Disruptive, Impulse Control & Conduct Disorders

What are different types of Disruptive, Impulse-Control and Conduct Disorders?

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 expand 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 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.

What is Conduct Disorder?

A diagnosis of “conduct disorder” is given to an individual with a repetitive and persistent pattern of behavior in which the basic rights of others or age-appropriate societal norms or rules are violated, as demonstrated by at least three of following criteria in the past 12 months, including one in the past 6 months:

  • Often bullies, threatens, or intimates 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.
  • Has deliberately engaged in fire setting with the intention of causing serious damage.
  • Has deliberately destroyed others’ property.
  • 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 trivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
  • Often stays out at night despite parental prohibitions, beginning before age 13.

The behavior causes significant impairment in social, academic, or occupational functioning. If the individual is 18 years or older, criteria are not met for antisocial personality disorder.

What are treatments for Conduct Disorder?

Treatment strategies for young children that focus on increasing social behavior and social competence are believed to reduce aggressive behavior. Studies show that cognitive behavioral therapy can result in significant reductions in conduct disorder symptoms in children and adolescents. Parental education is also important.

Pharmacotherapy may be helpful in treating aggression in youth associated with disruptive behavior disorders. Risperidone has proven effective for this purpose. Conduct disorder, including impulsivity and aggression, may occur in many childhood psychiatric disorders, ranging from ADHD to major depression to bipolar disorder and specific learning disorders. Mood disorders are often present in children who demonstrate irritability and aggressive behavior. Antipsychotics can decrease aggressive and assaultive behaviors in children with a variety of psychiatric disorders. Atypical antipsychotics, including risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify) are often effective and well tolerated. Selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are used to target symptoms of impulsivity, irritability, and mood swings, which frequently accompany conduct disorder.

What is Intermittent Explosive Disorder?

A diagnosis of “intermittent explosive disorder”is given to individuals at least 6 years old who have recurrent behavioral outbursts with a failure to control aggressive impulses shown 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. The behavior occurs at least twice weekly, on average, for a period of 3 months. They 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 outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. The aggressive outbursts are not premediated and are not committed to achieve some tangible objective (e.g., money, power, intimidation). The recurrent outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning,or are associated with financial or legal consequences. The behavior is not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma, Alzheimer’s disease) or to the physiological effects of a substance (e.g., a drug of abuse or medication). For children ages 6-18 years, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.

What are treatments for Intermittent Explosive Disorder?

A combination of pharmacotherapy and psychotherapy has the best chance of success in treating an individual with intermittent explosive disorder. Group psychotherapy and family therapy may also be helpful. A goal of therapy is to have the patient recognize and verbalize the thoughts or feelings that precede the explosive outbursts instead of acting them out.

Anticonvulsants have been used with mixed results in treating explosive patients. Lithium (Eskalith) has been reported useful in generally lessening aggressive behavior. Carbamazepine, valproate (Depakene) or divalproex (Depakote) and phenytoin (Dilantin) have also proven helpful. Selective serotonin reuptake inhibitors (SSRIs), trazodone (Desyrel), and buspirone (BuSpar) are useful in reducing impulsivity and aggression. Propranolol (Inderal) and other B-adrenergic receptor antagonists and calcium channel inhibitors have also been effective in some cases.

What is Pyromania?

A diagnosis of “pyromania” applies to a person who performs deliberate and purposeful fire setting on more than on occasion. In addition, the individual:

  • Experiences tension or affective arousal before the act.
  • Has a fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences)
  • Feels pleasure, gratification, or relief when setting fires or when witness 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 disability, substance intoxication).

What are treatments for Pyromania?

No single treatment has proven effective in treating pyromania. Because of the recurrent nature of pyromania, any treatment program should include supervision of the patient to prevent a repeated episode of fire setting. Incarceration may be the only method preventing a recurrence. Behavior therapy can then be administered in the institution.

Fire setting by children must be treated with the utmost seriousness. Intensive interventions should be undertaken when possible as therapeutic and preventive measures, not as punishment. In the case of children and adolescents, treatment should include family therapy.

Pyromania is often associated with substance abuse disorder (especially alcoholism), depressive or bipolar disorders, other impulse-control disorders, such as kleptomania in female fire setters, and Pyromania is often associated with substance abuse disorders (especially alcoholism), depressive or bipolar disorders, other impulse-control disorders, such as kleptomania in female fire setters, and various personality disturbances, such as inadequate and borderline personality disorders. Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities may be especially associated with childhood pyromania. Fire setters also tend to have a history of antisocial traits, such as truancy, running way from home, and delinquency. Co-existing conditions also need to be treated as appropriate.

What is Kleptomania?

A diagnosis of “kleptomania” is given to a person who repeatedly steals objects that are not needed for personal use or for their monetary value. The individual:

  • Experiences an increasing sense of tension immediately before committing the theft.
  • Feels pleasure, gratification, or relief at the time of committing the theft.
  • Does not steal to express anger or vengeance, or in response to a delusion or a hallucination.

The stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

What are treatments for Kleptomania?

Behavior therapy, including systematic desensitization and aversive conditioning, has proven successful in treating patients with kleptomania. Those who feel guilt and shame may be helped by insight-oriented psychotherapy. Pharmacotherapy may also be helpful. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and fluvoxamine (Luvox) appear to be effective in some patients. Case reports have also indicated successful treatment using tricyclic drugs, trazodone, lithium, valproate, and naltrexone.

What are the causes of Impulse-Control Disorders?

Psychological, social and biological factors all play a role in impulse-control disorders, which include intermittent explosive disorder, kleptomania, and pyromania.

Psychological factors often include psychic trauma from childhood, including exposure to violence in the home, abuse, alcohol abuse, promiscuity, and antisocial behavior. Impulsive behavior may be an attempt to master anxiety, guilt, depression, or an incomplete sense of self.

Research concerning biological factors associates violent and aggressive behavior with abnormal brain chemistry and certain hormones, especially testosterone. Individuals diagnosed with childhood attention-deficit hyperactivity disorder (ADHD) may have impulse-control disorder symptoms that continue into adulthood. In addition, lifelong or acquired mental deficiency, epilepsy, and even reversible brain syndromes have long been implicated in persons with impulse control problems.

In some cases, genetic factors may also play a role. First-degree relatives of patients with intermittent explosive disorder have higher rates of impulse-control disorders, depressive disorders, and substance use disorders.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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