DMDD vs. ODD: Understanding the Key Differences

This article will clarify the differences between Disruptive Mood Dysregulation Disorder (DMDD) and Oppositional Defiant Disorder (ODD).

DMDD and ODD are two commonly diagnosed behavioral disorders in children and adolescents. While there are shared traits and symptoms, there are also key differences with DMDD or ODD that can help identify the correct diagnosis. It is important to be able to correctly identify and distinguish between the two disorders for effective treatment.

Overview of DMDD

Disruptive mood dysregulation disorder is a condition that typically manifests in children or adolescents and is categorized as having severe, frequent temper outbursts in between which extreme irritability and mood issues remain.

Common causes and risk factors for DMDD

When looking at ODD and DMDD, the common causes for DMDD are temperamental, environmental, and genetic. 

Temperamental

Children who have a history of psychiatric complications, ADHD, major depressive disorder, or a history of chronic irritability are at a higher risk of developing disruptive mood dysregulation disorder.

Environmental

Exposure to environmental factors is heavily associated with disruptive mood dysregulation disorder, including:

1. Limited parental education
2. Psychological abuse or neglect
3. Living in a single-parent household
4. Parental psychiatric disorders
5. Experiencing early trauma like the death of a parent or divorce
6. Significant malnutrition, including vitamin deficiencies

Genetic

Those children with disruptive mood dysregulation disorder may be at a higher risk if they have a family history of depression or a personal history of pediatric bipolar disorder or similar mental illnesses.

Age of onset and developmental considerations 

The onset of disruptive mood dysregulation disorder must occur before a child is ten but not younger than 6. It is typically not diagnosed after the age of 18. Symptoms will change as a child matures, so developmental considerations are something a psychiatrist will need to prepare for when conducting a diagnosis.

Overview of ODD

Oppositional Defiant Disorder is where a child displays a pattern of irritable mood, argumentative or defiant behavior, and vindictiveness for at least six months. Those who are diagnosed as having Oppositional Defiant Disorder must have at least four symptoms from any of the three main categories:

1. Angry/irritable mood
   1. Often loses temper
   2. Is easily annoyed
   3. Is regularly resentful or angry
2. Argumentative/Defiant Behavior
   1. Often argues with authority figures or adults
   2. Often defies requests or refuses to comply with rules laid down by authority figures
   3. Deliberately annoys others
   4. Blames others for misbehavior or mistakes
3. Vindictiveness 
   1. Has been vindictive or spiteful at least twice in the last six months

Common causes and risk factors for ODD

One difference between DMDD and ODD has to do with risk factors. 

Temperamental

Oppositional Defiant Disorder is often related to issues with emotional regulation. This means that children who have high levels of emotional reactivity or don’t have good frustration tolerance are more likely to develop ODD. 

Environmental

There are also significant environmental causes and risk factors, such as neglectful child-rearing, harmful child-rearing practices, and inconsistent parenting. 

Genetic

There are neurobiological markers that are heavily associated with ODD, including:

1. Lower heart rate
2. Lower skin conductance reactivity
3. Reduced basal cortisol reactivity
4. Abnormalities in the prefrontal cortex
5. Abnormalities in the amygdala 

Age of onset and developmental considerations

Oppositional Defiant Disorder usually appears when a child is in preschool, and it rarely manifests after early adolescence. Those children who have symptoms of Oppositional Defiant Disorder are at a higher risk for other childhood-onset conduct disorders and may subsequently develop things like depressive disorder or anxiety disorder.

Many of the behaviors associated with ODD get worse during the preschool time frame and get worse during adolescence.

Key Differences Between DMDD and ODD

So, what is the difference between ODD and DMDD? When comparing DMDD vs. ODD, it’s important to recognize that there are many differences.

Symptoms of Oppositional Defiant Disorder do not typically occur in children who also have disruptive mood dysregulation disorder, and the symptoms of DMDD are equally rare in children who are legitimately diagnosed with oppositional defiant disorder. 

There are differences between ODD vs. DMDD that relate to emotional regulation, behavioral patterns, and diagnostics. 

Differences in emotional regulation and mood symptoms

The differences between ODD and DMDD start with emotional regulation and mood symptoms. The diagnostic criteria for Oppositional Defiant Disorder states that an individual must have a pattern of at least four of eight symptoms only two of which have to do with often losing temper or often being angry and resentful as opposed to DMDD which encompasses irritability and tantrums almost exclusively.

Differences in behavioral patterns and defiance

There are other differences between ODD and DMDD that have to do with defiance and behavioral patterns. For Oppositional Defiant disorder, for example, the behavioral patterns and defiance have to do with arguing with any authority figures, refusing to comply with rules from authority figures, and deliberately trying to annoy other people. 

By comparison, those with DMDD have physical or verbal outbursts as part of their tantrums and irritability directed at anyone, as a disproportionate response to frustration rather than as a vindictive and intentionally defiant form of behavior toward authority.

How DMDD and ODD are typically diagnosed in clinical settings

Both ODD and DMDD are diagnosed in clinical settings using diagnostic criteria from the DSM-5. During an appointment, a psychiatrist will ask questions about the current feelings and behaviors of both the child and family who are present, as well as information on family history and physical health.

All of this information will be used to determine whether the behavioral patterns can be better explained by another condition or whether they fit more with DMDD vs. ODD. 

The key difference between DMDD vs. ODD in terms of Diagnostics is the age group. As mentioned, ODD begins to manifest during early preschool years and doesn’t typically manifest beyond early adolescence, whereas DMDD is not diagnosed until a child is at least six years old and is typically not diagnosed beyond the age of 18.

Impact of DMDD vs. ODD on social lives

Another difference between DMDD and ODD has to do with the impact each disorder has on social relationships. 

Disruptive mood dysregulation disorder causes significant disruptions to a child’s peer relationships and family relationships as well as their academic performance. The low tolerance for frustration means that children with DMDD have significant challenges succeeding in school, and they are unable to participate in things that other children enjoy, like sports or group activities. The outburst and irritability make it difficult for said children to initiate or sustain friendships and can cause a disruption to family life.

Oppositional Defiant Disorder is often associated with distress in the individual as well as those within their immediate social group like peers, family, and work colleagues because it negatively impacts social functioning, as well as other important areas of functioning. For example, children and adolescents who have ODD will have problems in their relationships, increased workplace stress as they get older, poor academic achievement, higher risks of antisocial behavior, impulse control issues, depression, anxiety, and substance abuse.

Summing up

When comparing DMDD vs. ODD, it is important to recognize the key differences between ODD and DMDD and to work with a professional psychiatrist to get an accurate diagnosis. With the right diagnosis, you and your loved ones can start individual treatment plans for each condition