160 Depressive Disorders
should receive one of those di agnoses rather than disrupti ve mood dysregulation disor-
der. Children with disruptive mood dysregul ation disorder may have symptoms that also
meet criteria for an anxiety disorder and can receive both diagnoses, but children whose ir-
ritability is manifest only in the context of exacerbation of an anxiety disorder should re-
ceive the relevant anxiety disorder diagnosis rather than disruptive  mood dysregulation
disorder. In addition, children  with autism spectrum diso rders frequently present with
temper outbursts when, for example, their rout ines are disturbed. In that instance, the
temper outbursts would be considered secondary to the au tism spectrum disorder, and
the child should not receive the diagnosis of disruptive mood dysregulation disorder. 
Intermittent explosive disorder. Children with symptoms su ggestive of intermittent
explosive disorder present with instances of severe temper outburst s, much like children
with disruptive mood dysregulation disorder. However, unlike disruptive mood dysreg-
ulation disorder, intermittent explosive disorder does not re quire persistent disruption in
mood between outbursts. In addition, intermittent explosive disorder requires only 3 months
of active symptoms, in contrast to the 12- month requirement for disruptive mood dys-
regulation disorder. Thus, these two diagnoses should not be made in the same child. For
children with outbursts and intercurrent, persis tent irritability, only the diagnosis of dis-
ruptive mood dysregulation disorder should be made. 
Comorbidity
Rates of comorbidity in disruptive mood dysr egulation disorder are extremely high. It is
rare to find individuals whose symptoms meet  criteria for disrupti ve mood dysregulation
disorder alone. Comorbidity between disrupti ve mood dysregulatio n disorder and other