/ DBT-C, English, Supersensers / By Francheska Perepletchikova
Research study by Marit Coldevin et.al (2024)
Disruptive Mood Dysregulation Disorder (DMDD) is a relatively new childhood-onset depressive disorder added to the DSM-5 in 2013. DMDD is characterized by frequent, extreme emotional outbursts relative to their trigger, with chronic irritability between outbursts. To be diagnosed with DMDD, temper symptoms can’t be explained by other mental or neurological diagnoses, or due to physiological effects of substance use. Individuals with DMDD have high rates of comorbidity with other psychiatric diagnoses, most commonly oppositional and depressive disorders.
Since its introduction, research on DMDD has focused on understanding its prevalence, epidemiology, physiology, comorbidities, and, of course, effective treatment options. However, very limited research has been done to uncover relevant risk factors, including biological mechanisms and environmental influences.1 Of this limited research, DMDD has been linked with negative parenting styles, suggesting factors that influence parenting are integral in understanding DMDD’s development.2 3
Parental stress, defined as the stress caused by parenting tasks and adjustment to parenting responsibility, significantly influences the quality of caregiving; high levels of perceived parental stress are associated with negative parenting styles. Likewise, parents of children with mental disorders- especially those with externalizing behavior problems- suffer higher parental stress than parents of neurotypical children.
As DMDD is characterized by severe externalizing behavioral problems (extreme outbursts), parental stress load is expected to be high, as is its effect on parenting style.
Parental stress is categorized into three primary domains:4
-The child domain relates to stress caused by child temperament, behavior, demandingness, hyperactivity, and adaptability
-The parent domain relates to stress caused by parental responsibilities, parent personality, parent disorders (like depression), sense of competence, and attachment style to their child
-The situational domain relates to stress related to spousal relationships, role restrictions between parents, isolation, and social support
Coldevin et al. (2024) focused their study on parental factors involved in DMDD, comparing parental stress and attachment styles between parents of children with DMDD to parents of children with ADHD, anxiety disorders, depressive disorders, and oppositional disorders.5
Despite sharing similar levels of parental stress in the parent and situational domains, parents of children with DMDD had a significantly higher stress load due to the child domain alone. Children with DMDD have both higher symptom load and decreased functioning in several areas associated with child domain stress. Additionally, DMDD temper outbursts are both unpredictable and vary heavily in severity, making it very difficult for parents to assess and prepare to handle symptoms, further increasing overall stress load.
This study highlights the necessity of including parents in therapy, both to aid in the development of effective treatment plans and parenting management targets. Heavier involvement from parents can help to increase their preparedness in handling their children’s symptoms, learn and master healthy coping strategies to tackle parental stress, and sustainably incorporate positive parenting styles in the face of highly demanding parental responsibilities.
CITATIONS:
- Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., Zoccali, R. A., & Muscatello, M. R. (2019). Focus on disruptive mood dysregulation disorder: A review of the literature. Psychiatry Research, 279, 323–330. https://doi.org/10.1016/j.psychres.2019.05.043
- Morris, A. S., Criss, M. M., Silk, J. S., & Houltberg, B. J. (2017). The impact of parenting on emotion regulation during childhood and adolescence. Child Development Perspectives, 11(4), 233–238. https://doi.org/10.1111/cdep.12238
- Dougherty, L. R., Smith, V. C., Bufferd, S. J., Carlson, G. A., Stringaris, A., Leibenluft, E., & Klein, D. N. (2014). DSM-5 disruptive mood dysregulation disorder: Correlates and predictors in young children. Psychological Medicine, 44(11), 2339–2350. https://doi.org/10.1017/s0033291713003115
- Fang, Y., Luo, J., Boele, M., Windhorst, D., van Grieken, A., & Raat, H. (2022). Parent, child, and situational factors associated with Parenting Stress: A Systematic Review. European Child & Adolescent Psychiatry, 33(6), 1687–1705. https://doi.org/10.1007/s00787-022-02027-1
- Coldevin, M., Brænden, A., Zeiner, P., Øyen, A.-S., Melinder, A., & Stubberud, J. E. (2024a). Disruptive mood dysregulation disorder, parental stress, and attachment styles. Frontiers in Child and Adolescent Psychiatry, 3. https://doi.org/10.3389/frcha.2024.1430850