Week 11: Disruptive, Impulse-Control, and Conduct Disorders

What are disruptive, impulse-control, and conduct disorders?  

They are a new chapter to the DSM. It is now looked at across the lifespan. These disorders are distinguished by problems in emotional and behavioral self-control. The distinguishing features of the disorders is that they include very severe problems in self-control of emotions and behaviors. The behaviors violate the rights of others: (Aggression or destruction of property. They are more common in males. Emerge in childhood and adolescence - The child’s behavior is affected by various factors; (Family and home life, spiritual influences, culture, community - gangs & prosocial groups, and economic issues, and perhaps genetic makeup).

What are the DSM disruptive disorders?    

(6) Oppositional Defiant Disorder 313.81 (F91.3),

Intermittent Explosive Disorder 312.34 (F63.81),

Conduct Disorder 312.8X (F91.X),

Pyromania 312.33 (F63.1),

Kleptomania 312.32 (F63.3),

Unspecified Disruptive, Impulse-Control, and Conduct Disorder 312.9 (F91.9)

What are the cultural perspectives for disruptive disorders?   

The SW must differentiate between what may appear as illness behaviors as specified in the DSM and those inherent to specific cultural beliefs and practices (being incarcerated might warrant aggressive behavior to survive). Are the child’s behaviors functional and adaptive or do they produce conflict? (Are we looking at a rebellious teen or someone who has ODD? Are we looking at a child who is acting out due to being abused at home or are we looking at someone who truly has conduct disorder). Do these behaviors cause distress? (At what point do the behaviors cause distress? - caregivers are often able to tolerate a certain amont of acting out behavior, so when does the behavior cross the line to a bona fide diagnosis)?

What should we consider with disruptive disorders?    

Assess cultural contexts, lifestyle behaviors, expected standards of behavior, and everyday activities relevant for cultural adaptation and survival. (People living in high-traumatizing situations often act in ways that are very maladaptive in other settings - maximum security prisons, concentration camps). Comprehend meanings, labels, and interpretations commonly used to describe a child’s behavior or emotional problems based on culture. (How do caregivers describe the child’s behavior? Evaluate the cultural context of what, on the face of it, appears as illness behaviors to determine whether they essentially support the DSM criteria. Determine if the DSM criteria are valid for the specific population to be assessed. (Teens living in urban areas may have to join a gang to survive. When they relocate, their behavior may become much more adaptive. Consider the child’s and parents’ (also significant others’) threshold of stress and how they cope with the child’s behavioral problems. (Do they have a high tolerance for certain behaviors? Is there a history of CPS involvement)? Recognize how the client perceives the practitioner’s social position. (You bring yourself with you). Show self-awareness. Do not be triggered.

What is Oppositional Defiant Disorder 313.81 (F91.3)?    

Can be found in children who have a history of a succession of different caregivers or who live in families with harsh, inconsistent, neglectful child-rearing practices. These children typically show symptoms only at home and only with members of the family. Passive aggressive personality disorder is no longer a disorder. Now a child with this might transition into antisocial personality disorder.

What are common features of ODD?    

Excessive, often persistent anger, temper tantrums, or angry outbursts, and disregard for authority

What is the Oppositional Defiant Disorder Prevailing pattern?    

The lifetime prevalence of ODD is roughly 10.2%. Of those, 11.2% are males and 9.2% females. There is a substantial risk of secondary disorders: mood (45.8%), anxiety (62.3%), impulse-control. (68.2%), and substance use (47.2%).

What is the Oppositional Defiant Disorder Differential Assessment?  

It is characterized as an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond normal childhood behavior. The defiance is a need or an impulse. A recurrent pattern of angry, irritable mood, or vindictiveness that lasts for at least 6 months. Think about the caregivers of the parents. If a parent is antisocial, the kid might develop this

What do we need to see in ODD?    

at least 4 symptoms from any of 3 categories: Angry/irritable mood: frequent loss of temper, touchy, or easily annoyed, or often angry and resentful. Argumentative/defiant behavior: arguing with adults or other authority figures, being noncompliant, annoying others, or blaming others for mistakes or misbehavior. Vindictiveness: spiteful or malicious - in an opposing way

What are the age requirements for ODD?    

The behaviors can be seen on most days for at least 6 months for children under age 5. For those age 5 and older, the behavior should occur at least once a week for at least 6 months

What is the severity in ODD?    

Mild: behavior is confined to one setting. Moderate: symptoms are present in at least two settings. Severe: symptoms are seen in 3 or more settings.

What is Intermittent Explosive Disorder 312.34 (F63.81)?    

It can be seen in explosive outbursts wherein the person is unable to control (typically) his aggressive impulses. The impulses can be verbal or physical and go way beyond what one would expect given the stimulus. The impulses occur rapidly and without warning, lasting for a short time (Less than ½ hour & They may be described as “spells” or as “attacks).” The outbursts are commonly unprovoked and usually directed toward someone close to the individual. There is a sense of tension or arousal followed by a sense of relief - Afterward, the person may describe feeling upset, remorseful, regretful, or embarrassed.

