase comparison subjects (risky/illegal means ratio=2.0; 95% CI=1.1–3.6, p=0.02; financial/educational means ratio=2.3; 95% CI=1.6–3.3, p<0.001; and social means ratio=2.2; 95% CI=1.5–3.3, p<0.001). Relative to psychiatric comparison subjects, DMDD case subjects did not have worse risky/illegal behavior outcomes (means ratio=1.2; 95% CI=0.7–2.3, p=0.45) or financial/educational outcomes (means ratio=1.2; 95% CI=0.8–1.8, p=0.34), but had marginally worse social outcomes (means ratio=1.5; 95% CI=1.0–2.3, p=0.06).

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TABLE 1.Descriptive Statistics and Childhood Family Characteristics in a Study of Adult Outcomes of Disruptive Mood Dysregulation Disorder (DMDD)a
Table Footer Note

a Total N=1,420. All reported N values are unweighted and all percentages are weighted. p values are significant at p<0.05.

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TABLE 2.Associations of Childhood/Adolescent Diagnostic Groups With Young Adult Diagnostic Categoriesa
Table Footer Note

a N=1,273. All reported N values are unweighted and all percentages are weighted. DMDD=disruptive mood dysregulation disorder; ASPD=antisocial personality disorder; THC=marijuana-related disorders. p values are significant at p<0.05.

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TABLE 3.Associations Between Disruptive Mood Dysregulation Disorder (DMDD) in Childhood and Young Adult Health Functioning and Risky/Illegal Behaviorsa
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a N=1,273. All reported N values are unweighted and all percentages are weighted. Odds ratios significant at p<0.05.

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TABLE 4.Associations Between Disruptive Mood Dysregulation Disorder (DMDD) in Childhood and Young Adult Financial and Social Functioninga
Table Footer Note

a N=1,273. All reported N values are unweighted and all percentages are weighted. Odds ratios significant at p<0.05.

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1.
Which of the following best describes the evidence to date about the 3-month prevalence and comorbidity profile of disruptive mood dysregulation disorder (DMDD) in childhood?
2.
How does the risk for adult anxiety or depression in children with DMDD compare with psychiatric comparison subjects?
3.
The adult social functioning profile of individuals with a history of DMDD shows a greater likelihood of which of the following features compared to noncase subjects?
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