Editor's Note: After you read the case below, weigh in with your comments. The author will offer a wrap-up of key teaching points based on your input. For further reading, see Dr Axelson's December 2010 article, "Adding the Diagnosis of Temper Dysregulation Disorder to DSM-5," on which this case is based.
Albert, Henry, and Bill separately present for assessment at a child psychiatric outpatient clinic for concerns about severe anger outbursts. Each boy has outbursts, which are described as “rages” or “meltdowns,” in which he screams, throws things, turns over chairs, breaks things, and threatens others. At times, he will punch or kick a sibling or caregiver in the midst of the outbursts and will smash things against the door if he is forced to stay in his room. The outbursts can last anywhere from 15 minutes up to 2 hours and occur several times a week. All 3 boys were described by their parents as being moody since their toddler years, but each has become much more irritable over the past year. All 3 seem angry or miserable nearly every day.