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Research ArticleRegular Articles

Disruptive Mood Dysregulation Disorder in Juvenile Justice

Megan M. Mroczkowski, Larkin S. McReynolds, Prudence Fisher and Gail A. Wasserman
Journal of the American Academy of Psychiatry and the Law Online September 2018, 46 (3) 329-338; DOI: https://doi.org/10.29158/JAAPL.003767-18
Megan M. Mroczkowski
Drs. Mroczkowski and McReynolds are Assistant Professors of Psychiatry and Dr. Wasserman is a Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center, New York, NY. Dr. Fisher is Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) at Columbia University College of Physicians and Surgeons, New York, NY. Versions of this study were presented as a poster at the 45th Annual Meeting of the American Academy of Psychiatry and the Law, Chicago, October 23–26, 2014, and at the 63rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry, New York, October 24–29, 2016.
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Larkin S. McReynolds
Drs. Mroczkowski and McReynolds are Assistant Professors of Psychiatry and Dr. Wasserman is a Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center, New York, NY. Dr. Fisher is Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) at Columbia University College of Physicians and Surgeons, New York, NY. Versions of this study were presented as a poster at the 45th Annual Meeting of the American Academy of Psychiatry and the Law, Chicago, October 23–26, 2014, and at the 63rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry, New York, October 24–29, 2016.
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Prudence Fisher
Drs. Mroczkowski and McReynolds are Assistant Professors of Psychiatry and Dr. Wasserman is a Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center, New York, NY. Dr. Fisher is Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) at Columbia University College of Physicians and Surgeons, New York, NY. Versions of this study were presented as a poster at the 45th Annual Meeting of the American Academy of Psychiatry and the Law, Chicago, October 23–26, 2014, and at the 63rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry, New York, October 24–29, 2016.
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Gail A. Wasserman
Drs. Mroczkowski and McReynolds are Assistant Professors of Psychiatry and Dr. Wasserman is a Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center, New York, NY. Dr. Fisher is Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) at Columbia University College of Physicians and Surgeons, New York, NY. Versions of this study were presented as a poster at the 45th Annual Meeting of the American Academy of Psychiatry and the Law, Chicago, October 23–26, 2014, and at the 63rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry, New York, October 24–29, 2016.
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    Table 1

    Retrofitting DSM-5 Diagnosis of DMDD From V-Disc Data

    DSM-5 CriteriaRetrofit from V-DISC
    A. Severe recurrent temper tantrums manifested verbally and behaviorally grossly out of proportion in intensity or duration to the situation or provocation:“About how often do you lose your temper?” answering “A few days a week.” or “Nearly every day.”
    B. Temper outbursts inconsistent with developmental level“About how often do you lose your temper?” answering “A few days a week” or “Nearly every day.”
    C. Average, 3+ per week“About how often do you lose your temper?” answering “A few days a week” or “Nearly every day.”
    D. Irritable mood between outbursts“In the past six months, have you been grouchy or easily annoyed?” Answering “Nearly every day.”
    ANDAND
    Angry mood between outbursts.“In the past six months, have you been mad at people or things?” answering “Nearly every day” or “In the past six months, have you gotten angry because you've thought things were unfair?” answering “Nearly every day.”
    E. Criteria A–D for 12+ months.Data unavailable on V-DISC, which asks specifically about presence of criteria within the past six months.
    F. Criteria A–D in at least two settings (home, school, or peers); severe in one.Data unavailable on V-DISC.
    G. Not >6 years old and not >18 years old.Age is an inclusion parameter.
    H. Age at onset A–E: <10 years.Data unavailable on V-DISC.
    I. Episodes of elated mood plus manic-specific symptoms lasting more than one day cannot be present.Exclusion criteria included that DMDD cannot coexist with ODD, intermittent explosive disorder (IED), or bipolar disorder.
    J. Symptoms are not occurring exclusively during a psychotic or mood disorder or are better accounted for by another disorder.Data unavailable on V-DISC.
    K. Not from effects of a substance.Data unavailable on V-DISC.
    • View popup
    Table 2

