Disruptive, Impulse-Control, and Conduct Disorders

What disorders are included in disruptive impulse control and conduct disorders

Oppositional defiant disorder / intermittent explosive disorder / conduct disorder / antisocial personality disorder / pyromania / kleptomania / other specified disruptive impulse control and conduct disorder / unspecified disruptive impulse control and conduct disorder

What broadly defines disruptive impulse control and conduct disorders

Problems controlling emotions or behavior that violate the rights of others or create significant conflict with societal norms or authority

Which disorder in this chapter emphasizes anger and emotional dyscontrol most strongly

Intermittent explosive disorder

Which disorder in this chapter emphasizes serious behavioral violations most strongly

Conduct disorder

Which disorder falls between emotional dyscontrol and behavioral defiance

Oppositional defiant disorder

What specific impulses define pyromania and kleptomania

Pyromania = fire setting / kleptomania = stealing

When do most disruptive impulse control and conduct disorders begin

Childhood or adolescence

Is first onset of ODD or conduct disorder common in adulthood

No / it is very rare

Does most ODD eventually become conduct disorder

No

What should always be considered when judging disruptive behavior

Frequency / persistence / pervasiveness / impairment / developmental level / gender / culture

What is oppositional defiant disorder or ODD

Persistent pattern of angry or irritable mood / argumentative or defiant behavior / or vindictiveness

How long must ODD persist

At least 6 months

How many ODD symptoms are required

At least 4 of 8

With whom must ODD symptoms occur

At least one person who is not a sibling

What are the 3 ODD symptom categories

Angry or irritable mood / argumentative or defiant behavior / vindictiveness

What are the 3 angry or irritable ODD symptoms

Often loses temper / often touchy or easily annoyed / often angry and resentful

What are the 4 argumentative or defiant ODD symptoms

Argues with authority / defies or refuses requests and rules / deliberately annoys others / blames others for mistakes or misbehavior

What is the vindictiveness symptom in ODD

Spiteful or vindictive at least twice during the past 6 months

How frequent should ODD symptoms generally be in children younger than 5

On most days for at least 6 months

How frequent should ODD symptoms generally be at age 5 or older

At least once per week for at least 6 months

Does the special frequency rule apply to ODD vindictiveness

No / vindictiveness specifically requires at least twice in 6 months

What impairment requirement applies to ODD

Behavior causes distress to the person or others nearby or negatively affects important functioning

What disorders exclude an ODD diagnosis when the symptoms occur exclusively during them

Psychotic disorder / substance use disorder / depressive disorder / bipolar disorder

Can ODD be diagnosed when disruptive mood dysregulation disorder criteria are met

No

How is ODD severity determined

By the number of settings where symptoms occur

What is mild ODD

Symptoms are confined to one setting

What is moderate ODD

Some symptoms occur in at least 2 settings

What is severe ODD

Some symptoms occur in at least 3 settings

Can ODD exist only at home

Yes / one setting can still produce significant impairment

Why should ODD be assessed across several relationships and settings

Symptoms may be absent during an office visit and broader pervasiveness indicates greater severity

Do people with ODD always see themselves as oppositional

No / they often view their behavior as justified responses to unreasonable circumstances

What disorders commonly co occur with ODD

ADHD / conduct disorder / anxiety disorders / major depressive disorder

Does ODD increase suicide attempt risk

Yes

When do ODD symptoms usually begin

Preschool years and rarely later than early adolescence

Which ODD symptoms predict conduct disorder most strongly

Defiant / argumentative / vindictive symptoms

Which ODD symptoms predict depression and anxiety most strongly

Angry and irritable mood symptoms

What temperament is associated with ODD

High emotional reactivity / poor frustration tolerance

What environmental patterns are associated with ODD

Harsh / inconsistent / neglectful parenting and disrupted caregiving

How does ODD differ from conduct disorder

ODD is generally less severe and does not include the conduct disorder pattern of aggression / property destruction / theft / deceit

Can ODD and conduct disorder both be diagnosed

Yes

How does ODD differ from ADHD

ADHD noncompliance may occur because of inattention or difficulty sustaining effort while ODD involves a broader pattern of anger and defiance

How does ODD differ from disruptive mood dysregulation disorder

DMDD requires persistent severe irritability plus recurrent severe outbursts and takes diagnostic priority over ODD

How does ODD differ from intermittent explosive disorder

IED involves serious impulsive aggression while ODD centers more on anger / arguing / defiance / vindictiveness

How can PTSD resemble ODD in children

Trauma related dysregulation / tantrums / risk taking / reenactment may appear oppositional

How does adjustment disorder differ from ODD

Adjustment symptoms have a clear relationship to a stressor and usually resolve after the stressor or consequences end

What is intermittent explosive disorder or IED

Recurrent aggressive outbursts caused by failure to control impulsive aggressive urges

What are the 2 ways the aggression frequency requirement can be met in IED

Frequent lower severity aggression for 3 months OR at least 3 destructive or injurious outbursts within 12 months

What is the frequent lower severity IED pathway

Verbal or physical aggression about twice weekly for 3 months without property destruction or physical injury

