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ODD, Intermittent Explosive Disorder, and Conduct Disorder
Terms in this set (26)
What are the diagnostic criteria for Oppositional Defiant Disorder (ODD)?
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from any of the below categories, and exhibited during interaction with at least 1 individual who is not a sibling.
1. Angry/irritable mood
2. Argumentative/defiant behavior
NOTE: The persistence and frequency of the symptoms should exceed what is normative for an individual's age, gender, and culture. For 5yrs and younger, the behavior should occur on most days for a period of at least 6 months. For 5 yrs or older, the behavior should occur at least 1x per week for at least 6 months.
B. The disturbance in behavior is associated with distress in the individual or others in their immediate social context, or it impacts negatively on social, educational, occupational, or other important areas of functioning
C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. ALSO, the criteria are NOT met for disruptive mood dysregulation disorder (DMDD).
What symptoms lie under angry/irritable mood for ODD?
a. often loses temper
b. is often touchy or easily annoyed
c. is often angry and resentful
What symptoms lie under argumentative/defiant behavior for ODD?
a. often argues with authority figures, or for minors, with adults
b. often actively defies or refuses to comply with requests from authority figures or with rules
c. often deliberately annoys others
d. often blames others for their own mistakes or misbehavior
What symptom lies under vindictiveness for ODD?
a. has been spiteful or vindictive at least 2x within the past 6 months
What do the severity specifiers mean for ODD?
- mild: symptoms are confined to only 1 setting
- moderate: some symptoms are present in at least 2 settings
- severe: some symptoms are present in at least 3 settings
What is the prevalence rate of ODD?
- avg prevalence estimate is 3.3%
- rate of ODD may vary depending on the age and gender of the child
- disorder seems to be more prevalent in males than in females prior to adolescence (1.4 : 1)
What is the typical age of onset for ODD?
- first symptoms of ODD usually appear during the preschool years and rarely later than early adolescence
What are some risk and prognostic factors for ODD?
- temperamental factors related to problems in emotional regulation have been predictive of ODD
- harsh, inconsistent, or neglectful child-rearing practices are common in families of children and adolescents with ODD
- a # of neurobiological markers (like low HR, reduced basal cortisol reactivity) have been associated with ODD
What conditions tend to be comorbid with ODD?
- often precedes CD (more common in children with the childhood-onset subtype)
- anxiety disorders
- substance use disorders
What are the diagnostic criteria for Intermittent Explosive Disorder?
A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following
1. Verbal aggression or physical aggression toward property, animals, or other individuals, occurring 2x 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.
2. 3 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.
B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.
C. The recurrent aggressive outbursts are not premeditated and are not committed to achieve some tangible objective (e.g., money, power, intimidation)
D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences
E. Chronological age is at least 6 years
F. The recurrent aggressive outbursts are not better explained by another mental disorder and are not attributable to another medical condition or the physiological effects of a substance. For children ages 6-18 yrs, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.
NOTE: diagnosis should NOT be given to ppl with DMDD
What is the prevalence rate for Intermittent Explosive Disorder?
- more prevalent among younger individuals and in individuals with a high school education or less
What is the typical age of onset for Intermittent Explosive Disorder?
onset is most common in late childhood or adolescence, and rarely begins for the first time after age 40
What are some risk and prognostic factors for Intermittent Explosive Disorder?
- history of physical and emotional trauma during the first 2 decades of life
- genetic influence/heritability
- abnormalities in the limbic system
- greater amygdala responses to anger stimuli
What conditions tend to be comorbid with Intermittent Explosive Disorder?
- depressive disorders
- anxiety disorders
- substance use disorders
- antisocial personality disorder, borderline personality disorder
- disorders with disruptive behaviors (e.g., ADHD)
What are the diagnostic criteria for Conduct Disorder (CD)?
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least 3 of 15 criteria in the past 12 months from any of the categories below, with at least 1 criterion present in the past 6 months
1. Aggression to People and Animals
2. Destruction of Property
3. Deceitfulness or Theft
4. Serious Violations of Rules
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning
C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder
What criteria are listed under Aggression to People and Animals for CD?
1. Often bullies, threatens, or intimidates others
2. Often initiates physical fights
3. Has used a weapon that can cause serious physical harm to others
4. Has been physically cruel to people
5. Has been physically cruel to animals
6. Has stolen while confronting a victim
7. Has forced someone into sexual activity
What criteria are listed under Destruction of Property for CD?
