Disruptive, Impulse-control Disorders, and conduct disorder

• Oppositional Defiant Disorder (ODD)


  • Angry irritable mood, argumentative/defiant behavior against authority figure for at least 6 months
  • Annoys others
  • Blames others for his/her mistakes
  • Precedes the development of conduct disorder
  • Conveys risk for the development of anxiety disorders and MDD
  • Increased risk for a number of problems in adjustment as adults
  • Less severe than CD and do not include aggression towards people, property (IED)
  • Co-morbid with ADHD
  • Diagnosis should not be made if the symptoms occur exclusively during the course of a mood disorder
  • If criteria for DMDD are met, then DMM is given even if all criteria for ODD are met
• Intermittent Explosive Disorder (IED)

  • Behavioral outburst, failure to control aggressive impulses
  • Verbal aggression, physical aggression twice weekly for a period of 3 months
  • At least 6 yrs of age
  • Quite common regardless of the presence of ADHD or other disruptive, impulse-control, and conduct disorders
  • Also should not be made in children and adolescents ages 6-18 years, when the impulsive aggressive outbursts occur in the context of an adjustment disorder
  • A diagnosis of DMDD can only be given when the onset of recurrent, problematic, impulsive aggressive outburst is before age of 10 years
  • A diagnosis of DMDD should be made for the first time after 18 years
  • Aggression in ODD is typically characterized by temper tantrums and verbal arguments with authority figures, whereas IED are in response to a broader array of provocation and include physical assault
• Conduct Disorder (CD)


  • Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
  • Often bullies, initiates fights, physically cruel, destroying properties, theft, serious violation of rules
  • Onset may occur as early as the preschool years, but the first significant symptoms usually emerge during the period from middle childhood through middle adolescence
  • ODD is the most common precursor to the childhood-onset type
  • Physically aggressive symptoms = childhood
  • Nonaggressive symptoms = adolescence
  • May be diagnosed in adults, though onset is rare after age 16 years
  • Childhood-onset type predicts a worse prognosis and an increased risk of criminal behavior in adulthood
  • When criteria for both ODD and CD are met, both diagnoses can be given
  • When criteria for both ADHD and CD are met, both diagnoses can be given
  • Individuals with conduct disorder will display substantial levels of aggressive or nonaggressive conduct problems during periods in which there is no mood disturbance, either historically or concurrently
  • If criteria for both IED and CD has been met, the diagnosis of IED should be given only when the recurrent impulsive aggressive outbursts warrant independent clinical attention
  • CD is diagnosed only when the conduct problems represent a repetitive and persistent pattern that is associated with impairment in social, academic, or occupational functioning
• Pyromania


  • Purposeful fire setting on more than one occasion
  • Arousal before the act
  • Fascination to fire and its situational context
  • Not done for monetary gain or etc.
  • Separate diagnosis is not given when fire setting occurs as part of CD, manic episode, or antisocial personality disorder
• Kleptomania


  • Failure to resist impulses to steal objects that are not need for personal use
  • Increase tension before committing the theft
  • Pleasure after committing the theft