Disruptive, Impulse-Control and Conduct Disorders

Oppositional Defiant Disorder

pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting 6+ months as evidenced by 4+ sxs from any categories, and exhibited during interaction with 1+ individual who is not a sibling; associated with distress in the individual/others in his or her immediate social context or impacts negatively on functioning

ODD Symptoms

Angry/Irritable Mood

1. Often loses temper

2. Often touchy/easily annoyed

3. Often angry and resentful

Argumentative/Defiant Behavior

4. Often argues with authority figures/adults

5. Often actively defies/refuses to comply with requests from authority figures/rules

6. Often deliberately annoys others

7. Often blames others for his/her mistakes/misbehavior

Vindictiveness

8. Spiteful/vindictive 2+ times within 6 months

ODD Severity Specifiers

Mild: 1 setting

Moderate: 2 settings

Severe: 3+ settings

ODD Exclusion Criteria

psychotic disorder, mood disorder, substance use, disruptive mood dysregulation disorder

ODD Frequency of Behaviors

for children less than 5YO, behaviors should occur on most days for 6+ months; 5+ YO frequency at least once a week

ODD Etiology and Risk Factors

child variables: biological temperament, hyperactivity, low academic readiness, poor social skills

parent variables: substance abuse, maternal depression/psychosis, poor parenting skills with use of coerciveness and criticism

environmental: lack of supports and resources for parents, excess stress, poverty, low parental involvement in child's home and school life

Intermittent Explosive Disorder

Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by symptoms; magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors; not premeditated and are not committed to achieve some tangible objective

Intermittent Explosive Disorder Symptoms

1. Verbal aggression or physical aggression toward property, animals, or other individuals, 2x/week, on average for 3 months; physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals

OR

2. 3 behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period

Intermittent Explosive Disorder Onset

6YO+ (or equivalent developmental level)

Conduct Disorder

repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, 3+ sxs in the past 12 months from any of the categories with 1+ criterion present in the past 6 months; if 18YO+, criteria not met for antisocial personality disorder

Conduct Disorder Symptoms

Aggression to People and Animals

1. Often bullies/threatens/intimidates others

2. Often initiates physical fights

3. Has used a weapon that can cause serious physical harm to others

4. Physically cruel to people

5. Physically cruel to animals

6. Has stolen while confronting a victim

7. Has forced someone into sexual activity

Destruction of Property

8. Deliberately engaged in fire setting with the intention of causing serious damage

9. Deliberately destroyed others' property (other than by fire setting)

Deceitfulness or Theft

10. Has broken into someone else's house/building/car

11. Often lies to obtain goods/favors/to avoid obligations

12. Stolen items of nontrivial value without confronting a victim

Serious Violations of Rules

13.Often stays out at night despite parental prohibitions, beginning before 13YO

14. Has run away from home overnight 2x+ while living in the parental/parental surrogate home or 1x without returning for a lengthy period

15. Often truant from school, beginning before 13YO

Conduct Disorder Specifiers

Specify whether:

Childhood-onset type: 1+ sx before 10 YO

Adolescent-onset type: no sx before 10YO

Unspecified onset

Specify if:

With limited prosocial emotions (2+ persistently over 12+ months and in multiple relationships and settings; reflect typical pattern of interpersonal and emotional functioning, not just occasional occurrences)

1. Lack of remorse or guilt

2. Callous—lack of empathy

3. Unconcerned about performance

4. Shallow or deficient affect

Specify current severity: mild, moderate, severe

CD Etiology and Risk Factors

parent & family risk factors: abuse, disrupted attachment reducing loyalty and internalization of values

biological variables: low frontal lobe inhibition, concordance of CD in twin studies, genotype for low monamine oxidase activity (vulnerability to risk factors)

ODD v. CD

extent of defiance (CD - rights of others and societal norms are violated; no violations with ODD); ODD can lead to CD over time; CD can lead to antisocial personality disorder in 18YO+; ODD is characterized by persistent negativism; ODD typically develops first at home in relation to parents and later expands to school and teachers; ODD does not present in adulthood (resolved or becomes CD); CD can be diagnosed at any age

ODD and CD Similarities

oppositionality, defiance, authority conflicts and rule-breaking

Assessment of ODD and CD

attend to history of early attachment problems; assess parenting skills and expectations (GPEQ); if harsh treatment suspected, use of Parental Reaction Survey Schedule (PRSS); assess environment (Global Family Environment Scale) to which the child is exposed; assess child's behavior with rating scales (Disruptive Behavior Rating Scale, Eyberg Child Behavior Inventory); cognitive assessment (LD problems, intellectual deficits may be masked my oppositional behavior), assess faulty social cue reading (Children's Action Tendency Scale, Means-End Problem Solving, Social Situations Analysis); Self Report Delinquency Scale (current sxs); Adolescent Antisocial Behavior Self-Report Checklist; Refer for Psych Testing (TAT & MMPI) when patient's world view is not clear via interview

Pyromania

Deliberate and purposeful fire setting on more than 1 occasion; tension/affective arousal before the act; fascination with/interest in/curiosity about/attraction to fire and its situational contexts; pleasure/gratification/relief when setting fires or when witnessing or participating in their aftermath; not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment; not better explained by conduct disorder, a manic episode, or antisocial personality disorder

Kleptomania

Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value; increasing sense of tension immediately before committing the theft; pleasure, gratification, or relief at the time of committing the theft; not committed to express anger/vengeance and is not in response to a delusion/hallucination; not better explained by conduct disorder, a manic episode, or antisocial personality disorder