Multiple Complex Developmental Disorder

 Multiple complex developmental disorder is distinguished by an early beginning of combined impairment in regulating affective emotions, social behavior, and intellectual processes.


A combined disturbance defines the early-onset clinical picture in the regulation of affective states (leading to acute anxiety symptomatology), social behavior (withdrawal, hostility), and mental processes (magical thinking). Previously, these patients were labeled with 'borderline syndrome of childhood' or 'childhood schizotypal disease.' Cohen et al. introduced the term "multiplex developmental disorder" for these problems in 1986, which Towbin et al. revised in 1993 as "multiple complicated developmental disorder" (MCDD). Cohen et al. proposed specific diagnostic criteria and saw this clinical picture as a bridge between pervasive developmental disorders (PDDs), which are roughly equivalent to what is now known as autism spectrum disorders (ASDs), and particular developmental diseases.

In contrast to autism, cognitive functioning in MCDD is often normal or only minimally impaired. Because of the early-onset impairment in several developmental areas, including social functioning, with pervasive characteristics, the most common diagnosis for patients with MCDD after 1986 was 'pervasive developmental disorder not otherwise specified (PDDNOS). According to the Diagnostic and Statistical Manual of Mental Disorders, PDDNOS was a residual category in the context of PDDs that included, in particular, atypical autism that did not meet the 'autistic disorder' (classic autism) criteria due to late-onset, atypical symptomatology, and subthreshold symptomatology. Follow-up research suggests that MCDD may progress to schizophrenia spectrum disorder (SSD):

An SSD affected 22% of adolescents and 64% of young adults who had previously been diagnosed with MCDD. As a result, patients with MCDD require thorough clinical surveillance to detect this type of progression early.


The current diagnostic criteria for MCDD are debatable because they are not included in the DSM-V or ICD-10. Various diagnostic criteria can be found on multiple websites. At least three of the categories listed below must be present. Co-occurring clusters of symptoms must not be explained better by being symptoms of another condition, such as having mood swings owing to autism or cognitive difficulties due to schizophrenia, and so on. The precise diagnostic criteria for MCDD are unknown, although it may be a helpful diagnosis for persons who do not fit into any of the other categories. It might also be claimed that MCDD is an ambiguous and ineffective label for these people.


The symptoms of MCDD is divided into three categories:

1- Affective State Regulation (anxiety, panic, and aggression).

Diffuse tension or anger, as well as intense generalized anxiety.

Unusual anxieties and phobias are strange in their content or intensity.

Recurrent panic attacks, fright, or anxiety overload.

Behavioral disorganization or regression spanning minutes to days, with the appearance of noticeably immature, primitive, and self-injurious behaviors.

With or without environmental precipitants, there is significant and extensive emotional diversity.

Frequent idiosyncratic anxiety reactions, such as:

  • Excessive giggling

  • Giddiness

  • Laughter

  • Or "silly" effect that is inappropriate in the scenario context.

2- Impaired Social Behavior and Sensitivity Consistently.

Social apathy, detachment, avoidance, or retreat in the face of (at times) evident competency in social engagement, particularly with adults.

Attachments are more likely to appear friendly and cooperative, but only on the surface, and are solely concerned about receiving material necessities.

Inability to form or sustain peer relationships.

Disturbed attachments to adults, particularly parents/caregivers, are prevalent, as evidenced by:

  • Clinging

  • Overly controlling

  • Dependent behavior

  • Violent behavior

  • Oppositional behavior toward parents, teachers, or therapists.

  • Significant deficiencies in empathy or the ability to effectively interpret or understand the impacts of others.

3- Cognitive Processing Impairment (thinking disorder)

  • Irrationality

  • Unexpected intrusions into normal thought processes

  • Magical thinking

  • Neologisms or nonsense words repeated over and over

  • Desultory thinking

  • Glaringly illogical strange notions are examples of thought disorders that are out of proportion with mental age.

  • Confusion between real and imagined existence.

Perplexity and easiness (difficulties understanding current social processes and keeping one's thinking "straight").

Delusions such as:

  • Personal omnipotence delusions

  • Obsessive preoccupations

  • Over engagement with dream figures

  • Grandiose fantasies of exceptional powers and referential ideation


A combination of hereditary factors most likely causes multiple complex developmental disorders. Each person with MCDD is unique and has a particular set of symptoms. Family members of patients with MCDD may also have various cognitive issues.


As it is a complex disorder that is very difficult to identify, the treatment also varies according to the symptoms of every individual. 

Only an expert can tell what treatment plan can be followed. If you think there could be a problem with you or your loved ones, you should consult a specialist before it's too late. If you are confused about getting the best consultant, you can visit Marham. It is the best online platform that gives you access to the best doctors in every field. If you want advice from the best expert, you can book your appointment with the Best Psychiatrist in Lahore   through Marham. It is very easy to make your appointment through this platform.

Frequently Asked Questions (FAQs)

1- Is MCDD related to autism?

Based on symptomatology, Multiple Complex Developmental Disorder (MCDD) is a unique category within the autism spectrum. In contrast to autistic children, some MCDD children acquire schizophrenia as adults.

2- Is MCDD uncommon?

The prevalence of MCDD is unknown: it is likely to be low but not negligible.

3- What exactly is complex developmental trauma?

Complex developmental trauma is trauma that occurs early in a child's life. So, according to some scientists, it is chronic in those critical years of brain development, which are 0 to 3, sometimes 0 to 5.

4- What exactly is complex autism?

Children and young people with proven or suspected ASD who also have co-occurring neurodevelopmental and mental health (for example, emotional and behavioral) issues are referred to as having complex autism.

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