Impaired Mood Regulation Nursing Diagnosis and Nursing Care Plan

Impaired mood regulation is a NANDA nursing diagnosis that can be used to describe how a person experiences and manages emotions. It is frequent in children and teenagers and can last into adulthood.

When someone suffers from it, they may struggle to regulate their emotions, resulting in furious outbursts, anxiety, sadness, or self-harming behaviors. People with impaired mood regulation may not have an appropriate emotional response to the event.

The illness can eventually have an impact on their quality of life, social interaction, personal life, work life, and relationships. Impaired mood regulation can also be a feature of other disorders such as complex post-traumatic stress disorder, borderline personality disorder, attention deficit hyperactivity disorder, and others.

Signs and Symptoms of Impaired Mood Regulation

• Severe, recurring temper tantrums. These outbursts might include yelling, pushing, hitting, or property destruction.
• Outbursts three or more times per week. A child may be diagnosed with impaired mood regulation even if they do not usually have this many outbursts per week. Children may have more tantrums in one week and fewer in the following. Tantrums three or more times a week are required on average for the diagnosis.
• Tantrums that are inappropriate to the situation. A child with impaired mood regulation may act out with physical aggression and excessive and strong vocal outbursts.
• Tantrums that are unsuitable for the child’s age. For example, while a very young infant might have a tantrum that involves dropping to the floor wailing and shouting, it is not something that is anticipated from a 12-year-old.
• Irritable and angry moods between tantrums. Children with impaired mood regulation experience moods that are persistently angry and severely irritable in between bouts of intense emotional outbursts. Such moods are most of the time prevalent and are noticed by others.
• Symptoms occur in different settings. This suggests that temper tantrums do not occur only in one place, such as school. Tantrums in at least two contexts, such as school, home, or with peers, are symptoms of impaired mood regulation.

Causes of Impaired Mood Regulation

• Biological
  • Neurological impairment. Some neurological disabilities, such as recurrent migraines, can be extremely debilitating and harm a person’s entire behavior and well-being. Children and adolescents with neurological disabilities, such as migraines, frequently exhibit irritability and violent behavior, which can become chronic and, in some situations, lead to a diagnosis of impaired mood regulation.
  • Brain chemistry. Certain research suggests that brain chemistry is one of the possible reasons for impaired mood regulation. These findings reveal that children had greater activation in areas (the frontal gyrus and anterior cortex) of the brain that controls aggressiveness and inhibition.
  • Family history. Children of parents with a history of substance misuse and/or mental illness are more prone than other children to develop impaired mood regulation.
• Environmental
  • Childhood trauma. Emotional, physical, or sexual abuse has been associated with the development of impaired mood regulation in children and adolescents.
  • Recent divorce, death, or relocation in the family.
  • Diet. A lack of proper nutrition or vitamin deficiency such as iron, vitamin B12, and folate have been linked to the development of impaired mood regulation symptoms such as chronic depression and continuing irritability.
• Prenatal and Perinatal. Some studies show a link between a woman’s pregnancy and postpartum experience and her child’s risk of impaired mood regulation.
  • Maternal depression. When experienced during pregnancy and/or the first few months after birth has been linked to an increased risk of the child having impaired mood regulation.

Related Factors to Impaired Mood Regulation

• Gender and Age. Evidence suggests that impaired mood regulation is more common in boys and younger children.
• Parenting practices. It also raises the likelihood of developing impaired mood regulation. Factors such as inconsistent punishment and parental expression of negative emotions, for example, can raise the likelihood of impaired mood regulation.
• Individual characteristics. Children with higher levels of positive emotions and impulsivity may be at greater risk for impaired mood regulation. These children may be very motivated by rewards and, as a result, may be especially unhappy when their rewards or goals are obstructed.
• Family History. Children who have a family history of certain mental health concerns including anxiety, depression, and substance abuse are more likely to have impaired mood regulation, implying that the disorder may be inherited. However, no specific gene or genes have been linked to impaired mood regulation. The disorder is most likely caused by a mix of hereditary and environmental factors.
• Early psychological trauma. Caused by caregiver abuse or neglect. This trauma may result in the child failing to create bonds with their caregivers and developing a reactive attachment disorder.
• Environment. Children who are exposed to chaotic home life, substance abuse, or uneven parental care are more prone to develop impaired mood regulation.