What is the severe lower frequency IED pathway

At least 3 outbursts within 12 months involving property damage or physical injury

How proportional is IED aggression to the trigger

Grossly out of proportion to provocation or psychosocial stress

Are IED aggressive outbursts planned

No / they are impulsive or anger based

Can IED aggression be performed to obtain money or power

No / it is not instrumental aggression

What impairment is required for IED

Marked distress / occupational or interpersonal impairment / or financial or legal consequences

What is the minimum age for IED

At least age 6 or equivalent developmental level

How long do IED outbursts typically last

Less than 30 minutes

How quickly do IED outbursts usually begin

Rapidly with little or no warning period

What commonly triggers IED outbursts

Minor provocation from a close person or other relatively small stressor

What must be ruled out before diagnosing IED

Other mental disorders / medical causes / substances or medications

Can IED be diagnosed with ADHD ODD conduct disorder or autism

Yes / when the impulsive aggression clearly exceeds what is usual for the other disorder and requires separate attention

Can IED be diagnosed with disruptive mood dysregulation disorder

No

Can a child age 6 to 18 receive IED when aggression occurs only within adjustment disorder

No

How does IED differ from conduct disorder

IED aggression is impulsive and anger based / conduct disorder aggression can be planned or used to obtain something

How does IED differ from ODD

IED includes more serious aggression while ODD centers on arguing / defiance / irritability

How does IED differ from disruptive mood dysregulation disorder

DMDD has persistent irritable mood between outbursts while IED does not require persistent irritability

What disorders commonly co occur with IED

Depressive disorders / anxiety disorders / substance use disorders

When does IED usually begin

Late childhood or adolescence

Is first onset of IED after age 40 common

No

What early experience is associated with increased IED risk

Physical or emotional trauma during the first 20 years of life

What is conduct disorder

A repetitive persistent pattern that violates the basic rights of others or major age appropriate societal rules

How many conduct disorder symptoms are required

At least 3 of 15 during the past 12 months

What recent symptom requirement applies to conduct disorder

At least 1 symptom must have occurred during the past 6 months

What are the 4 conduct disorder categories

Aggression to people or animals / destruction of property / deceitfulness or theft / serious rule violations

What are the 7 aggression criteria for conduct disorder

Bullying or intimidation / initiating fights / using a dangerous weapon / cruelty to people / cruelty to animals / stealing while confronting a victim / forcing sexual activity

What dangerous weapon behavior can count toward conduct disorder

Using a weapon capable of causing serious physical harm

What confronting theft behaviors can count toward conduct disorder

Mugging / purse snatching / extortion / armed robbery

What are the 2 property destruction criteria for conduct disorder

Deliberate fire setting intended to cause serious damage / deliberate destruction of property by another method

What are the 3 deceitfulness or theft criteria for conduct disorder

Breaking into property or vehicles / lying or conning for gain or avoidance / stealing valuable items without confronting a victim

What are the 3 serious rule violation criteria for conduct disorder

Staying out at night before age 13 despite prohibition / running away overnight / truancy beginning before age 13

What running away pattern counts toward conduct disorder

At least twice overnight OR once for a lengthy period

What functional requirement applies to conduct disorder

Clinically significant social / academic / or occupational impairment

What diagnosis must be considered instead of conduct disorder in someone age 18 or older

Antisocial personality disorder

What defines childhood onset conduct disorder

At least 1 conduct disorder symptom begins before age 10

What defines adolescent onset conduct disorder

No conduct disorder symptom occurs before age 10

What is unspecified onset conduct disorder

Not enough information to determine whether symptoms began before or after age 10

Which conduct disorder onset type generally has the worse prognosis

Childhood onset type

What is common with childhood onset conduct disorder

Aggression / disturbed peer relationships / earlier ODD / ADHD or other neurodevelopmental difficulties

What is more common in adolescent onset conduct disorder

More typical peer relationships despite conduct problems

What is the limited prosocial emotions specifier

Pattern of callous or unemotional characteristics associated with conduct disorder

How many limited prosocial emotion traits are required

At least 2 of 4

How long must limited prosocial emotion traits persist

At least 12 months

Across how many settings must limited prosocial emotion traits appear

Multiple relationships and settings

What are the 4 limited prosocial emotion traits

Lack of remorse or guilt / callous lack of empathy / unconcerned about performance / shallow or deficient affect

What is lack of remorse or guilt in conduct disorder

Little concern after wrongdoing or harming others beyond possible remorse when caught or punished

What is callous lack of empathy

Disregard for others feelings with greater concern about consequences for oneself

What is unconcerned about performance

Lack of concern about poor school work or other performance and little effort despite expectations

What is shallow or deficient affect

Emotional expression appears superficial / insincere / easily switched / or used to manipulate others

Why should multiple informants be used for the limited prosocial emotions specifier

The traits must represent the persons typical functioning across time and settings and may be underreported by the individual

What defines mild conduct disorder

Few excess symptoms and relatively minor harm

What defines moderate conduct disorder

Number and impact of behaviors fall between mild and severe

What defines severe conduct disorder

Many excess symptoms or behaviors causing considerable harm