Disruptive, Impulse-Control, and Conduct Disorders

Disorders usually first diagnosed in infancy, childhood, or adolescence

Prior to DSM 5, these disorders were simply referred to as?

impulsivity
self-regulation
& emotional/behavioral control

these disorders are distinguished by what problems (4)

oppositional defiant disorder

A. pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
lasting 6 months at least with 4 symptoms from any category
B. causes distress for individuals with immediate social context
C. DMDD criteria not met
-possible to only occur in one setting

angry or irritable mood
argumentative or defiant behavior
vindictiveness

symptom categories (3)

angry/irritable mood

1. Often loses temper
2. Is often touchy or easily annoyed
3. Is often angry and resentful

argumentative/defiant behavior

Frequently argumentative
Active defiance & noncompliance with authority figures
Deliberately annoys others.
Blames others for mistakes / misbehavior.

vindictiveness

spiteful or vindictive at least twice within past 6 months
-for children under 5 this should occur on most day for 6 months
-for 5 and older, behavior should occur at least once per week for 6 months

mild - confined to one setting
moderate - symptoms appear in 2 settings
severe - 3 or more settings

oppositional defiant disorder severity levels

Intermittent Explosive Disorder

impulsive or anger based aggressive outbursts that have a rapid onset and little or no prodromal period. Usually last less than 30 minutes and come from a minor stimulus or provocation
*not diagnosed before 6 years old

Intermittent Explosive Disorder Episodes

recurrent behavioral outbursts representing a failure to control aggressive impulses by either of:
-verbal or physical aggression for 3 months
-3 behavioral outbursts involving damage/destruction of property + physical injury occurring within 12 month period

conduct disorder

repetitive and persistent pattern of behaviors in which the basic rights of others, age-appropriate norms, or rules are violated.
-3 criteria for past 12 months
-18 years or older = does not meet criteria for antisocial personality disorder

aggression to people and animals,
destruction of property,
deceitfulness or theft,
serious violations of rules

Conduct disorder symptom categories (4)

Aggression to people and animals

Bullying, threatening, intimidating others.
Using weapons.
Physically cruel to animals or people.
Stealing while confronting victim (e.g., mugging, robbery, extortion).
Forcing sexual activity.

destruction of property

-has deliberately engaged in fire setting with the intention of causing serious damage
-has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

Breaking into house, building, or vehicle.
Lying to obtain goods or favors or to avoid obligations.
Stealing without confronting victim (e.g., shoplifting, burglary, forgery).

Serious violations of rules

often stays out at night despite parental prohibitions, beginning before age 13 years,
has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period),
is often truant from school, beginning before age 13 years

childhood onset type CD

one symptoms of CD prior to age 10

adolescent onset type CD

no symptoms of CD prior to age 10

Unspecified onset type

criteria met for CD but not enough info when symptoms appear

limited prosocial emotions

A specifier used in DSM-5 to describe youths with CD who also show two of the following: (1) lack of remorse or guilt, (2) callousness or lack of empathy, (3) lack of concern about performance, and (4) shallow or deficient affect

mild- few if any symptoms. minor harm
moderate - number of problems and effect on others
severe - many problems in excess of those required to make a diagnosis

severity specifiers

risk factors for CD

early maternal rejection
separation from parents with no caregiver
parent incarcerated
alcohol/drug use at home
early institutionalization
family neglect/abuse
parental mental illness
spousal abuse
large family size
crowded home
lack of structure/stability
poverty

children with CD diagnosis

-higher rates or depression and suicidal ideation
-academic difficulties
-poor relationships
-STD's
-illicit drug use
-violence

antisocial personality disorder

a pervasive pattern of disregard for and violation of the rights of others since age 15
-failure to conform to societal norms
-deceitfulness
-impulsivity
-irritability
-reckless disregard
-lack of remorse
-consistent irresponsibility
*must be 18 years old with onset before 15 years

characteristics of antisocial personality disorder

lack of empathy
disrespectful
disregard
persistent lying
manipulating
intimidating
aggressive/violent behavior
arrogant
opinionated
irresponsible
sexually exploitive

pyromania

multiple episodes of purposeful fire setting. Fascination with and attraction to fire, fire contexts, and associations

Pyromania Criteria

A. Deliberate and purposeful fire setting on more than one occasion

B. Tension or affective arousal before the act

C. Fascination with, interest in, curiosity about, or attraction to fire and things associated with fire

D. Pleasure, gratification, or relief when setting fires, or when watching or participating in the events following a fire

E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment

kleptomania

recurrent failure to resist urges to steal things not needed for personal use or their monetary value

Kleptomania Criteria

A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value

B. Increasing sense of tension immediately before committing the theft

C. Pleasure, gratification, or relief at the time of committing the theft

D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination

other specified disruptive, impulse-control and conduct disorder

symptoms characterize a disruptive-impulse control, and conduct disorder that causes distress and impairment but doesn't meet full criteria