NCM 116 – Care of Clients with Maladaptive SEM 02
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 23: DISRUPTIVE BEHAVIOR DISORDERS
TOPIC OUTLINE more intense in this setting than settings outside the
I. Introduction home.
II. Oppositional Defiant Disorder
III. Intermittent Explosive Disorder
IV. Conduct Disorder
V. Nursing Management
INTRODUCTION
• Disruptive Behavior Disorders include problems
with the person’s ability to regulate his or her own
emotions or behaviors. They are characterized by
persistent patterns of behavior that involve anger,
hostility, and/or aggression toward people and
property.
• The primary disorders in this category include
Oppositional Defiant Disorder (ODD), Conduct • Children with ODD have limited abilities to make
Disorder, and Intermittent Explosive Disorder associations between their behavior and
(IED). It has been posited by some psychiatrists that consequences of behavior—both negative and
ODD and conduct disorder can be viewed on a positive, indicative of a reduced sensitivity to reward
continuum concept that would include antisocial and punishment. Therefore, learning appropriate
personality disorder. behavior and learning to refrain from inappropriate
• Others believe that ODD is a milder variant of conduct behavior are impaired. They also exhibit impaired
disorder. IED is viewed as an impulse control disorder, problem-solving abilities and deficiencies in attention,
but it is included in this discussion because it involves flexibility of thinking, and decision-making. All of these
aggression toward people and property. The age of problems are also present in children diagnosed with
onset for IED can occur after age 6, but is often conduct disorder —to an even greater degree.
diagnosed from adolescence to young adulthood
(Ramesh, Hassamai, & Moeller, 2017). TREATMENT
• Treatment for ODD is based on parent management
RELATED DISORDERS training models of behavioral interventions. These
• Kleptomania is characterized by impulsive, repetitive programs are based on the idea that ODD problem
theft of items not needed by the person, either for behaviors are learned and inadvertently reinforced in
personal use or monetary gain. Tension and anxiety the home and school. A hierarchy of problem
are high prior to the theft, and the person feels relief, behaviors is developed, and the most disruptive or
exhilaration, or gratification while committing the theft. problematic behaviors are targeted for intervention.
The item is often discarded after it is stolen. • Adolescent children benefit from interventions that
Kleptomania is more common in females and often use enhancement of personal strengths to improve
has negative legal, career, family, and social behavioral and social functioning. Older children may
consequences. also benefit from individual therapy in addition to the
• Pyromania is characterized by repeated, intentional behavioral program.
fire-setting. The person is fascinated about fire and • Psychosocial Interventions: Parent training, Group
feels pleasure or relief of tension while setting and Therapy, Anger Management.
watching the fires. There is neither any monetary gain • Cognitive-Behavioral Approaches
or revenge or other reason, such as concealing other • FDA has not approved any drugs for treatment;
crimes, nor is it associated with another major mental Divalproex Sodium (Depakote) - an antiseizure
disorder. Pyromania as a primary disorder is rare. reduces aggression.
Persons, if caught, become part of the legal rather
than mental health system. PROGNOSIS
• Prognosis for ODD varies by age of onset, symptom
OPPOSITIONAL DEFIANT DISORDER (ODD) severity, and the presence of comorbid psychiatric
• Oppositional Defiant Disorder (ODD) consists of an disorders. Early onset, more severe symptoms, and
enduring pattern of uncooperative, defiant, comorbid conditions are associated with poorer long-
disobedient, and hostile behavior toward authority term outcomes. Early onset is also associated with an
figures without major antisocial violations. A certain increased risk for developing conduct disorder.
level of oppositional behavior is common in children • Children with this disorder can develop conduct
and adolescents; indeed, it is almost expected at some disorder; some will be diagnosed with antisocial
phases such as 2 to 3 years of age and in early personality disorder as adults. ODD is often comorbid
adolescence. with other psychiatric disorders such as attention-
• ODD is diagnosed only when behaviors are more deficit/hyperactivity disorder (ADHD), anxiety, and/or
frequent and intense than in unaffected peers and mood disorders that need to be treated as well.
cause dysfunction in social, academic, or work
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 23: DISRUPTIVE BEHAVIOR DISORDERS
TOPIC OUTLINE more intense in this setting than settings outside the
I. Introduction home.
II. Oppositional Defiant Disorder
III. Intermittent Explosive Disorder
IV. Conduct Disorder
V. Nursing Management
INTRODUCTION
• Disruptive Behavior Disorders include problems
with the person’s ability to regulate his or her own
emotions or behaviors. They are characterized by
persistent patterns of behavior that involve anger,
hostility, and/or aggression toward people and
property.
