Oppositional Defiant Disorder

Excerpt

Oppositional defiant disorder is a type of disruptive behavior disorder that primarily involves difficulties with managing emotions and behaviors. This condition is most often diagnosed and treated in childhood, but it may also be detected in adults. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), oppositional defiant disorder is diagnosed when an individual exhibits at least four symptoms across any category, frequently, and with people other than siblings. The categories and their associated symptoms are as follows:

1. Angry/irritable mood

2. 1. Frequent temper loss

   2. Touchy or easily annoyed

   3. Angry and resentful

1. Argumentative/defiant behavior

2. 1. Regularly arguing with authority figures, such as teachers and employers

   2. Defying or refusing requests or rules

   3. Deliberately annoying others

   4. Blaming others for their behavior

1. Vindictiveness

2. 1. Spiteful or vindictive behavior 2 or more times within 6 months

These behaviors need to be normed for the individual's level of development. The DSM-5-TR provides the following guidance for diagnosing the behavior as pathological:

1. For patients younger than 5, the behavior must occur more than 50% of the time within 6 months.

2. For individuals 5 or older, the behavior must be displayed once a week or more for 6 months.

Additional criteria that establish the behavior as substantively problematic and primary include the following:

1. The behaviors cause significant distress in social contexts, such as family, school, or work, or negatively impact functioning.

2. The behavior does not exclusively occur in conjunction with another mental health condition, such as substance use or mood disorders.

The severity of oppositional defiant disorder is determined by the number of settings in which the symptoms occur:

1. Mild: 1 setting

2. Moderate: 2 settings

3. Severe: 3 or more settings

No further specifiers are included in DSM-5-TR. However, the International Classification of Disease, 11th Revision (ICD-11) adds the specifiers with chronic irritability-anger and without chronic irritability-anger. For all disruptive behavioral disorders, specifiers for either limited or typical prosocial behavior are suggested.