Disruptive, Impulse-Control, and Conduct Disorders Overview

Disruptive, Impulse-Control, and Conduct Disorders

Overview

  • Disorders characterized by behaviors violating the rights of others and involve self-control issues regarding emotions and actions.
  • Commonly seen in boys and men more than in girls and women.
  • Generally has first onset in childhood or adolescence.

Intermittent Explosive Disorder (IED)

Diagnostic Criteria (F63.81)

  1. Recurrent Behavioral Outbursts
    • Two Types:
      • Verbal aggression: e.g., temper tantrums, verbal arguments, occurring twice weekly on average for 3 months (without property damage or injury).
      • Physical aggression: e.g., three outbursts with destruction or physical assault within 12 months.
  2. Magnitude of Aggressiveness
    • Outbursts are grossly out of proportion to provocation.
  3. Impulsiveness
    • Outbursts are impulsive, not premeditated, and not aimed at achieving a specific tangible outcome (e.g., money, power).
  4. Distress or Impairment
    • Causes marked psychological distress or impaired social, occupational functioning.
  5. Age Requirement
    • Minimum age of six years.
  6. Exclusion of Other Disorders
    • Symptoms not explained by other mental disorders or medical conditions.

Additional Notes on IED

  • Patients experience unplanned, spontaneous outbursts of aggression;
  • Related to disruption in the orbital frontal cortex inhibiting amygdala activation and serotonin system changes.

Oppositional Defiant Disorder (ODD)

Diagnostic Criteria (F91.3)

  1. Pattern of Behaviors
    • At least six months with four symptoms from three areas:
      • Angry/Irritable Mood:
      • Often loses temper, touchy, angry.
      • Argumentative/Defiant Behavior:
      • Arguments with authority, defiance, deliberately annoying others.
      • Vindictiveness:
      • Spiteful or vindictive at least twice in the last six months.
  2. Distress
    • Related distress in individual or immediate social context.
  3. Exclusion of Other Disorders
    • Symptoms do not occur exclusively during the course of other disorders.

Severity Specifiers

  • Mild: Symptoms in one setting.
  • Moderate: Symptoms in at least two settings.
  • Severe: Symptoms in three or more settings.

Notes on ODD Development

  • Often precedes conduct disorder, particularly in childhood-onset types.
  • Defiant, argumentative symptoms carry greater risk for conduct disorder than angry/irritable mood symptoms for mood and anxiety disorders.

Pyromania

Diagnostic Criteria (F63.1)

  1. Fire Setting
    • Deliberate and purposeful on more than one occasion.
  2. Tension Before Act
    • Experience of tension or arousal prior to setting fires.
  3. Fascination with Fire
    • Interest or curiosity about fire and its implications.
  4. Pleasure/Gratification
    • Relief when setting fires or witnessing aftermath.
  5. Exclusion of Other Motivations
    • Not for monetary gain or to express sociopolitical views.
  6. Not Explained by Other Disorders
    • Excludes conduct disorder, manic episodes, or antisocial personality disorder.

Summary of Pyromania

  • Impulse-control disorder with an irresistible urge to set fires.

Kleptomania

Diagnostic Criteria (F63.2)

  1. Recurrent Impulse to Steal
    • Objects not needed for personal use or for monetary value.
  2. Tension Before Theft
    • Increased tension immediately preceding the act.
  3. Pleasure During Theft
    • Feelings of gratification while stealing.
  4. Exclusion of Other Motivations
    • Not for personal vendetta or hallucinations.
  5. Not Explained by Other Disorders
    • Excludes conduct disorder or manic episodes.

Additional Notes on Kleptomania

  • Individuals may hoard or return stolen items surreptitiously.
  • Likely to avoid stealing when risk of arrest is high; typically unplanned.

Conduct Disorder

Diagnostic Criteria

  1. Pattern of Behavior
    • Repetitive violation of the rights of others or societal norms, evidenced by three of the following criteria over 12 months:
      • Aggression: bullying, physical fights, use of weapons.
      • Destruction of Property: fire-setting, deliberate destruction.
      • Deceitfulness/Theft: breaking and entering, lying for personal gain.
      • Serious Rule Violations: staying out at night, running away, truancy.
  2. Significant Impairment
    • Causes clinically significant impairment in functioning.
  3. Age Specification
    • If age 18+, not meeting criteria for antisocial personality disorder.

Severity Specifiers

  • Childhood-onset Type: Symptoms before age 10.
  • Adolescent-onset Type: No symptoms before age 10.
  • Unspecified Onset: Insufficient information on symptom onset.

Characteristics of Limited Prosocial Emotions

  1. Lack of Remorse
    • No feelings of guilt after wrongdoing.
  2. Callousness
    • Unconcerned about the feelings of others.
  3. Unconcerned About Performance
    • Poor performance without concern or effort.
  4. Shallow Affect
    • Insincerity in emotional expression.

Severity Levels

  • Mild: Minor rule-breaking and conduct problems.
  • Moderate: Intermediate level of conduct leading to significant harm.
  • Severe: Considerable harm caused to others.

Personality Traits

  • Negative emotionality, poor self-control, irritability, temper outbursts often accompany conduct disorder.