There is an interesting article at Psychiatric Times on the temper dysregulation disorder (TDD) controversy. Particularly, it is noted that TDD is classified as a mood disorder rather than a state of disordered personality development:
In English, that asks whether we should put temper outbursts in with depression and other mood disorders (ie, in the clearly-defined cluster of genetically-determined
chemical imbalances of the brain, or should they be lumped with the personality disorders?). Is an impulsively aggressive person with a long record of assault, drug and alcohol abuse, poor work record, and unstable interpersonal relations suffering a formal mental illness (with all the forensic and social complications that would imply), or is he or she simply choosing to act this way, and is therefore responsible for his/her actions? This is not a trivial question, but it flows directly from the question of whether “such diverse symptoms as irritability, anger, agitation, aggression, distractibility, hyperactivity,
and conduct problems” are or are not of the same ontological nature as depression and hallucinations. For example, in Australia, which has universal welfare
and treatment, if these behavioral factors are held to be mental illness per se, then the “sufferer” is entitled to a pension for life, unlimited (world class) treatment, and an endlessly renewable excuse for all manner of antisocial conduct.
I wonder, actually, why it makes a difference. People who are personality disoredered, should in fact get treatment as much as, or even more than, those with a mental illness. In the Netherlands, in fact, people with personality disorders are entitled to the same welfare and treatment as those with an axis I disorder – which welfare and treatment are by no means universal, by the way.
Also, TDD is a proposed childhood disorder rather than a lifelong disorder, so why should one worry? I think that children with TDD warrant as much treatment as those with oppositional defiant disorder, who at least in the Netherlands do get treatment. Indeed, TDD was at one point proposed as a subtype of ODD, but this idea was thrown out for a reason.
Of course, it is important to decide whether children with TDD are presumed to choose their behaviors, not for the sake of excusing or whether they’re allowed treatment, but because of what treatment is chosen. I, in this light, support the classification of TDD as a mood disorder, especially because dysphoria is part of its currently proposed criteria. Children who are dysphoric (or depressed, as many TDD kids seem to be) need to have this mood recognized and treated with psychotherapy and, in severe cases, medication. Behavior modification alone isn’t going to help.
I have an interest in the matter, of course, in that I would’ve been diagnosed with TDD had it existed in DSM-IV. I was treated with harsh forms of informal behavior modification, and they didn’t work. It could be because I am autistic instead of TDD – and autism needs to be ruled out first before diagnosing TDD -, but it is likely many children currently diagnosed with Asperger’s/PDD and/or ADHD will later be diagnosed with TDD based on observations and the fact that TDD will be the new fashion disease. Now I have little against new fashion diseases – I do not think the children diagnosed with them, are just brats -, but at least these warrant proper, caring treatment.