1.8 Disruptive, Impulse-Control Disorders, and Conduct Disorder

Oppositional Defiant Disorder (ODD)

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

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?

Disruptive Mood Dysregulation Disorder (DMDD)

If the criteria for this disorder is met, then it is given even if all criteria for ODD are met. What disorder is it?

Intermittent Explosive Disorder (IED)

Recurrent behavioral outbursts, whether verbal or physical, that represent a failure to control aggressive impulses

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?

Before 10 y/o

At what age should IED be diagnosed?

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

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

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, adolescent-onset, & unspecified-onset

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

Mild, moderate, & severe

Subtypes 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 15

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