Temper Dysregulation Disorder: The Proposed New Label for Children with Bipolar Disorder

The hot topic among psychiatrists and psychologists these days is the release of the draft of the proposed Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Fifth Edition, on February 10, 2010. The paper indicated a possible new label for some symptoms of Child Bipolar Disorder. It will now be called Temper Dysregulation Disorder with Dysphoria (TDD). Specifically, TDD involves temper outbursts in the form of verbal and physical rages to common stress triggers on the average of three to four times a week for children over 6 and under 10 years old in a continuous span of 3 to 12 months. Is this new label a welcome change or will it create unforeseen problems?

The diagnosis of Pediatric Bipolar Disorder has risen dramatically to 1,000,000 or a whooping 4,000 percent from 1990's figures. It is safe to assume that this development correspondingly increased the income of pharmaceutical companies with the rise in demand for anti-psychotic and mood stabilizer drugs totaling $17.4 billion in 2008 for adult and child bipolar disorders based on a table prepared by WikInvest.org. The wealth generated translated to more research funds for companies such as GlaxoSmithkline, Johnson and Johnson, Pfizer, Eli Lilly, Bristol- Myers Squibb, and AstraZeneca, the key players in the pharmaceutical market today.

In the last decade, parents were relieved when the Conduct Disorder in the old DSM manual was modified to Child Bipolar Disorder. First, parents felt freed, as the guilt for being the cause of a child's severe emotional dysregulation, was removed. Suddenly, they are not accused anymore as the "negligent parents". Secondly, the insurance companies were more than willing to reimburse the treatments under the new coding of Child Bipolar Disorder, which is seen as a "medical" problem rather than due to poor family dynamics and emotional environment.

Along the same line, some folks, who were already having a difficult time handling the poor impulse control of their children with Attention Deficit Hyperactivity Disorder (ADHD), hailed the diagnosis of Child Bipolar Disorder. The severity and intensity of the child's anger and tantrums seem to involve some mood fluctuations which is not a classic ADHD symptom. Changing the category from ADHD or Conduct Disorder to Pediatric Child Disorder necessitated a revision of the treatment protocols to "medical" aside from just therapeutic interventions. Thus, thousands of children under 10 may have been misdiagnosed. They risk suffering from the long term side effects of anti-psychotic and mood stabilizer drugs. Clinical studies have revealed the powerful effects of these drugs to an individual's brain chemistry and mechanism. Furthermore, it can hinder the growth of the child's nervous system.

The diagnosis of Child Bipolar Disorder became also a convenient one for parents with adopted children. Many adopted children manifest attachment challenges to their adoptive families. They may exhibit bizarre behaviors and defiant responses to normal loving parenting techniques. Thus, many parents seek medical help in regulating the symptoms of their highly dysregulated adopted child. Due to the limited studies available on attachment, it was easier to categorize children with inconsistent negative behaviors under the category of Child Bipolar Disorder. The proposed DSM-V draft, which will be implemented in May 2013, took into careful consideration results of international studies on the effects of ethnicities, races and genders on a psychiatric diagnosis. What may be a behaviorally-challenged child in the US, may be treated as a child with customary growing pains in another country.

The Temper Dysregulated Disorder with Dysphoria (TDD) is met with positive and negative reactions. The main benefit is it eliminates the need for long term medications. TDD, limited to children from ages 6 and above until age 10, can protect this age group from unwarranted risks of the side effects of powerful drugs. When they reach the age of 11 and up, the diagnosis can be re-evaluated for Bipolar Disorder or a more accurate diagnosis. It is expected that "therapy, counseling" route will now take a driver's seat in the treatment options for TDD after taking a passenger seat since it was categorized as Pediatric Bipolar Disorder under DSM-IV.

The negative effects include the possibility that TDD may not be covered by the health insurance providers. It also may mean the emergence of many "atypical" and alternative treatments that are not subject to long term clinical trials and whose side effects might be detrimental to the child's well being. The worse effect is the coming out of a new, scary-sounding label, not to adults who are so used to name-calling but to naive children, who had enough labels than they could possibly comprehend.

Temper Dysregulated Disorder (TDD) has no cure. But, it comforts Americans to know they are doing something towards an understanding of this disorder even if it historically compromised the health of the child in the long term by mislabeling the disorder in the wrong category. Perhaps, the future DSM-V may be correct in its entirety and thus, we may expect an upsurge in the job outlook for therapists who may be clueless to TDD but will label a child because DSM-V says so. Wouldn't you wish the bible of psychiatry and psychology be as infallible as the bible of Christians?

Sources:

"Antipsychotic Drug Market", wikInvest.org

Dr. Nestor Lopez-Duran, Phd, "Childhood Bipolar Disorder is not Bipolar?", Child-psych.org.

"APA announces draft diagnostic criteria for DSM-5", Scienceblog.com

"Guide to Mental Disorders Under Review", The Dallas News

"My Diagnosis is Killing Me", Psychology Today