Disruptive Impulse Control and Conduct Disorder

Oppositional Defiant Disorder

Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting ≥6 months, with ≥4 symptoms, and exhibited with at least one non-sibling individual. Causes distress or impairment in social, academic, or occupational functioning. Not occurring exclusively during a psychotic, mood, or substance use disorder; not better explained by disruptive mood dysregulation disorder

Angry/irritable mood

Often loses temper. Often touchy or easily annoyed. Often angry and resentful

Argumentative/Defiant Behavior

Often argues with authority figures/adults. Actively defies/refuses to comply with rules. Deliberately annoys others. Blames others for own mistakes/misbehavior

Vindictiveness

Spiteful or vindictive at least twice in past 6 months

ODD Diagnostic Features

Symptoms may be limited to one setting, often the home. More severe cases involve multiple settings. Individuals often externalize blame, justifying behavior as reactions to perceived injustice. Environmental factors (e.g., neglect, institutional settings) may influence presentation

ODD DSM Updates

Symptom Clusters: Now grouped into three domains: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. Conduct Disorder Exclusion Removed. Frequency Guidelines: Clarifies what's considered developmentally normative vs. symptomatic. Severity Rating Added: Pervasiveness across settings indicates severity.

Intermittent Explosive Disorder

Recurrent outbursts due to failure to control aggressive impulses, as shown by: Verbal/physical aggression ≥2× per week for ≥3 months (no injury/damage), OR ≥3 outbursts involving injury/damage within 12 months. Outbursts are grossly out of proportion to provocation. Behavior is impulsive, not goal-oriented. Outbursts cause distress, impairment, or legal/financial consequences. Age ≥6 years. Not better explained by another disorder, condition, or substance

IED Diagnostic Features

Sudden, unplanned outbursts with minimal warning. Episodes typically <30 minutes, often triggered by minor events. Most common in response to perceived provocation. Must be distinguished from other childhood disorders with aggression

Conduct Disorder

A. Repetitive and persistent behavior violating rights or norms, with ≥3 of the following in past 12 months, and ≥1 in past 6 months: Aggression to People/Animals: bullying, cruelty, use of weapons, sexual coercion, Destruction of Property: fire-setting, vandalism, Deceit/Theft: breaking/entering, lying, stealing, Serious Rule Violations: truancy, running away, curfew defiance. Causes significant impairment. If ≥18 years old, does not meet criteria for Antisocial Personality Disorder

Childhood onset type

Conduct disorder with symptoms before age 10

Adolescent onset type

Conduct disorder with no symptoms before age 10

With limited prosocial emotions

Conduct disorder that requires ≥2 of the following for ≥12 months in multiple contexts: Lack of remorse/guilt, Callous lack of empathy, Unconcerned about performance, Shallow or deficient affect

CD Diagnostic features

May manifest across home, school, community. Individuals may conceal behavior; collateral information is essential. Frequently involves aggression, property destruction, deceit, and rule violations. Childhood-onset often linked to future antisocial traits

Pyromania

Multiple deliberate fire-setting episodes. Tension or emotional arousal before the act. Fascination with or attraction to fire-related contexts. Pleasure/relief when setting or witnessing fires. Fire-setting not for gain, ideology, revenge, or due to impaired judgment. Not better explained by other disorders (e.g., Conduct Disorder, Mania)

Pyromania diagnostic features

May frequently observe fires or associate with fire-related professions. Motivation is intrinsic gratification, not external reward. May set false alarms or loiter around fire stations

Kleptomania

Recurrent failure to resist impulses to steal unneeded items. Increasing tension before theft. Relief or gratification after theft. Theft not motivated by anger, vengeance, delusions, or hallucinations. Not better explained by another disorder (e.g., CD, mania, ASPD)

Kleptomania diagnostic features

Items stolen often of little value or later discarded. Typically done alone, without premeditation or accomplices. Impulse-driven rather than strategic theft. May feel remorse but unable to stop behavior