Title 17 AbPsy - Disruptive, Impulse-Control, and Conduct Disorders.pdf ✅

17 – Disruptive, Impulse-Control, and Conduct Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Oppositional Defiant Disorder 2. Intermittent Explosive Disorder 3. Conduct Disorder 4. Pyromania 5. Kleptomania OPPOSITIONAL DEFIANT DISORDER DEFINING OPPOSITIONAL DEFIANT DISORDER Disruptive, Impulse-Control, and Conduct Disorders – include conditions involving problems in the self-control of emotions and behaviors ● Manifested in behaviors that violate the rights of others and/or ● Other disorders bring the individual into significant conflict with societal norms or authority figures ● Conduct Disorder: focus largely on poorly controlled behaviors that violate the rights of others or that violate major societal norms ● Conduct disorder cannot be diagnosed without prior diagnosis of ODD ● Intermittent Explosive Disorder: focus largely on poorly controlled emotion, outbursts of anger that are disproportionate ● Tend to be more common in males than in females ● First onset is in childhood or adolescence ● Characterized by disinhibition and (inversely) constraint and, to a lesser extent, negative emotionality Oppositional Defiant Disorder – recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months ● Symptoms of oppositional defiant disorder may be confined to only one setting, and this is most frequently the home ● They often justify their behavior as a response to unreasonable demands or circumstances ● Usually begins by the age of 8 and has a lifetime prevalence of 10 percent ● Prospective studies have found a developmental sequence from ODD to conduct disorder ○ All cases of conduct disorder are preceded developmentally by ODD ○ Not all children with ODD go on to develop conduct disorder within a 3-year period DIAGNOSTIC CRITERIA A. 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/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), 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. Specify current severity: Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings. CAUSES / RISK FACTORS Genetic and Physiological Risks ● Antisocial behavior in the parents ● Overlapping neural correlates Environmental Risks ● Family discord 1 | @studywithky

● Twin studies have demonstrated a substantial genetic influence for impulsive aggression DIAGNOSTIC ISSUES Culture ● Greater in males than in females DIFFERENTIAL DIAGNOSIS AND COMORBIDITY ● A diagnosis of IED should not be made when Criteria A1 and/ or A2 are only met during an episode of another mental disorder ● It also should not be made when the impulsive aggressive outbursts occur in the context of an adjustment disorder Disruptive Mood Dysregulation Disorder ● A diagnosis of DMDD can only be given when the onset of recurrent, problematic, impulsive aggressive outbursts is before age 10 years ● DMDD should not be made for the first time after age 18 years TREATMENT ● Cognitive-behavioral interventions ● Approaches modeled after drug treatments CONDUCT DISORDER DEFINING CONDUCT DISORDER Conduct Disorder – persistent, repetitive violation of rules and a disregard for the rights of others ● Has a median age of onset of 12 years and a lifetime prevalence of 10 percent ● Childhood-Onset Type: onset of at least one criterion characteristic of CD prior to age 10 years ● Adolescent-Onset Type: absence of any criteria characteristic of CD prior to age 10 years ● With a Callous-Unemotional Presentation: reduced emotional responsiveness to others’ distress, low sensitivity to punishment cues, and impairment in empathic concerns ● Many children with conduct disorder become juvenile offenders and tend to become involved with drugs ● Many adults with antisocial personality disorder or psychopathy had conduct disorder as children ● Children with conduct disorder may become adults with antisocial personality disorder DIAGNOSTIC CRITERIA 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 three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months Aggression to People and Animals 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 (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). Deceitfulness or Theft 10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. 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. CAUSAL FACTORS IN ODD AND CD Self-Perpetuating Cycle ● A genetic predisposition leading to low verbal intelligence, mild neuropsychological problems, and difficult temperament can set the stage for early-onset CD ● The child’s difficult temperament may lead to an insecure attachment ● Low verbal intelligence and mild neuropsychological deficits may cause a lifelong course of difficulties 3 | @studywithky