Disruptive Mood Dysregulation Disorder and Trauma: A Neuropsychological Perspective

This chapter examines the unique symbiosis and shared pathophysiology between stress, trauma, and disruptive mood dysregulation disorder (DMDD), with an emphasis on how early childhood trauma can predispose children toward severe emotional self-regulation issues. According to the American Psychological Association [APA; 2021), trauma can be defined “as any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.” Similarly, emotional dysregulation, a hallmark feature associated with numerous mental health conditions including DMDD, can be defined as “the inability to recognize, evaluate, modify, and/or manage our emotions in a manner to maintain mental control and adapt to the surrounding environment” (Paulus et al., Front Psychiatry 12: 2021). There is emerging evidence that persistent trauma exposure increases the risk for a variety of mental health disorders related to affective regulation, including DMDD (Dvir et al., Harvard Rev Psychiatry 22:149–161, 2014). Specifically, children and adolescents who develop DMDD may have compromised neural pathways involved with fear conditioning, reward processing, and emotional self-regulation skills. Future research examining underlying neural mechanisms involved with traumatic environmental events and subsequent mood dysfunction may offer the greatest hope for devising more effective assessment and treatment options for children and adolescents with deficits in regulating their mood and behavior.