The Criteria
DMDD or BPD? Looking at the DSM
Eli’s official diagnosis is DMDD. Here are the criteria:
(1) severe, recurrent (≥3 times/week) temper outbursts (verbally and/or behaviorally) that are grossly out of proportion in intensity or duration to the situation, and inconsistent with the developmental level;
Okay, this is our life.
(2) the mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and observable by others;
Yes….again, this is something that has improved over the past year with DBT.
(3) the symptoms must be present for 12 or more months, with no more than 3 consecutive months of symptom-free period;
Ugh, this is painful. He DOES have long stretches of being symptom-free, never more than about a month. The ending of each symptom-free stretch is the part that feels like it might kill me.
(4) the symptoms/behaviors must be present at least in two of three settings (i.e., at home, at school, with peers), and to a severe degree at least in one setting;
Yes, yes, home and school, and sometimes when he’s with his friends, with just the right provocation.
(5) the diagnosis should not be made for the first time before age 6 years or after 18 years; and (6) by history or observation, the age at onset is before 10 years.
Maybe this is why we were told to “watch him” when he was 5.5 and he got his first neuropsych eval?
And now the diagnostic criteria for BPD (which cannot be formally diagnosed at his age). There are 9 criteria, and for a diagnosis, a person needs to meet 5 of the 9.
Chronic feelings of emptiness
We used to get a lot of, “what is the meaning of life?” “Why are we even here?” “I wish I had never been born.”
Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Intense Episodes of Emotion have ruled our lives for going on 6 years.
Frantic efforts to avoid real or imagined abandonment
This one, I’m not so sure of. There are definitely a lot of fears around people (us, his friends) abandoning him emotionally. I don’t think I could say whether or not his behavior reflects frantic efforts to avoid this.
Identity disturbance with markedly or persistently unstable self-image or sense of self
No more than anyone else his age….except that he has tremendous swings in his understanding of his own self-worth.
Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
We are not seeing this currently, thank goodness, but in the past we’ve seen impulsivity around spending (with stolen credit cards) and binge eating.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Oh yes. I was just interrupted by a blow-out in the other room. There was screaming, crying, name-calling, swearing…..because Sarah had sweetly asked him a question about how to do something in Minecraft. Seriously.
Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as "splitting")
Yes, though this has gotten better with DBT. He definitely has the tendency to give someone his whole heart and then let one argument or comment shake his entire faith in a person.
Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
Yes. ☹ Again, this has gotten a lot better with DBT. And I am terrified for his teen years.
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Not frequently….but there have definitely been times when he has been convinced that something was out to get him, or that his friends were ganging up on him behind his back.
What to make of all of this? I’m turning it over in my head a lot recently. I’m going to do a post on my thoughts on diagnosis at some point. For now, it was therapeutic to just put it in black and white. Thanks for listening.
We’ve dealt with a lot of similar symptoms. Have they ruled out bipolar disorder? We have an ODD diagnosis, but I wouldn’t be surprised if it gets changed to DMDD at some point. DMDD is also a precursor to bipolar, which is why bipolar is on my radar too (especially because we have family history of bipolar). The symptoms of bipolar in kids gave some overlap to DSM, and the symptom-free periods sound a lot like something a bipolar child might experience.