B6. Disruptive, Impulse-Control Disorders, and Conduct Disorder

Disruptive, Impulse-Control, and Conduct Disorders

Group of disorders that involves problems with self-control of emotions and behaviors that violate the rights of others and/or bring the individual into significant conflict with societal norms or authority figures.

They often emerge during childhood or adolescence

Oppositional Defiant Disorder (ODD)

Disorder characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness towards at least one individual who is not a sibling.

It is less severe compared to Conduct disorder and does not include aggression towards people or property (IED)

If symptoms occur exclusively during a mood disorder, this diagnosis should not be med

At least 6 months. For children under 5 years, it should occur on most days. For 5 years or older, it should occur at least once a week

How long should symptoms of ODD last?

Mild (One setting)

Moderate (Two settings)

Severe (3 or more settings)

Specifiers of ODD

Disruptive Mood Dysregulation Disorder (DMDD)

Even if all criteria for ODD are met, a different diagnosis is given if it meets the criteria for this disorder. What disorder is it?

Intermittent Explosive Disorder (IED)

Disorder characterized by recurrent out-of-proportion behavioral outbursts, whether verbal or physical, that represent a failure to control aggressive impulses. People often feel guilty after these outbursts

Twice a week for at least 3 months

How long should symptoms of IED occur?

6 years

At what chronological age or developmental age can IED be given?

Conduct Disorder

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

3 out of 15

How many of the 15 criteria should be met in the past 12 months to diagnose Conduct Disorder?

At least 3 behaviors in the past 12 months with at least one in the past 6 months.

How long should the pattern of Conduct Disorder last?

Aggression to People and Animals

Destruction of Property

Deceitfulness or Theft

Serious Violations of Rules

Categories of Symptoms of Conduct Disorders

Aggression to People and Animals

Destruction of Property

Deceitfulness or Theft

Serious Violations of Rules

What are the categories of behavior in Conduct Disorder?

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.

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)

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.

Childhood-onset (At least 1 symptom before 10 years old)

Adolescent-onset (No symptom prior to age 10)

Unspecified-onset (No enough info)

With limited prosocial emotions: Lack of remorse or guilt, callous, unconcerned about performance, & shallow or deficient affect

Mild (Minor harm)

Moderate (Intermediate harm)

Severe (Considerable harm)

Specifiers of Conduct Disorder

IED only when the recurrent impulsive, aggressive outbursts warrant independent clinical attention

If criteria for IED and CD are met, which diagnosis should be given?

Before age 18

At what age should CD be diagnosed?

Pyromania

Deliberate and purposeful fire setting on more than one occasion

Kleptomania

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