This valuable contribution by Findling et al. reports on trends in diagnostic patterns since the inclusion of disruptive mood dysregulation disorder (DMDD) in the DSM-5. As the authors note, the introduction of the DMDD diagnosis was designed to address the problematic over-diagnosis of bipolar disorder and the associated rise in antipsychotic and polypharmacy use in youths.1 Using a large, national, electronic health record database (n = 14,157), this study showed a clear increase in the treated prevalence of DMDD from 2016 to 2018 (0.08-0.35%, p < .0001) coupled with a decrease in the treated prevalence of bipolar disorder from 2015 to 2018 (0.42%-0.36%, p < .0001).1 This suggests that the introduction of DMDD did seem to achieve the aim of reducing the rates of bipolar diagnoses. In what is discouraging but not surprising news, the study demonstrates a troubling increase in the use of antipsychotics (58.9% DMDD vs 51.0% bipolar disorder) and polypharmacy in the DMDD cohort compared to the bipolar disorder cohort (45.0% DMDD vs 37.4% bipolar disorder).1.
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