What is the IED Prevailing Pattern?  

It is estimated that 4% to 7% of people in the US have IED and usually meet full diagnostic criteria, and the first occurrence typically occurs in early adolescence ranging from 14 to 18 years of age. Further, the disorder is more prevalent among younger individuals (or those younger than 35 to 40) compared with older individuals. The majority are male. An average of 14 lifetime attacks are reported. However, only 28.8% receive treatment.

What is the IED Differential Assessment?    

The essential feature is distinct episodes of failure to resist aggressive impulses that are evident in verbal aggression such as temper tantrums, tirades, and arguments or physical aggression. The incidents happen about twice a week for at least 3 months. The episodes are not premeditated, nor is the person’s behavior motivated by a desire to gain money or power of to intimidate. The aggression is out of proportion to any provocation or precipitating stressor.

What should the SW consider in IED?    

other syndromes such as antisocial PD - motivated by gain,

borderline PD - responding to threat, psychotic disorder, a manic episode,

conduct disorder - looking to gain some reward or cause harm

ADHD.

Always rule out the direct physiological effects of a substance such as head trauma or Alzheimer's disease.

What is Conduct Disorder, 312.8X (F91.X)?    

The essential feature of this is a consistent pattern of violating the rights of others or violating major age-appropriate societal norms or rules. These individuals are at higher risk: (for other mental disorders - antisocial, legal problems, and premature mortality). They tend to report higher levels of distress and impairment in virtually all areas of living than youth with other mental disorders. We would see higher rates of this in children of depressed mothers where a lack of emotional stability and availability have adversely influenced the emotional environment. Inconsistent child-rearing practices such as: (harsh discipline, a lack of supervision, maternal smoking during pregnancy, and exposure to violence).

What is Conduct Disorder's Prevailing Pattern?   

Lifetime prevalence is from 2% to 4%. The prevalence is higher for males than for females. This tends to be seen before ag 16 and is believed to be influenced by environmental as well as genetic factors. It may not be reported. It is more physical than ODD and the consequences are more severe.  

What is Conduct Disorder Differential Assessment?    

The diagnosis requires the presence of any 3 of the following 15 symptoms. Aggression to people and animals: (Bullying or intimidating others, Using a weapon to cause harm, Being physical cruel to people, Being physically cruel to animals, Stealing while confronting a person, Committing sexual assault). Destruction of property: (Setting fires with the intention of causing harm, Destroying property). Deceitfulness or theft: (Breaking into another’s property, Lying, Stealing without confronting the person (e.g., shoplifting or forgery)). Serious violation of rules: (Staying out at night, Running away from home, Refusing to attend school).

What are the specifiers for conduct disorder?    

Specify if: Child onset (before age 10) or Adolescent onset (after age 10). Specify if: severity is mild, moderate, or severe.

What are the conduct disorder characteristics?    

The person shows significant social, school, or work problems. Both boys and girls can show little empathy and concern for others, callousness, lack of guilt, low self-esteem, irritability, poor frustration tolerance, recklessness, and high levels of aggression. They are more likely to engage in early sexual behaviors, smoke, drink, use drugs, and engage in gang-related activity. Always consult with family, teachers, or co-workers.

Boys with CD are more likely to show?   

fighting, stealing, vandalizing property, and breaking school rules.

Girls with CD are more likely to?    

lie, run away from home, be truant, use drugs, and become involved in prostitution.

What is Pyromania 312.33 (F63.1)?    

The essential feature is the deliberate and purposeful setting of a fire on more than one occasion. Someone with tendencies experiences emotional arousal before setting the fire. The individual is fascinated, curious, interested in or attracted to fire and its contexts. There is a sense of relief experienced when setting fires, witnessing its effects, or participating in its aftermath. There is no motivation for setting fires such as financial gain, or to conceal a criminal act, or to express anger or vengeance. There is also no delusion or hallucination process going on. The person loves setting and watching fires

What is Pyromania Prevalence and Differential Assessment?    

We don’t know the prevalence. The SW rules out other similar disorders such as conduct disorder, a manic episode, or antisocial personality disorder. There is also no schizophrenia characteristics such as responding to internal cues.

What is Kleptomania 312.32 (F63.3)?    

The central feature is the individual’s inability to resist stealing something that has no personal use or monetary value. Women stealing jock straps, men stealing tampons. The prevalence is rare, but more common in females than in males by a 3:1 ratio. The person experiences a sense of tension just before the theft and feelings of relief or gratification at the time of the theft. This is NOT shoplifting, which is motivated and deliberate.

What are unspecified disruptive, impulse-control, and conduct disorder (312.9) (F91.9)?

We would see symptoms of a disruptive, impulse-control, and conduct disorder that causes clinically signifcant distress or impairment in social, occupational, or other important areas of functioning that do not meet the full criteria for any other disorders in the chapter. The social worker uses the diagnosis when choosing not to specify the reasons that the criteria are not met for a specific disorder and includes presentations in which thre is insufficient information to make a more specific diagnosis.