Summary DISRUPTIVE DISORDER DSM-5

Disruptive, Impulse-Control, and Conduct Disorders

 Disruptive, impulse-control, and conduct disorders involve much more critical and constant
behaviors than typical, temporary episodes of most children and adolescents.
 They belong to a group of disorders that involve oppositional defiant disorder, intermittent
explosive disorder, conduct disorder, antisocial personality disorder, pyromania, and
kleptomania.
 These disorders can cause individuals to behave violently or aggressively toward others or
property.
 They may have problems controlling and managing their sentiments, emotions, and behavior
and may violate rules or laws.

Description
1. Oppositional defiant disorder (ODD)
 A childhood mental health disorder that includes frequent and persistent pattern of
anger, irritability, arguing, defiance or vindictiveness toward a person and other
authority figures.
2. Intermittent explosive disorder (IED)
 A disorder that involves repeated, unforeseen episodes of impulsive, destructive, violent
behavior or angry verbal outbursts in which the person react grossly out of proportion
to the situation.
3. Conduct disorder (CD)
 This disorder is characterized by persistent antisocial behavior in children and
adolescents that significantly impairs their ability to function in social, academic, or
occupational areas.
 People with conduct disorder have little empathy for others; they have low self-esteem,
poor frustration tolerance, and temper outbursts.
 Conduct disorder frequently is associated with early onset of sexual behavior, drinking,
smoking, use of illegal substances, and other reckless or risky behaviors.
4. Antisocial personality disorder (ASPD or APD)
 A mental condition in which a person has a long-term pattern of manipulating, abusing,
or violating the rights of others without any guilt.
5. Pyromania
 A disorder that is characterized by an impulse to set fires.
 The definition focused on the recurrent failure to resist impulses to set fire in persons
who were not psychotic, cognitively impaired, or antisocial.
6. Kleptomania
 A rare but serious mental health disorder that involves recurrent inability to resist urges
to steal items that the person generally doesn’t really need and that usually have little
value

Statistics and Incidences
 Conduct disorder occurs between two and 10 percent of the population, with a median
prevalence rate of 4 percent. Prevalence rates increase from childhood to adolescence and are
higher in males than in females.
 Oppositional defiant disorder occurs between one and 11 percent of the population, though the
average prevalence estimate is around 3.3 percent.
 It may be more prevalent in males, with a ratio of approximately 1.4:1 prior to adolescence.
 This prevalence does not consistently continue into adolescence or adulthood.
 Intermittent explosive disorder occurs in approximately 2.7 percent of the population and is
more prevalent among individuals younger than 35-40 years.
 The prevalence of kleptomania has been estimated at 0.3%–0.6% in the general population.

Causes
Researchers generally accept that genetic vulnerability, environmental adversity, and factors such as
poor coping interact to cause the disorder

, Genetics
 There is a genetic risk for conduct disorder, although no specific gene marker has been
identified; the disorder is more common in children who have a sibling with conduct disorder or
a parent with antisocial personality disorder, substance abuse, mood disorder, schizophrenia, or
ADHD.
Biologic
 A lack of reactivity of the autonomic nervous system has been found in children with conduct
disorder; this non-responsiveness is similar to adults with antisocial personality disorder.
 Medical and metabolic causes: encephalopathy, phenylketonuria, lead poisoning,
hyperthyroidism, fragile x-syndrome, Tourette’s syndrome, brain tumors or history of head
trauma.
 Teenagers with conduct disorders have been found to be exposed to cocaine in utero

Psychodynamic
 The child has failed to separate from mother and remains in the dependent position.
 Fears of abandonment nurture this dependency.
 The ego remains in an underdeveloped condition
Environmental
 Poor family functioning, marital discord, poor parenting, and a family history of substance abuse
and psychiatric problems are all associated with the development pf conduct disorder.
 Theories of family dynamics: contributing factors
o Poor parent-child interpersonal relationship
o Lack of father figure
o Parental rejection
o Lack of secure, permanent family group, as experienced by orphan or foster children
during institutional living.
o Failure to bond during infancy
o Incompatibility of the child’s and parents’ temperament
o Inconsistency in setting limits and disciplining a child by parents or authority figures.
o Large family size
o Association with lower socioeconomic class children, including exposure to ‘delinquent
groups.
o Parents with anti-social personality disorders and or alcohol dependence

Clinical Manifestations

Symptoms of oppositional defiant disorder include:
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6
months as evidenced by at least four symptoms from any of the following categories, and exhibited
during interaction with at least one individual who is not a sibling.
Angry and irritable mood
 Often loses temper.
 Is often touchy or easily annoyed.
 Is often angry and resentful.
Argumentative and 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.
Vindictiveness
 Has been spiteful or vindictive at least twice within the past 6 months.

Symptoms of intermittent explosive disorder
Occur twice weekly, on average, for a period of 3 months include:
 Verbal aggression

 Temper tantrums