Disruptive, Impulse-Control, and Conduct Disorders

Disruptive, Impulse-Control, and Conduct Disorders

• Problems with behavior and emotional regulation

• Effort to resist authority

• Acts may be illegal & result in injury

• Brings individual into conflict with social norms

• Typical onset in childhood or adolescence

Symptoms

• Angry Irritable Mood:

  • Loses temper

  • Easily annoyed 

  • Angry & resentful 

• Argumentative/Defiant:

  • Argues with authority figures

  • Active defiance or refusal to comply with authority/rules

  • Deliberately annoys others 

  • Blames others for their misbehavior

• Vindictiveness:

  • Spiteful or vindictive behavior at least 2x within past 2 months

Oppositional Defiant Disorder

• Several symptoms for 6 months or more:

  • Mild: symptoms occur only in 1 location (home, school, work)

  • Moderate: Symptoms in 2+

  • Severe: Symptoms in 3+ locations

Conduct Disorder

• More severe than ODD

• Chronic disrespect rules & rights of others 

• Aggression against peers and elders 

  • Bullying 

  • Starting fights

  • Weapons

  • Cruelty to people or animals 

• Setting fires: destroying property; B&E

• Lying to advance goals

Conduct Disorder con.

• F91.1: Childhood onset 

• F91.2: Adolescent onset 

• F91.9: Unspecified Onset 

• Mild: sufficient, but not many symptoms, harm to others minimal

• Moderate: symptoms and harm to others intermediate 

• Severe: many symptoms, much harm to others

Intermittent Explosive Disorder

• Frequent, repeated, impulsive outbursts of aggression (verbal or physical without damage) OR

• Less frequent eruptions with harm to people, property, or animals

• Unplanned, no obvious goal, excessive, no provocation

• Stimulus may be benign:

  • Accidental bump from a passerby 

  • Offhanded comment from a friend 

• Treatments often involve increasing frustration tolerance & analysis of beliefs (REBT)

Pyromania

• Deliberately set multiple fires 

• Motivation isn’t profit, revenge, terroism, cover up a crime 

• Tense or excited before starting the fire & sense of release after 

Kleptomania

• Repeatedly act on impulse to steal objects they don’t need

• Tension before theft & relief after 

• Not prompted by anger, revenge, delusions, or hallucinations

• Rule out mania, ordinary criminal bx, neurocognitive disorder 

Personality Disorders

• Disorder in personality (ways individuals experience, interact with, and think about everything)

• Collection of traits that have become rigid and work to an individual’s disadvantage

• Present since early adulthood and recognizable for a long time

• Usually not diagnosed before age of 18

• Can be difficult to treat

Cluster A disorders

Withdrawn, cold, suspicious, irrational

Cluster B disorders

Theatrical, emotional, attention-seeking, intense interpersonal conflicts

Cluster C disorders

Anxious, tense, overcontrolled

Paranoid Personality Disorder

• Pervasive distrust in the loyalty or reliability of others

• Unjustified suspicions others want to deceive, hurt, or exploit them 

• Unjustified suspicions about partner faithfulness

• Generalizable paranoia without concrete delusions

Schizoid Personality Disorder

• Indifferent to the society of others 

• Often lifelong loners with restricted emotional range

• May appear cold, reclusive, detached

• May succeed in solitary jobs but find others difficult to tolerate 

• Rarely marry or have lasting friendships

• Indifferent to praise or criticism

Schizotypal Personality Disorder

• Like Schizoid for isolation & limited emotional range

• Paranoid or suspicious ideas 

  • Not to a delusional degree 

• Odd/eccentric dress or mannerisms 

• Vague, impoverished, or overly abstract speech

• May report strange perceptions or physical sensations

• May experience “magical thinking” (i.e., telepathy, clairvoyance)

• Paranoid ideas about society that don’t improve with acquaintance

Antisocial Personality Disorder

• Chronic disregard and violation of the rights of others 

• Can’t or won’t conform to norms of society

• Usually begins before age 15 (must have evidence of conduct disorder before 15)

• Lie, can give an alias - engaging in illegal bxs

• Violence 

• No remorse, regret, apprehension, empathy

Borderline Personality Disorder

• Instability in relationships; perpetual crisis of mood or behavior

• Disturbed identity (insecure self-image)

• Attach strongly to others they will later vigorously reject 

  • While frantically trying to avoid desertion 

  • Idealization -> devaluation

• Impulsiveness; potentially harmful bxs

• May self-harm or threaten (or attempt) suicide

Histrionic Personality Disorder

• Crave the limelight & unhappy when not the focus of attention

• Actively trying to draw attention to themselves with appearance and mannerisms 

• Speech: overly dramatic, nonspecific, vague, grandiose

• Affect: superficial and fleeting

• Behavior;’ unpredictable, rash

Narcissistic Personality Disorder

• Self-important, crave admiration, lack concern for the feelings of others 

• Exaggerate abilities and accomplishments 

• Arrogant or haughty

• Sense of entitlement 

• Belief others envy them 

• Needs excessive admiration

• Lacks empathy

Avoidant Personality Disorder

• Socially inhibited, overly sensitive to criticism

• Pathological feelings of inadequacy & inferiority

• Profound fear of disapproval with all others

• Reluctant to risk any embarrassment 

• Avoiding social situations, relationships, new experiences 

Dependent Personality Disorder

• Excessive need for support in relationships 

• Clingy, submissive, fearful of separation

• No disagreements 

• May take extraordinary steps to gain approval

• Low self-confidence makes carrying tasks out independently difficult 

• Every day decisions require significant advice and reassurance 

• Exaggerated, unrealistic fears of abandonment

Obsessive-Compulsive Personality Disorder

• Intense focus on control, organization, and perfection

• Absorbed with details and rules

• Rigid perfectionism interferes with completion of tasks

• Overly conscientious, inflexible about ethics, morals, values

• Excessive devotion to work & productivity ot the cost of leisure

Treatment

• Psychotherapy - treatment team approach based on needs 

• DBT - especially for BPD

• Group therapy

• EMDR

• Psychoeducation

• Mentalization-Based Therapy (MBT)