Diagnosis of Impaired Mood Regulation

• Physical assessment. This exam is used to rule out any physical disorders that may be causing the symptoms.
• Psychological evaluation. To examine the patient’s mood, mental condition, and mental health history, these assessments may take the form of questionnaires or conversation sessions with a mental health expert. These assessments may also require the participation of family members or caregivers.
• DSM criteria. The results of the psychological exams will be compared to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for impaired mood regulation (DSM). The DSM criteria for impaired mood regulation include the following:

At least three times per week, the child has significant anger outbursts.

Almost every day, the child is irritable or angry for the majority of the day.

Outbursts from the child are out of proportion to the situation.

Symptoms appear before the age of ten.

The symptoms have been there for at least a year.

The child ranges in age from six to eighteen.

Symptoms affect a child’s functioning in more than one situation (e.g., at home, school, or with peers).

Coping with Impaired Mood Regulation

• Behavioral therapy. Cognitive-behavioral therapy, a type of psychotherapy, is often used to teach children and adolescents how to deal with ideas and feelings that contribute to feelings of depression or anxiety.
• Parent training. This aims to assist parents in interacting with their children in a way that reduces hostility and irritable behavior while also improving the parent-child bond.
  • Recognizing triggers for the child’s behavior may also be beneficial to caregivers. Making plans to avoid the child’s severe emotional reaction may be helpful.
  • Adults should address the child’s emotional difficulties with school teachers to devise effective solutions. Schools may offer special education programs to students who have been diagnosed with a disability.
• Medications. Many drugs used to treat the mental disorder in children and adolescents are successful at easing symptoms.
  • Antidepressants. Antidepressant medication is used to alleviate the irritability and mood issues associated with impaired mood regulation.
  • Atypical antipsychotics. May be recommended for children who have very violent temper outbursts involving physical aggressiveness toward people or property.
  • Stimulants. are typical drugs used to treat ADHD. Stimulant drugs have been shown to reduce irritability in children with irritability and ADHD.

Prevention of Impaired Mood Regulation

There are currently no ways to prevent or minimize the prevalence of impaired mood regulation. However, early diagnosis and treatment can lessen the severity of symptoms.

The first step is to seek professional health such as a psychiatrist or psychologist so that a formal evaluation can be performed. Promoting normal growth and development, and improving the quality of life of people suffering from impaired mood regulation are also beneficial.

Nursing Considerations for Impaired Mood Regulation

• Provide a safe environment for the patient. A primary nursing responsibility is to provide a safe environment for the patient; for patients who feel out of control, the nurse must emphatically and nonjudgmentally impose external controls.
• Meet the patient’s physiologic demands. Reduced environmental stimulation may help the patient relax; the nurse must provide a calm atmosphere free of noise, television, and other distractions; finger meals or foods that the patient may consume while moving about are the greatest options for improving nutrition.
• Practice therapeutic communication. Because of the patient’s short attention span, the nurse must communicate in simple, straightforward terms; the patient may not be able to handle a lot of information at once, so the nurse should break the information down into many small segments.
• Encourage the child patient’s parents to maintain intimate, face-to-face contact with their children to foster communication.
• Advise the patient’s caregiver to maintain a consistent and predictable daily schedule to avoid outbursts. Prepare the child for routine adjustments.
• Educate the parents on the signs of a tantrum and how to prioritize intervening and anticipating needs before a tantrum arises.
• Advise the parents to keep their children safe at home by installing locks and gates.
• Educate the family members on the medication administration and schedule.
• Provide parents with emotional support and knowledge.
• Arrange for family counseling to assist parents in better understanding the disorder and help them with coping mechanisms.
• Arrange referrals for early intervention, home care assistance, and support groups. Early intervention and special education programs help children learn, communicate, and interact with others. This reduces the seriousness and frequency of disruptive behaviors.

Impaired Mood Regulation Nursing Diagnosis

Impaired Mood Regulation Nursing Care Plan 1

Depression

Nursing Diagnosis: Impaired Mood Regulation related to ineffective social interaction secondary to depression as evidenced by dysfunctional interaction with family and peers, reports of a shift in interaction habits, expressed displeasure in socialization ,and avoidance of interaction with people.

