In the last fifteen years, the diagnosis of bipolar disorder, long neglected, surfaced in American psychiatry, particularly in child psychiatry and psychology. Confronted with irritable, difficult children, many therapists and psychopharmacologists decided that these children deserved the label of bipolar disorder and a trial of mood stabilizers. At NIMH, the exponential increase in the diagnosis aroused consternation and alarm as DSM-IV criteria were not followed in making this determination. Ellen Liebenluft, et al questioned the validity of this trend and developed a different model for viewing this group of children. Severe mood dysregulation, or SMD, will very likely offer an alternative to the diagnosis of bipolar disorder in children and adolescents. We will discuss severe mood regulation and make the argument for its entry into DSM-V along with the diagnostic category of bipolar disorder.

Eileen Bazelon M.D. is a board certified child, adolescent and adult psychiatrist. She serves on the faculty of Drexel University College of Medicine where she teaches medical students and residents and provides psychotherapy supervision to residents during their rotation at The Counseling Service at Bryn Mawr College. She also consults with students at Philadelphia University around medication issues. As part of her private practice, Dr. Bazelon sees patients for therapy, collaborates with other professionals and provides expert testimony in court cases involving child custody and sexual abuse.