Disruptive, Impulse-Control, and Conduct Disorders

Disorders in this category are a combination of different disorders that characterized by the presence of difficult, disruptive, aggressive, or antisocial behavior. These behaviours are often associated with physical or verbal injury to self, others, or objects or with violating the rights of others. They can appear in several forms and can be defensive, premedi­tated, or impulsive in nature.

 

  1. Oppositional Defiant Disorder (ODD)

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness (the three different subtypes in DSM 5) lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited when interacting with at least one individual who is not a sibling.

 

ODD is being viewed as precursor for conduct disorder.

No two people with oppositional defiant disorder acting in the exact same manner.

 

Major symptoms of ODD are as follows:

Loss temper, argues with adults, actively defies or refuses to comply with requests or rules, deliberately annoyed people, blames others for his or her mistakes or misbehaviour, touchy or easily annoyed by others, angry or resentful, and spiteful or vindictive.

Case Example:

Sam, an eight-year old boy, is described by his teachers and parents as an easily angry child. He argues with those adults whom he perceives as having authority over him. Sam is purposefully defiant, and he will do anything to stand his ground even when his behaviours are so obviously unacceptable to others. When he makes mistakes, he either blames others or he will harbour revengeful thoughts against others.

 

  1. Conduct disorder (CD)

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Conduct disorder and antisocial personality disorder are closely associated together because of presenting symptomology. Individuals having this disorder often show a lack of remorse or guilt, callous, lack of empathy, unconcerned about performance, shallow or deficient affect.

 

Aggression to People and Animals

  1. Often bullies, threatens, or intimidates others.
  2. Often initiates physical fights.
  3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  4. Has been physically cruel to people.
  5. Has been physically cruel to animals.
  6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery
  7. Has forced someone into sexual activity.

 

Destruction of Property

  1. Has deliberately engaged in fire setting with the intention of causing serious damage.
  2. Has deliberately destroyed others’ property (other than by fire setting).Deceitfulness or Theft
  3. Has broken into someone else’s house, building, or car.
  4. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
  5. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

 

Serious Violations of Rules

  1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or has once without returning for a lengthy period.
  3. Is often truant from school, beginning before age 13.

Case Example:

Peter, an eleven-year old boy, was raised by his grandmother since he was three years old. He was removed from her mother’s custody because of neglect. Peter has never met his father. He was an average student, and his teachers did not observe any unusual behaviours from him until he started grade three. Peter was described by his teachers as increasingly aggressive, and he showed more inappropriate behaviors in school, at home and in the community. Peter’s performance in school deteriorated rapidly, and he is currently prohibited from entering any of the schools in the district where he lives. Peter has assault, break-and-enter and fire-setting charges pending against him. He is now under house-arrest. His grandmother is very concerned about what she can do to help her grandson.

 

  1. Intermittent Explosive disorder (IED)

Intermittent explosive disorder (IED) is characterized by recurrent, problematic, impulsive aggression. Individuals having this disorder may also suffer from mood disorders, anxiety disorders, personality disorders and substance abuse disorders. A significant percentage of individuals with IED may have a history of childhood trauma.

In DSM-5, diagnostic criteria for Intermittent Explosive Disorder are as follows:

Failure to control aggressive impulse that leads to behavioral outbursts, as manifested by either:

Verbal aggression (temper tantrums, tirades, arguments, or fights) or physical aggression directed toward property, animal or other individuals that does not result in physical damage or injury, with outbursts occurring on average at least twice weekly for three months.

Or physical assaults that damage property or injure animals or other people, occurring at least three times in a 12-month period.

Aggressive behavior grossly out of proportion to the provocation or precipitating psychosocial stressors

Behavior outbursts are not premeditated (either  impulsive or anger-based) and are not committed to achieve some tangible objective (such as money, power, intimidation)

Case Example:

Paul, a thirty-year old man, is known to fly-off the handle easily. He is recently separated from his wife. Paul has difficulty with being challenged. For this reason, he changes jobs very frequently, and his behaviours pushed his friends and family from him. A month ago, he was lining up on the ‘merchandise for return’ counter. A sales manager was trying to be helpful and came up to Paul, and he asked Paul what he was returning. The conversation seemed going well until Paul was asked for the receipt. When Paul handed over the receipt to the sales manager, the latter appeared to have some difficulty with finding the item that was corresponding to the product Paul was returning. Just at this point, Paul went into an outburst that was unexpected. When the sales manager tried to understand what he might have triggered Paul’s anger, Paul became very verbally aggressive toward this manager despite of having children and women in the surrounding area that are showing signs of fear of his behaviours.

 


DISCLAIMER: Description of each of the mental issue is intended for a quick reference only. You are advised not to use it for self-diagnosis. If you have concerns about your mental health conditions, you are advised to seek medical advice from your family doctor or from a psychiatrist. If you already have a confirmed diagnosis of a mental health issue and you are considering counselling as an alternative treatment, you are encouraged not to stop taking medications without discussing and consulting with your family doctor or psychiatrist. Please also mention to your medical professionals about seeking counselling if you can.