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Übersichtsarbeit

Disruptive Affektregulations- störung: eine umstrittene neue Diagnose im DSM-5

Disruptive Mood Dysregulation Disorder: a controversial new diagnostic entity in the DSM-5

Published Online:November 17, 2016https://doi.org/10.1024/1422-4917/a000496

Abstract

Zusammenfassung. Die Disruptive Affektregulationsstörung wurde in die 5. Auflage des DSM erstmals als Störungsbild aufgenommen. Den Anlass, eine eigenständige diagnostische Kategorie im Kapitel „Depressive Störungen“ für einen Verhaltensphänotyp aus chronischer, nichtepisodischer Reizbarkeit und häufigen plötzlichen Wutanfällen zu entwickeln, gab die transatlantische Kontroverse um das klinische Bild und die Prävalenz früh beginnender bipolarer Störungen. Die vorliegende Arbeit stellt erste vorliegende Arbeiten dar, die auf die neuen Kriterien zurückgreifen. Während die Abgrenzbarkeit der Disruptiven Affektregulationsstörung in Symptomatik und Verlauf von bipolaren Störungen gut gelingt, finden sich Hinweise auf starke Überlappungen mit oppositionell-gereizten Symptombildern. Für die anstehende Revision der ICD sollte daher diskutiert werden, keine neue Diagnose, sondern eher eine Zusatzcodierung einzuführen, die kennzeichnet, ob eine oppositionelle Störung auch reizbar-wütendes Verhalten umfasst. Unabhängig von der nosologischen Einordnung besteht die Herausforderung, den Verhaltensphänotyp hinsichtlich Ätiologie, Entwicklungspsychopathologie und Prognose besser zu verstehen und hilfreiche Behandlungsmöglichkeiten zu entwickeln.


Disruptive Mood Dysregulation Disorder: a controversial new diagnostic entity in the DSM-5

Abstract. The Disruptive Mood Dysregulation Disorder (DMDD) was included for the first time in the 5th Revision of the DSM. A transatlantic controversy surrounding the clinical picture and prevalence of early-onset bipolar disorder gave the occasion to develop a new diagnostic category in the chapter “Depressive Disorders” capturing a behavioral phenotype of non-episodic, chronic irritability and frequent temper tantrums. The present paper reviews the first available studies applying the new criteria. While DMDD can be clearly distinguished from bipolar disorder, preliminary evidence suggests a strong overlap with oppositional-defiant disorders (ODD). For the upcoming revision of the ICD it should be discussed to introduce a specifier indicating whether or not the presentation of ODD includes chronic irritability and anger, rather than establishing a new diagnosis. Regardless of the nosological categorization of the described behavioral phenotype main challenges represent a better understanding with regard to its etiology, developmental psychopathology and prognosis and the development of beneficial treatment options.

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