Desired Outcomes:

• The patient will be able to identify the feelings that lead to poor social interactions.
• The patient will be able to socialize with family and peers.
• The patient will be able to participate in community social activities.
• The patient will express excitement in interacting with others in activities.

Impaired Mood Regulation Nursing Interventions	Rationale
Provide the patient with tasks that demand little concentration such as drawing and playing simple board games.	Depression and impaired mood regulation disrupt concentration and memory. Activities with no right or wrong or winner or loser decrease the patient’s ability to put himself/herself down.
Encourage the patient to engage in gross motor activities that need little concentration such as walking.	Such activities will help to relieve tension and may even improve the patient’s mood.
Involve the client in one-on-one activity when the patient is the most depressed.	Increases the possibility of interactions while lowering anxiety levels.
Encourage the patient to join group activities including group discussions, art therapy, and dance therapy.	Isolation is reduced by socialization. Genuine concern for others can boost emotions of self-worth.
Maximize the patient’s contact with others throughout time by first one other, then two others, etc.	Contact with others diverts the patient’s attention away from himself.
Refer the patient and family to community self-help organizations.	People who share their experiences can provide valuable support and insight to the patient and family.
Encourage the patient to communicate his or her feelings and perceptions of the problem.	The nurse can then identify and clarify the probable causes of difficulties in communicating with people. Feelings of being unloved or unlovable, for example, as well as sexual insecurity.

Impaired Mood Regulation Nursing Care Plan 2

Conduct Disorders

Nursing Diagnosis: Impaired Mood Regulation secondary to conduct disorder, as evidenced by expressions of disinterest and distrust, poor adherence, temper tantrums, and argumentative behavior.

Desired Outcomes:

• The patient will be able to participate in the treatment.
• The patient will be able to demonstrate a dedication to improving the health status by implementing positive habits.
• The patient will gain access to resources to improve compliance.

Impaired Mood Regulation Nursing Interventions	Rationale
Create a therapeutic relationship with and between the patient and significant others.	This allows the patient to win the nurse’s trust and boosts confidence in the treatment’s compliance.
Involve the patient in planning the correct treatment.	Patients who are involved in the planning have higher compliance with the result.
Remove any disincentives to compliance of the patient. Provide brief and straightforward therapy and remove all needless medications.	Reducing clinic wait times, advocating lower levels of activity, and offering drugs with fewer side effects can all help to promote compliance. Therapy that is brief and simple to understand enhances compliance.
Encourage the patient to be independent and allow the patient to perform tasks with minimal to no help. Make contact information, resources, and education available, and encourage them to take action.	Allowing dependence hinders the patient from taking initiative and progressing toward their goals.
Arrange the patient’s schedule, any needless clinic appointments should be avoided.	Because of the physical demands of getting to an appointment, the patient avoids prospective follow-ups.
Involve the patient in decision-making.	Patients are more likely to stick with it and stay engaged if they helped set their own goals based on their priorities.
Educate the patient about the ways on reducing the medication’s side effects.	Medication side effects are a regularly reported issue for noncompliance.
Create a reward system with the patient that follows successful compliance.	Positive reinforcement is provided through rewards for compliant conduct.
Educate the patient and family members about the treatment regimen that will be followed.	This raises awareness of the significance of finishing the specified treatment. It increases adherence to such treatment.

Impaired Mood Regulation Nursing Care Plan 3

Bipolar Disorder

Nursing Diagnosis: Impaired Mood Regulation related to increased risk for self-directed violence secondary to bipolar disorder, as evidenced by loud and threatening speech, poor impulse control, and agitated behavior.

Desired Outcomes:

• The patient will be able to express control of emotions.
• The patient will exhibit nonviolent behavior toward himself with the help of medications and nursing interventions.
• The patient will be able to seek help when experiencing aggressive impulses.
• The patient will be free from injury.

