Disruptive mood dysregulation disorder in Zimbabwe. The human brain.

Disruptive mood dysregulation disorder in Zimbabwe. Understanding human behavior at a multidimensional and multifaceted level has always been a challenge across many domains. The conceptualization of how the human mind operates from birth to death, through developmental stages remains one of the most complex processes accounted for by probability of hypo, average and hyper secretions. Transformations occur through maturation and in areas such as developmental, emotional, psychological, behavioral and intellectual domains of individuality. However, these areas play a critical and significant role in the narratives around sensation and perception of the world around us, therefore contributing to the manifestation of either positive or negative human traits. Henceforth, a reflection on these domains will enable us understand how disruptive mood dysregulation disorder affects people, specific to the context of Zimbabwe.

Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder (DMDD) is a childhood disorder usually characterized by pervasive irritability and angry mood and usually manifests itself usually at age 6 and manifesting before age 10. This is usually characterized by persistent and frequent anger or aggressive outbursts that is least regulated by the individuals involved. Individual suffering from these disorders have a short temper fuse and are highly charged with irritability which in turn affects their affective and emotional states, triggering aggression as an immediate response in any interaction. Understanding DMDD is important and this can only be attained through critical reviews from the Diagnostic and Statistical Manual for Mental Disorders (DSM V). The etiology, prognosis and transgression of the pathology is explicitly referenced in the manual for mental health interventions and disorder characterization. Therefore, on many cases, the disorder is identified through the manifestation of several temper outburst in both verbal and behavioral formats, such occurring for over a period of 12 months and a presence of chronic irritable or angry mood in nearly every day interaction. This is what then separates the pathology from the normal of anger and aggression triggered by events of daily living that affect some aspects of our lives.

Picture by Pixelgraphy Zimbabwe

Understanding the brain, neurons and neurotransmission systems.

Over the years, belief in creating safe mental health spaces to allow growth and development in individuality have been championed for. Terms such as “mental health” have become keystone towards improvement systems of care. However, the conceptualization of mental illness has been the one to disorient what really affects individual’s’ understanding of mental health related issues. Mental illness in literal sense implies a challenge with the whole metal faculties, translating into an inability of the brain as a structure to function normal. However, the major problem around these issues is not introduction a dissection into the mind structure, understanding the organs of the brain and introducing organ specific remedies that are targeted towards improvement.

Conceptualizing DMDD as a mental illness translates and equates the pathology to disorders such as disorganized schizophrenia and bipolar disorder. DMDD however does not have the maniac episodes presented in bipolar, thus DMDD presents itself as unipolar and translates into anxiety and depression in adulthood.

Neurological disabilities have been identified by research as at times the primary cause or explanation of DMDD. Thus, in children, the presence of migraines has been highly correlated with development of irritable behaviors and aggression which then amounts to a persistent behavioral pattern translating into DMDD. It is therefore important to note that the neurological basis of DMDD separates it from other pathologies and also enables care givers to understand better that their children are not deliberately presenting disrespect for their elderly and peers but rather are suffering from a psychological pathology that needs attention. Due to its nature in behavioral manifests itself as oppositional difference disorders, and the inability to regulate their mood (dysregulation aspects) will then interfere with how others view them.

Disruptive mood disorder as a function of the environment

Temper tantrums below the ages of five and six are common as children face challenges in emotional regulation and management. However, after age six, the presence of temper tantrums and further presentation of irritability may trigger diagnosis of DMDD. However, over the years, the environment has been seen to pay a crucial role in the development, manifestation and transgression of disorders. Historically, local cultures of Zimbabwe are not conversant of some of the disorders and pathologies such as DMDD present themselves as indiscipline and lack of respect. This is made worse by the low intake of psychiatric and psychological service consumption in most Zimbabwean communities and the general categorization of every challenge as a mental illness without being specific for interventions to kick in. thus as the pathology manifests, care givers tend to use punitive and restrictive measures on behavior which sometimes amounts to nothing but rather affects the general function of the child in the long run further inadequate care translates the condition into anxiety and depression with much severity.

DMDD symptom if not adequately assessed or understood, as in the case of most local communities in Zimbabwe can amount to the perception of bad choices by the children. Thus, lack of understanding that it is more that choices, it is a deception by the mind which translation irrational behaviors into what they feel is normal, hence imposing behavioral changes and punitive measures may not necessarily help but rather reinforce the behavioral challenges.

Improving experiences of DMDD patients?

Unlike oppositional diffidence disorder and other behavioral regulation disorders such as conduct which may require psychotherapeutic and counselling interventions, DMDD requires psycho-pharmacological interventions to improve treatment outcomes. Being a new pathology, DMDD treatment has capitalized on medication that are associated with other relatively old but similar pathologies such as Oppositional Defiance Disorder (ODD), Attention Deficit Hyper-Active Disorder (ADHD) and even major depression. Furthermore, psycho-education on the part of care givers from the Zimbabwean context could play a critical role in the management and care of DMDD, improving knowledge and attitudes that it is not a deliberate act of defiance but rather a pathology that needs care.