1. Has deliberately engaged in fire setting with the intention of causing serious damage
2. Has deliberately destroyed others' property (other than by fire setting)
What criteria are listed under Deceitfulness or Theft for CD?
1. Has broken into someone else's house, building, or car
2. Often lies to obtain goods or favors or to avoid obligations
3. Has stolen items of nontrivial value without confronting a victim
What criteria are listed under Serious Violations of Rules for CD?
1. Often stays out at night despite parental prohibitions, beginning before age 13 years
2. Has run away from home overnight at least 2x while living in the parental or parental surrogate home, or once without returning for a lengthy period
3. Is often truant from school, beginning before age 13 years
What are the specifiers for CD?
- child-onset type: if at least 1 symptom of CD is shown before age 10
- adolescent-onset type: if no symptoms of CD are shown until after age 10
- unspecified onset: criteria for a diagnosis of CD are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10
- with limited prosocial emotions: must have displayed 2 of the following characteristics persistently over at least 12 months and in multiple relationships and settings, multiple information sources are necessary (lack of remorse or guilt; callous - lack of empathy; unconcerned about performance; shallow or deficient affect)
- mild severity: few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others
- moderate severity: the # of conduct problems and the effect on others are intermediate
- severe severity: many conduct problems in excess of those required to make the diagnosis are present or conduct problems cause considerable harm to others
What does are the 4 characteristics under the "with limited prosocial emotions" specifier for CD?
- lack of remorse or guilt: does no feel bad or guilty when they do something wrong (exclude re3morse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of their actions
- callous - lack of empathy: disregards and is unconcerned about the feelings of others. Described as cold and uncaring. Appears more concerned about the effects of their actions on themself, rather than the effects on others, even when they result in substantial harm to others
- unconcerned about performance: does not show concern about poor/problematic performance at school, at work, or in other important activities. does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for their own poor performance
- shallow or deficient affect: does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial or when emotional expressions are used for gain
What is the prevalence rate for CD?
- between 2-10%
- prevalence rates rise from childhood to adolescence
- rates are higher among males
What is the development and course for CD?
- onset may occur as early as preschool, but first significant symptoms usually emerge during middle childhood through middle adolescence
- ODD common precursor to childhood-onset CD
- onset rare after age 16
- course of CD after onset is variable
- for majority, CD remits by adulthood
- many with CD (mainly those with adolescent-onset and with few and midler symptoms) achieve adequate social and occupational adjustments as adults
- early-onset predicts worse prognosis and increased risk of criminal behavior, CD, and substance-related disorders in adulthood
- at risk for later mood, anxiety, PTSD, impulse-control, psychotic, somatic symptom, and substance-related disorders as adults
- symptoms vary with age as they develop increased physical strength, cognitive abilities, and sexual maturity
- symptom behaviors that emerge first tend to be less serious and vice versa
What are some risk and prognostic factors for CD?
- temperamental risk factors include a difficult undercontrolled infant temperament and lower-than-average intelligence
- family-level risk factors: parental rejection and neglect; inconsistent child-rearing practices; harsh discipline; physical or sexual abuse; lack of supervision; early institutional living; frequent changes of caregivers; large family size; parental criminality; certain kind of familial psychopathology
- community-level risk factors: peer rejection; association with a delinquent peer group; neighborhood exposure to violence
- genetic factors: heritability, family having CD, family with other mental disorders, slower HR, reduced autonomic fear conditioning, structural and functional differences in brain areas associated with affect regulation and affect processing
- persistence is more likelyt for individuals with behaviors that meet criteria for the childhood-onset type and with limited prosocial behavior specifier (also if they have ADHD and/or substance abuse)
What are some gender-related diagnostic issues for CD?
- males with CD frequently exhibit fighting, stealing, vandalism, and school discipline problems/ tend to exhibit both physical and relational aggression
- females with CD more likely to exhibit lying, truancy, running away, substance use, and prostitution/ tend to exhibit more relational aggression
What conditions tend to be comorbid with CD?
- exhibit features of antisocial personality disorder
- specific learning disorder, anxiety disorders, depressive or bipolar disorders, substance-related disorders
- lower academic achievement
- maybe communication disorder
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