Impaired Mood Regulation Nursing Interventions	Rationale
Assess the patient’s behavior regularly for indicators of increased agitation and hyperactivity.	Early detection and control of rising mania will reduce the risk of self-harm or harm to others, as well as the requirement for isolation.
Maintain a calm and firm demeanor when dealing with the patient.	Structure and control are provided for a patient who is out of control.
Use concise, short explanations or assertions when giving instructions to the patient.	A short attention span limits comprehension of small pieces of information.
Maintain consistency when approaching the patient, use consistent expectations, and create a structured workplace.	Clear and consistent limitations and expectations reduce the possibility of client manipulation of personnel.
Reduce environmental stimulation by providing the patient with a calming environment or assigning a private room.	Aids in the reduction of anxiety and manic symptoms.
Remove any objects that may harm the patient or the people around them.	Removing anything that a patient could use to harm ensures the patient’s safety as well as the safety of others.
Direct the patient’s self-destructive behavior to physical activities to alleviate the patient’s anxiety.	Physical activity is a safe and effective approach to releasing underlying tensions.

Impaired Mood Regulation Nursing Care Plan 4

ADHD

Nursing Diagnosis: Impaired Mood Regulation related to disturbance in cognitive process secondary to attention deficit hyperactivity disorder, as evidenced by inability to perform tasks as instructed, poor decision making skills and inability to concentrate.

Desired Outcomes:

• The patient will be able to accomplish the given tasks.
• The patient will be able to retain memory through memory retaining strategies.
• The patient will be able to express feelings of frustrations.

Impaired Mood Regulation Nursing Interventions	Rationale
Assess the patient’s current level of functioning and approach the patient based on the mental age rather than chronological age.	To encourage the patient to speak up and be open and honest about thoughts and feelings.
Assist the patient with activities of daily living.	To encourage autonomy by allowing the patient to undertake ADLs while remaining safe.
Use simple phrases and instructions to simplify work for the patient. When necessary, use written notes and other memory devices.	A child with impaired mood regulationmay struggle to complete complex tasks and may be forgetful.
Provide the patient with opportunities for meaningful social connection.	To prevent the patient from feeling isolated.
Give the patient polite instructions in a step-by-step manner. When washing, for example, “damp your face first with a washcloth, lather soap on hands, then gently apply to the face.”	Because ADHD has a low degree of concentration and impaired mood regulation, breaking tasks down into small steps might assist organize thoughts and actions.
Allow the patient time to consider what to say or do.	To allow the patient adequate time to communicate because the patient may be forgetful and unable to make quick decisions.

Impaired Mood Regulation Nursing Care Plan 5

Personality Disorders

Nursing Diagnosis: Impaired Mood Regulation related to chronic low self-esteem secondary to personality disorder, as evidenced by the inability to deal with events, expression of shame and guilt, hesitance in trying new things, and exaggeration of negative feedback about self.

Desired Outcomes:

• The patient will be able to learn one skill to meet future goals.
• The patient will be able to set a realistic goal with the nurse.
• The patient will be able to express willingness to work on realistic future goals.

Impaired Mood Regulation Nursing Interventions	Rationale
Maintain a neutral, calm, and respectful attitude, even if this is easier said than done with some patients.	Helps the patient see himself or herself as a person who is appreciated even when his or her behavior is inappropriate.
Discuss with the patient the various sorts of cognitive distortions that impact self-esteem like self-blame, mind reading, overgeneralization, selective inattention, and all-or-none thinking.	These are the most prevalent cognitive distortions encountered by people. Identifying them is the first step toward fixing errors in one’s self-image.
Educate the patient on how to reframe and challenge cognitive distortions. Disputes must be forceful, detailed, and nonjudgmental.	Over time, practice and belief in the debates help patients achieve a more realistic assessment of events, the world, and themselves.
Work with the patient to identify cognitive distortions. Encourage the patient to keep a journal.	Cognitive distortions occur automatically. Keeping a journal, aids in the clarification of automatic, unconscious thoughts.
Discourage the patient from making negative and self-blaming comments.	Unacceptable behavior does not imply that a patient is a bad person; rather, it indicates that the patient has made some poor decisions in the past.
Discuss the patient’s plans. Set reasonable short-term goals with the patient and identify skills that need to be learned to assist the patient in reaching the goal.	Looking forward reduces concentrating on the past and negative self-rumination. When patients achieve realistic short-term goals, they might feel a feeling of success, direction, and purpose in life. Achieving goals can increase one’s sense of control and improve one’s self-perception.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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