DISRUPTIVE

DISORDERS

Dr. Amna Aurooj

Disruptive, impulse-control, and
conduct disorders
Disruptive, impulse-control, and conduct disorders include conditions
involving problems in the self-control of emotions and behaviors. While
other disorders in DSM5 may also involve problems in emotional and/or
behavioral regulation, the disorders in this chapter are unique in that these
problems are manifested in behaviors that violate the rights of
others (e.g., aggression, destruction of property) and/or that bring the
individual into significant conflict with societal norms or authority
figures.
Oppositional Defiant Disorder
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
(revenge) lasting at least 6 months as evidenced by at least four symptoms, and
exhibited during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
• Often loses temper.
• Is often touchy or easily annoyed.
• Is often angry and resentful.
Argumentative/Defiant Behavior
• Often argues with authority figures or, for children and adolescents, with adults.
• Often actively defies or refuses to comply with requests from authority figures or with
rules.
• Often deliberately annoys others.
• Often blames others for his or her mistakes or misbehavior.
Oppositional Defiant Disorder
Vindictiveness
• Has been spiteful or vindictive at least twice within the past 6 months.
Note. For children younger than 5 years, the behavior should occur on
most days for a period of at least 6 months. For individuals 5 years or
older, the behavior should occur at least once per week for at least 6
months, the frequency and intensity of the behaviors are outside a range
that is normative for the individual’s developmental level, gender, and
culture.
• Specify current severity:
• Mild: Symptoms are confined to only one setting (e.g., at home, at
school, at work, with peers).
• Moderate: Some symptoms are present in at least two settings.
• Severe: Some symptoms are present in three or more settings.
Factors
• Temperamental factors related to problems in emotional regulation
(e.g., high levels of emotional reactivity, poor frustration tolerance) have
been predictive of the disorder.
• Children with oppositional defiant disorder influence their
environments, which in turn can influence them. For example, harsh,
inconsistent, or neglectful child-rearing practices predict increases in
symptoms, and oppositional symptoms predict increases in harsh and
inconsistent parenting.
• A number of neurobiological markers (e.g., lower heart rate and skin
conductance reactivity; reduced basal cortisol reactivity; abnormalities in
the prefrontal cortex and amygdala) have been associated with
oppositional defiant disorder.
Intermittent Explosive Disorder
• Recurrent behavioral outbursts representing a failure to control aggressive
impulses as manifested by either of the following:
• Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights)
or physical aggression toward property, animals, or other individuals, occurring
twice weekly, on average, for a period of 3 months. The physical aggression
does not result in damage or destruction of property and does not result
in physical injury to animals or other individuals.
• Three 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.
• The magnitude of aggressiveness expressed during the recurrent outbursts is
grossly out of proportion to the provocation or to any precipitating
psychosocial stressors.
• The recurrent aggressive outbursts are not premeditated (i.e., they are
impulsive and/or anger-based) and are not committed to achieve some tangible
objective (e.g., money, power, intimidation).
• Chronological age is at least 6 years (or equivalent developmental level).
Conduct Disorder
• A repetitive and persistent pattern of behavior in which the basic rights of others
or major age-appropriate societal norms or rules are violated, by the presence of
at least 3 of the following 15 criteria in the past 12 months, with at least one
criterion present in the past 6 months:
Aggression to People and Animals
• Often bullies, threatens, or intimidates others.
• Often initiates physical fights.
• Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick,
broken bottle, knife, gun).
• Has been physically cruel to people.
• Has been physically cruel to animals.
• Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed
robbery).
• Has forced someone into sexual activity.
Destruction of Property
Conduct Disorder
Destruction of Property
• Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
• Has broken into someone else’s house, building, or car.
• Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
• Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting,
but without breaking and entering; forgery).
Serious Violations of Rules
• Often stays out at night despite parental prohibitions, beginning before age 13
years.
• Has run away from home overnight at least twice while living in the parental or
parental surrogate home, or once without returning for a lengthy period.
• Is often truant from school, beginning before age 13 years.
• If the individual is age 18 years or older, criteria are not met for antisocial
Subtypes
• Childhood-onset type: Individuals show at least one symptom
characteristic of conduct disorder prior to age 10 years.
• Adolescent-onset type: Individuals show no symptom characteristic
of conduct disorder prior to age 10 years.
• Unspecified onset: Criteria for a diagnosis of conduct disorder are met,
but there is not enough information available to determine whether
the onset of the first symptom was before or after age 10 years.
Specifiers
•Mild: Few if any conduct problems in
With limited prosocial emotions: an excess of those required to make the
individual must have displayed at least two of diagnosis are present, and conduct
the following characteristics persistently over problems cause relatively minor harm
at least 12 months and in multiple to others (e.g., lying, truancy, staying
relationships and settings. out after dark without permission,
• Lack of remorse or guilt: Does not feel bad other rule breaking).
or guilty when do something wrong (exclude • Moderate: The number of conduct
remorse when expressed only when caught problems and the effect on others are
and/or facing punishment). intermediate between those specified
• Callous, lack of empathy: Disregards and in “mild” and those in “severe” (e.g.,
is unconcerned about the feelings of others. stealing without confronting a victim,
vandalism).
• Unconcerned about performance: Does
• Severe: Many conduct problems in
not show concern about poor/problematic
performance. excess of those required to make the
diagnosis are present, or conduct
• Shallow or deficient affect: Does not problems cause considerable harm to
express feelings or show emotions to others, others (e.g., forced sex, physical
 PYROMANIA
• Deliberate and purposeful fire setting on more than one occasion.
• Tension or affective arousal before the act.
• Fascination with, interest in, curiosity about, or attraction to fire and its
situational contexts (e.g., paraphernalia, uses, consequences).
• Pleasure, gratification, or relief when setting fires or when witnessing
or participating in their aftermath.
• The fire setting is 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 (e.g., in major neurocognitive
disorder, intellectual developmental disorder [intellectual disability], substance
intoxication).
• The fire setting is not better explained by conduct disorder, a manic episode,
or antisocial personality disorder.
KLEPTOMANIA
A. Recurrent failure to resist impulses to steal objects that are not
needed for personal use or for their monetary value.
B. Increasing sense of tension immediately before committing the
theft.
C. Pleasure, gratification, or relief at the time of committing the theft.
D. The stealing is not committed to express anger or vengeance and
is not in response to a delusion or a hallucination.
E. The stealing is not better explained by conduct disorder, a manic
episode, or antisocial personality disorder.