    Sample Demographic, Offense, and Disorder Characteristics

    DMDD + (n = 314)DBD + (without mood or DMDD) (n = 1,952)Other Mood + (without DBD or DMDD) (n = 232)
    Characteristicsn (%)n (%)n (%)
    Female*131 (41.7)360 (18.4)85 (36.6)
    White128 (40.8)916 (46.9)89 (38.4)
    Age (mean, SD)*15.8 (1.5)16.0 (1.3)15.9 (1.5)
    Grade (mean, SD)†8.7 (1.4)8.9 (1.4)9.0 (1.6)
    Juvenile justice setting*
        System intake122 (38.9)403 (20.6)82 (35.3)
        Secure care192 (61.1)1549 (79.4)150 (64.7)
    Interpersonal offense*127 (41.0)582 (30.0)92 (39.7)
    Age at first offense (mean, SD)13.3 (1.9)13.2 (2.0)13.4 (1.8)
    Repeat offender*221 (71.8)1608 (84.0)184 (80.3)
    Posttraumatic stress disorder*65 (20.8)38 (1.9)46 (19.8)
    Traumatic exposure
        Forced sexual activity*75 (24.0)231 (11.8)64 (27.6)
        Assaultive violence223 (71.2)1374 (70.5)150 (64.7)
    Affective disorder*,†142 (47.0)—232 (100.0)
        Major depressive disorder*,†132 (42.0)—195 (84.1)
        Lifetime suicide attempt*113 (36.0)376 (19.3)80 (34.5)
    Disruptive behavior disorder*188 (84.7)1952 (100.0)—
    Substance use disorder*,†165 (54.3)1221 (64.6)68 (29.7)
    • ↵* Significant difference (p < .001) between DMDD + and DBD + (without mood or DMDD).

    • ↵† Significant difference (p < .001) between DMDD + and other mood + (without DBD or DMDD).

    • View popup
    Table 3

    Multinomial Regression Estimates Predicting Diagnostic Status

    DMDD vs. DBD with neither mood disorder nor DMDD OR (95% CI)DMDD vs. Other mood with neither DBD nor DMDD OR (95% CI)
    Female0.45*** (0.33–0.60)0.73 (0.49–1.08)
    White (vs. nonwhite)1.25 (0.96–1.63)0.88 (1.62–1.27)
    System intake setting (vs. secure care)0.46*** (0.34–0.61)0.69 (0.47–1.01)
    Interpersonal offense0.69** (0.53–0.90)0.86 (0.60–1.23)
    Posttraumatic stress disorder0.09*** (0.06–0.14)0.90 (0.57–1.42)
    Substance use disorder1.27 (0.97–1.67)0.32*** (1.22–0.47)
    Lifetime suicide attempt0.60*** (0.44–0.81)1.03 (0.70–1.52)
    Exposure to forced sexual activity0.91 (0.63–1.30)1.36 (1.87–2.13)
    • ↵** p < .01;

    • ↵*** p < .001.

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Journal of the American Academy of Psychiatry and the Law Online: 46 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 46, Issue 3
1 Sep 2018
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Disruptive Mood Dysregulation Disorder in Juvenile Justice
Megan M. Mroczkowski, Larkin S. McReynolds, Prudence Fisher, Gail A. Wasserman
Journal of the American Academy of Psychiatry and the Law Online Sep 2018, 46 (3) 329-338; DOI: 10.29158/JAAPL.003767-18

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Disruptive Mood Dysregulation Disorder in Juvenile Justice
Megan M. Mroczkowski, Larkin S. McReynolds, Prudence Fisher, Gail A. Wasserman
Journal of the American Academy of Psychiatry and the Law Online Sep 2018, 46 (3) 329-338; DOI: 10.29158/JAAPL.003767-18
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