Disruptive,
Impulse-Control, and
Conduct Disorders
DSM-5 Diagnostic Criteria for
Oppositional Defiant Disorder
• A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
lasting at least 6 months as evidenced by at least four symptoms from any of the following
categories, and exhibited during interaction with at least one individual who is not a
sibling.
• Angry/Irritable Mood
• 1. Often loses temper.
• 2. Is often touchy or easily annoyed.
• 3. Is often angry and resentful.
• Argumentative/Defiant Behavior
• 4. Often argues with authority figures or, for children and adolescents,
• with adults.
• 5. Often actively defies or refuses to comply with requests from authority
• figures or with rules.
DSM-5 Diagnostic Criteria for
Disorder Oppositional Defiant
• 6. Often deliberately annoys others.
• 7. Often blames others for his or her mistakes or misbehavior.
• Vindictiveness
• 8. Has been spiteful or vindictive at least twice within the past 6 months.
• Note: The persistence and frequency of these behaviors should be used to
distinguish a behavior that is within normal limits from a behavior that is
symptomatic. For children younger than 5 years, the behavior should occur on
most days for a period of at least 6 months unless otherwise noted (Criterion A8).
For individuals 5 years or older, the behavior should occur at least once per week
for at least 6 months, unless otherwise noted (Criterion A8). While these
frequency criteria provide guidance on a minimal level of frequency to define
symptoms, other factors should also be considered, such as whether the
frequency and intensity of the behaviors are outside a range that is normative
for the individual’s developmental level, gender, and culture.
DSM-5 Diagnostic Criteria for
Disorder Oppositional Defiant
• B. The disturbance in behavior is associated with distress in the individual or others in his
or her immediate social context (e.g., family, peer group, work
• colleagues), or it impacts negatively on social, educational, occupational, or
• other important areas of functioning.
• C. The behaviors do not occur exclusively during the course of a psychotic,
• substance use, depressive, or bipolar disorder. Also, the criteria are not
• met for disruptive mood dysregulation disorder.
• Specify current severity:
• Mild: Symptoms are confined to only one setting (e.g., at home, at
• school, at work, with peers).
• Moderate: Some symptoms are present in at least two settings.
• Severe: Some symptoms are present in three or more settings.
• Typically, in addition to temper outbursts, these children argue with their
parents, refuse to clean their rooms, or fail to obey a curfew.
• ODD has a prevalence of around 3%,
• it is more frequent in boys
• ODD first appears during the preschool years and rarely later, and may
precede the onset of conduct disorder, particularly for those with the
childhood-onset type.
• many children and adolescents with ODD do not develop conduct disorder,
but remain at risk for mood and anxiety disorders.
• DDx:
Conduct Disorder
ADHD.
Disruptive mood dysrgulation .
disorder
• individual and family counseling,
• treatment of co-occurring ADHD or other disorders with medications as
needed.
• helping the child manage anger, improve problem-solving ability, develop
techniques to delay impulsive responses, and improve social interactions.
• parents learn to better manage their child’s behavior as well as to promote
desired behaviors.
• School based programs,
DSM-5 Diagnostic Criteria for
Intermittent Explosive Disorder
A. Recurrent behavioral outbursts representing a failure to control aggressive
impulses as manifested by either of the following:
• 1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or
fights) or physical aggression toward property, animals, or other individuals,
occurring twice weekly, on average, for a period of 3 months.
• The physical aggression does not result in damage or destruction of property
and does not result in physical injury to animals or other individuals.
• 2. Three behavioral outbursts involving damage or destruction of property
and/or physical assault involving physical injury against animals or other
individuals occurring within a 12-month period.
B. The magnitude of aggressiveness expressed during the recurrent outbursts
is grossly out of proportion to the provocation or to any precipitating
psychosocial stressors.
DSM-5 Diagnostic Criteria for
Disorder Intermittent Explosive
• C. The recurrent aggressive outbursts are not premeditated (i.e., they
areimpulsive and/or anger-based) and are not committed to achieve some
tangible objective (e.g., money, power, intimidation).
• D. The recurrent aggressive outbursts cause either marked distress in the
individual or impairment in occupational or interpersonal functioning, orare
associated with financial or legal consequences.
• E. Chronological age is at least 6 years (or equivalent developmental level).
