Will tantrums be overdiagnosed as DMDD?

There are many controversial changes to the Diagnostic and Statistical Manual of Mental Disorders, which recently had its first full revision in 19 years.  One of these changes is the new diagnosis of DMDD, Disruptive Mood Dysregulation Disorder.
     DMDD is one of many changes that has generated alarming statements based on inaccurate information.  I cannot claim that I know the alarming predictions are wrong, but on this and other issues I can at least help the discussion start with important information we can agree on, such as what the diagnostic criteria actually say.  Whether people will misuse the manual and ignore the criteria and overdiagnose tantrums as a mental disorder depends on getting accurate information out there.

The work below is based on my summary of the criteria; others have posted the full criteria but I will choose not to violate APA's copyright nor use more words than necessary.  The words below will be published in a different form in one of the "Controversy Boxes" I wrote for Abnormal Psychology by Robin Rosenberg and Stephen Kosslyn (Worth/MacMillan, 2014).  I have more material available about how to differentiate DMDD from ODD, ADHD, Bipolar, Intermittent Explosive Disorder, if anyone is interested.

Disruptive Mood Dysregulation Disorder:  Overlabeling of tantrums?

Disruptive Mood Dysregulation Disorder, or DMDD, is a diagnosis designed to be a more accurate description of kids who have out of control rage episodes and were getting inappropriately labeled as having bipolar disorder.

The criteria for using this diagnosis, which is brand new in the DSM 5:

A.       Temper outbursts, including verbal or physical aggression, with a duration or intensity that is out of proportion to the situation and inconsistent with developmental level.

B.       These outbursts happen 3 times a week or more.

C.       Even between outbursts, mood is persistently irritable or angry.

D-H.  This pattern starts between ages 6-10 in at least two settings, continue for at least a year with no 3 month break, and does NOT include more than a day of mania, nor does it happen exclusively as a function of Major Depressive Disorder or other mental disorder.

The controversy, the critique:   Just as bipolar disorder diagnosis was overused to describe these kids with out of control rage episodes, this diagnosis might be used to label kid who merely have a lot of tantrums, including those with tantrums that are just manipulation of adults.  Or, it might focus blame on kids when the problem is in the family. This diagnosis might give those kids an excuse for their behavior or lead to overmedicating the kids.

The other side of this issue:   The severity, duration and frequency criteria are designed to prevent diagnosing kids who are sometimes grumpy and tantruming. To apply this diagnosis, there must be a persistent daily irritable mood that exists even when there is no reward as there might be for a tantrum.  The rages must also show up at school and home and not be an expected response to a home or school situation.  This diagnosis will theoretically lead to FEWER kids being medicated, since they will no longer be considered to have bipolar disorder unless they have the symptoms and duration of a true manic episode.

Critical thinking questions:  Even with narrow criteria designed to prevent overdiagnosing, won’t some people just associated this diagnosis with a grumpy tantruming kid and overuse it?  How can we prevent this? Was there a better solution to the problem of overdiagnosing bipolar besides adding another diagnosis?