• The primary disorders in this category include
Oppositional Defiant Disorder (ODD), Conduct • Children with ODD have limited abilities to make
Disorder, and Intermittent Explosive Disorder associations between their behavior and
(IED). It has been posited by some psychiatrists that consequences of behavior—both negative and
ODD and conduct disorder can be viewed on a positive, indicative of a reduced sensitivity to reward
continuum concept that would include antisocial and punishment. Therefore, learning appropriate
personality disorder. behavior and learning to refrain from inappropriate
• Others believe that ODD is a milder variant of conduct behavior are impaired. They also exhibit impaired
disorder. IED is viewed as an impulse control disorder, problem-solving abilities and deficiencies in attention,
but it is included in this discussion because it involves flexibility of thinking, and decision-making. All of these
aggression toward people and property. The age of problems are also present in children diagnosed with
onset for IED can occur after age 6, but is often conduct disorder —to an even greater degree.
diagnosed from adolescence to young adulthood
(Ramesh, Hassamai, & Moeller, 2017). TREATMENT
• Treatment for ODD is based on parent management
RELATED DISORDERS training models of behavioral interventions. These
• Kleptomania is characterized by impulsive, repetitive programs are based on the idea that ODD problem
theft of items not needed by the person, either for behaviors are learned and inadvertently reinforced in
personal use or monetary gain. Tension and anxiety the home and school. A hierarchy of problem
are high prior to the theft, and the person feels relief, behaviors is developed, and the most disruptive or
exhilaration, or gratification while committing the theft. problematic behaviors are targeted for intervention.
The item is often discarded after it is stolen. • Adolescent children benefit from interventions that
Kleptomania is more common in females and often use enhancement of personal strengths to improve
has negative legal, career, family, and social behavioral and social functioning. Older children may
consequences. also benefit from individual therapy in addition to the
• Pyromania is characterized by repeated, intentional behavioral program.
fire-setting. The person is fascinated about fire and • Psychosocial Interventions: Parent training, Group
feels pleasure or relief of tension while setting and Therapy, Anger Management.
watching the fires. There is neither any monetary gain • Cognitive-Behavioral Approaches
or revenge or other reason, such as concealing other • FDA has not approved any drugs for treatment;
crimes, nor is it associated with another major mental Divalproex Sodium (Depakote) - an antiseizure
disorder. Pyromania as a primary disorder is rare. reduces aggression.
Persons, if caught, become part of the legal rather
than mental health system. PROGNOSIS
• Prognosis for ODD varies by age of onset, symptom
OPPOSITIONAL DEFIANT DISORDER (ODD) severity, and the presence of comorbid psychiatric
• Oppositional Defiant Disorder (ODD) consists of an disorders. Early onset, more severe symptoms, and
enduring pattern of uncooperative, defiant, comorbid conditions are associated with poorer long-
disobedient, and hostile behavior toward authority term outcomes. Early onset is also associated with an
figures without major antisocial violations. A certain increased risk for developing conduct disorder.
level of oppositional behavior is common in children • Children with this disorder can develop conduct
and adolescents; indeed, it is almost expected at some disorder; some will be diagnosed with antisocial
phases such as 2 to 3 years of age and in early personality disorder as adults. ODD is often comorbid
adolescence. with other psychiatric disorders such as attention-
• ODD is diagnosed only when behaviors are more deficit/hyperactivity disorder (ADHD), anxiety, and/or
frequent and intense than in unaffected peers and mood disorders that need to be treated as well.
cause dysfunction in social, academic, or work