• F. The recurrent aggressive outbursts are not better explained by another
mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive
mood dysregulation disorder, a psychotic disorder, antisocial personality
disorder, borderline personality disorder) and are not attributable to another
medical condition (e.g., head trauma, Alzheimer’s disease) or to the physiological
effects of a substance (e.g., a drug of abuse, a medication). For children ages 6–18
years, aggressive behavior that occurs as part of an adjustment disorder should
not be considered for this diagnosis.
DSM-5 Diagnostic Criteria for
Disorder Intermittent Explosive
• Both the selective serotonin reuptake inhibitor (SSRI) fluoxetine and the
antiepileptic drug oxcarbazepine have been found superior to placebo in
reducing impulsive aggression in people with IED. Other SSRIs, mood
stabilizers (e.g., lithium carbonate, carbamazepine), and -blockers (e.g.,
propranolol) have been used to treat IED, but their use is supported mainly
by case studies or small case series. Second-generation antipsychotics (e.g.,
risperidone) have been used to dampen aggressive impulses in other clinical
populations (e.g., dementia patients, patients with borderline personality
disorder) and may be helpful in treating IED. Benzodiazepines should be
avoided because of their tendency to cause behavioral disinhibition.
• Cognitive-behavioral therapy (CBT) may be helpful. With CBT, patients can
learn to recognize when they are becoming angry and to identify and defuse
the triggers that lead to outbursts. One study showed that CBT was superior
to a wait list in reducing anger and hostility in persons with IED.
DSM-5 Diagnostic Criteria for
Conduct Disorder
• A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-
appropriate societal norms or rules are violated, as manifested by the presence of at least three of the
following 15 criteria in the past 12 months from any of the categories below, with at least one criterion
present in the past 6 months:
• Aggression to People and Animals
• 1. Often bullies, threatens, or intimidates others.
• 2. Often initiates physical fights.
• 3. Has used a weapon that can cause serious physical harm to others
• (e.g., a bat, brick, broken bottle, knife, gun).
• 4. Has been physically cruel to people.
• 5. Has been physically cruel to animals.
• 6. Has stolen while confronting a victim (e.g., mugging, purse snatching,
• extortion, armed robbery).
• 7. Has forced someone into sexual activity.
DSM-5 Diagnostic Criteria for
Conduct Disorder
• Destruction of Property
• 8. Has deliberately engaged in fire setting with the intention of causing
• serious damage.
• 9. Has deliberately destroyed others’ property (other than by fire setting).
• Deceitfulness or Theft
• 10. Has broken into someone else’s house, building, or car.
• 11. Often lies to obtain goods or favors or to avoid obligations (i.e.,
• “cons” others).
• 12. Has stolen items of nontrivial value without confronting a victim
• (e.g., shoplifting, but without breaking and entering; forgery).
DSM-5 Diagnostic Criteria for
Conduct Disorder
• Serious Violations of Rules
• 13. Often stays out at night despite parental prohibitions, beginning before
• age 13 years.
• 14. Has run away from home overnight at least twice while living in the
• parental or parental surrogate home, or once without returning for
• a lengthy period.
• 15. Is often truant from school, beginning before age 13 years
DSM-5 Diagnostic Criteria for
Conduct Disorder
• B. The disturbance in behavior causes clinically significant impairment in
social, academic, or occupational functioning.
• C. If the individual is age 18 years or older, criteria are not met for
antisocial personality disorder.
• Specify whether:
• Childhood-onset type: Individuals show at least one symptom
characteristic
• of conduct disorder prior to age 10 years.
• Adolescent-onset type: Individuals show no symptom characteristic of
conduct disorder prior to age 10 years.
• Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but
there is not enough information available to determine whether the onset of
the first symptom was before or after age 10 years.
• A relatively mild case, such as was represented by Heather, typically is
treated with individual and family therapy.
• At the opposite extreme are those cases in which the child comes from a
highly deviant family and engages in repeated antisocial acts that bring him
or her to legal attention; such cases may require removal from the home and
placement in a group home or perhaps even in a juvenile detention facility.
In some situations, an important part of managing the child with a conduct
disorder involves teaching the parents more effective parenting skills. With
parental management training, parents learn to communicate more
effectively with their child, to apply appropriate and consistent discipline, to
monitor the child’s whereabouts, and to steer the child away from bad peers.
Research suggests that this approach may offer the best hope for the errant
child.
Pyromania
Kleptomania
