Objective

To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community.

Method

Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology.

Results

At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%.

Conclusion

Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.

中文翻译：

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破坏性情绪失调障碍：症状和症状阈值以及诊断操作化

客观的

确定破坏性情绪失调障碍 (DMDD) 诊断的最合适阈值以及诊断规则的潜在变化对社区患病率水平的影响。

方法

训练有素的心理学家使用发展和幸福行为评估 (DAWBA) 对 2004 年 Pelotas 出生队列中的 3,562 名青春期前/青少年早期进行了评估。临床阈值分三个阶段进行评估：症状阶段、综合征阶段和临床操作阶段。症状阈值确定了每个 DAWBA 项目中的反应类别，它将规范性不当行为与临床指标区分开来。症状阈值确定了捕获具有高症状水平的青春期前/青少年早期所需的烦躁情绪和爆发的数量。临床操作比较了将烦躁情绪和爆发结合起来的 AND/OR 规则对精神病理学损伤和水平的影响。

结果

在症状阈值，大多数烦躁情绪项目在其最低反应类别中是正常的，在其最高反应类别中具有临床意义。对于爆发，有些人即使只出现轻微的症状，也表明有症状，而另一些人则没有任何程度的症状。在症状层面，7个烦躁情绪中的2个和8个爆发指标中的3个组合准确地捕捉到了一组具有高水平症状的个体。结合烦躁情绪和爆发的分析描绘了 DMDD 的非重叠方面，为临床操作中的 OR 规则提供支持。最佳 DMDD 标准的患病率为 3%。

结论

结果为旨在为 DMDD 提供数据驱动和临床导向的可操作标准的举措提供了信息。