This blog is based on a presentation from the Psychopharmacology Institute by Carrie Vaudreuil, MD from Massachusetts General Hospital/Harvard Medical School.
Children who have an outburst of angry behavior, which is out of proportion to what caused it, usually have changes in mood, sleep, appetite, energy, and functioning. During the outburst, the child may yell, slam doors, throw things, or even engage in violent behavior.
The most common trigger for the explosive outburst is limit setting. The child is told they cannot do something they like to do (e.g., play video games) or must do something they don’t like (e.g., get dressed for school).
There are many causes of explosive behavior. They include mood disorders (depression, bipolar disorder, disruptive mood dysregulation disorder), an anxiety disorder, PTSD, autism spectrum disorder, tics and Tourette syndrome, ADHD, oppositional defiant disorder, conduct disorder, substance use disorder, learning disability, or intellectual disorder. With such a wide range of possible diagnoses, an evaluation by a mental health specialist with expertise in childhood disorders is needed.
If a child with outbursts of explosive behavior has a negative or abnormal emotional state that is present even when the child is not having an outburst, the symptoms they experience may suggest the diagnosis. For example, a chronic sad mood suggests a depressive disorder. Likewise, an elevated mood with excessive energy may suggest a bipolar disorder.
Other ongoing symptoms may also be present and suggest certain diagnoses. Changes in sleep, appetite, energy level, functioning, or having excessive worries are common examples.
Disruptive Behavior Disorders are characterized by emotional impulsivity (very rapid increase in emotional state) and deficient self-regulation (unable to calm themselves down).
Treatment depends on the underlying psychiatric illness. For example, ADHD may require medication and therapy, substance use disorder requires discontinuing the alcohol or drug used and therapy, bipolar disorder requires medication and therapy, etc.
Parents and guardians benefit from education about their child’s disorder and learning about approaches to manage the emotional outbursts. Sometimes the outbursts may appear to be manipulative but may not be. This needs to be explored.
If your child has explosive outbursts, take them to an appropriate mental health professional for an evaluation.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
