ADHD and Disruptive Mood Dysregulation Disorder: Insights from Cathryn Galanter, MD

Cathryn Galanter, MD, discussed the diagnostic history and clinical management of disruptive mood dysregulation disorder (DMDD), bipolar disorder, and attention-deficit/hyperactivity disorder (ADHD).

Galanter traced the origins of DMDD, noting that pediatric bipolar disorder had shifted from being underdiagnosed to significantly overdiagnosed as clinicians increasingly attributed irritability and outbursts to the condition.¹ In response to this diagnostic drift, DMDD was developed and incorporated into the DSM-5 to more accurately characterize children presenting with persistent negative mood and severe behavioral dysregulation. She described this evolution as illustrative of a field in rapid progress, observing that the history "really speaks to how our field is rapidly evolving."

Regarding assessment, Galanter emphasized that a thorough, evidence-informed workup was foundational before initiating any treatment. She stressed the importance of identifying comorbid conditions, as DMDD frequently cooccurs with ADHD and anxiety disorders. Treatment of those comorbidities—using stimulants, behavioral therapy, SSRIs, and cognitive behavioral therapy—was described as a primary strategy. For residual mood dysregulation, Galanter advocated symptom-targeted approaches, noting that "we don't yet have treatments that we know work for DMDD," and that low-dose atypical antipsychotics might be considered in select cases.²

Galanter also highlighted significant gaps in the dissemination of research, observing that effective interventions developed in research settings often fail to reach community clinicians. She called for expanded research and better knowledge translation.

Galanter will be delivering the inaugural Lois Flaherty Memorial Lecture on March 13. She will cover ADHD, DMDD, and bipolar in her talk, which is accessible online and recorded here.

Dr Galanter is a professor of psychiatry and behavioral health at Stony Brook University and division director for child and adolescent psychiatry.

References

1. Benarous X, Lahaye H, Consoli A, et al. Prevalence and comorbidity rates of disruptive mood dysregulation disorder in epidemiological and clinical samples: systematic review and meta-analysis. Eur Psychiatry. 2025;68(1):e11.

2. Rajkumar RP. Antipsychotics in the management of disruptive behavior disorders in children and adolescents: an update and critical review. Biomedicines. 2022;10(11):2818.