Diagnoses for disruptive, impulse-control, and conduct disorders include:

• Oppositional Defiant Disorder (associated with childhood)
• Conduct Disorder (associated with childhood)
• Intermittent Explosive Disorder
• Kleptomania
• Pyromania

Each of these disorders is characterized by the inability to resist an intense impulse, drive, or temptation to perform a particular act that is harmful to oneself and/or others. Shameful secretiveness about the repeated impulsive activity frequently expands to pervade the individual’s entire life, often significantly delaying treatment.

In addition to the disorders listed above, a diagnosis of “other specified” or “unspecified” disruptive, impulse-control, or conduct disorder may be given to an individual who shows some symptoms of one of these behavioral disorders but not enough to meet the full criteria for any single disorder.

What is Oppositional Defiant Disorder?

“Oppositional defiant disorder” is a pattern or an angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four of the following symptoms, and demonstrated during interaction with at least one individual who is not a sibling:

• Often loses temper.
• Is often touchy or easily annoyed.
• Is often angry or resentful.
• 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.
• Has been spiteful or vindictive at least twice within the past 6 months.

For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months to qualify as an oppositional defiant disorder. For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months. The behavior is associated with distress in the individual or others in his or her immediate social environment (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. In addition, the behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder.

What are treatments for Oppositional Defiant Disorder?

The primary treatment for oppositional defiant disorder in children is family education. The goal is to reinforce more prosocial behaviors in the child while diminishing undesired behaviors. Children with oppositional defiant disorder may also benefit from individual psychotherapy in which they role-play and practice more appropriate responses. In the therapeutic relationship, the child can learn new strategies to develop a sense of mastery and success in social situations with family members and peers. Often, self-esteem must be restored before a child with oppositional defiant disorder can make more positive responses. Also, parent-child conflict strongly predicts conduct problems. Patterns of harsh physical and verbal punishment particularly evoke aggression in children. Replacing harsh, punitive parenting and increasing positive parent-child interactions may positively influence the course of oppositional and defiant behaviors.