Skip to content

Disruptive, impulse control, and conduct disorders

Videos

Notes

Behavioral sciences

Psychological disorders

Mood disorders
Anxiety disorders
Obsessive-compulsive disorders
Stress-related disorders and abuse
Psychotic disorders
Cognitive and dissociative disorders
Eating disorders
Personality disorders
Somatoform and factitious disorders
Substance use disorders and drugs of abuse
Sleep disorders
Sexual dysfunction disorders
Pediatric disorders
Psychiatric emergencies
Psychological disorders review

Assessments
Disruptive, impulse control, and conduct disorders

Flashcards

0 / 5 complete

Questions

1 / 9 complete
High Yield Notes
6 pages
Flashcards

Disruptive, impulse control, and conduct disorders

5 flashcards
Questions

USMLE® Step 1 style questions USMLE

9 questions

USMLE® Step 2 style questions USMLE

8 questions
Preview

A 14-year-old boy comes to the office to be evaluated for his behavior. His neighbor recently called the police because he was seen setting fire to the toolshed in the backyard. The first time he was caught setting a fire was in his old house three years ago. His mother subsequently found a collection of lighters in a cabinet in his room. She says that lately, her son has been having a difficult time coping with the loss of his father who was killed on active duty a few months ago. Her son has since kept to himself, but is planning to be a volunteer firefighter when he becomes eligible. Which of the following disorders belongs to the same diagnostic category as this patient's most likely diagnosis?

External References
Transcript

The Diagnostic and Statistical Manual of Mental Disorders, the 5th edition, or DSM 5, has a relatively new category called “Disruptive, Impulse Control, and Conduct Disorders” or DIC for short, which were previously organized into different sections. This category includes a number of disorders like oppositional defiant disorder, conduct disorder, antisocial personality disorder, intermittent explosive disorder, as well as other impulse control disorders like the compulsive desire to start fires, or pyromania, and the compulsive desire to steal things, or kleptomania. The common thread that runs through all of these is that they all involve impulsive behaviors, or a lack of self-control. These disorders tend to start in childhood or adolescence, and persist into adulthood.

Oppositional defiant disorder, or ODD, is defined by defiant behavior that’s both persistent and willful, and can be thought of in terms of emotional, behavioral, and cognitive patterns. People with ODD have emotional dysregulation which can lead them to feel irritable and resentful towards others. These emotions can lead to behaviors like frequent arguments, angry outbursts, and refusing to go along with the requests of authority figures - like teachers. People with ODD might even deliberately annoy their family or friends, purposefully defying anyone who tries to control their behavior. Cognitively, these people often fall into a pattern of vindictiveness and spitefulness, believing that others are to blame for their own behaviors. In order to meet the criteria for ODD, these emotional, behavioral, and cognitive patterns must be ongoing for at least 6 months, and must interfere with family, school, and other social interactions.

Conduct disorder has a lot of overlap with oppositional defiant disorder with one key additional feature - aggressive behavior towards people and animals. For example, people with conduct disorder might violently destroy property, steal things, or hurt pets, causing grief and frustration for those around them. These are considered antisocial behaviors because they completely break the boundaries of social norms. There are two main types of conduct disorder, childhood-onset type, where the abnormal behaviors start before the age of ten and adolescent-onset type, which starts between age ten and age 18. Typically the earlier the symptoms, the more severe the behavioral problems.

Alright, so next, there’s antisocial personality disorder—and this is where people disregard moral values and societal norms, have little empathy, and poor impulse control. This combination makes them willing to hurt others if it helps them, making them prone to aggressive and unlawful behavior, at times earning the label sociopath or psychopath. In fact, individuals with this disorder tend to be overrepresented in prison populations and have higher rates of substance use. These people typically fail to show remorse or guilt and rarely accept responsibility for any of the harm that they cause others. That said, they can be superficially charming and often use that to manipulate others for their personal gain. To be diagnosed with this disorder, individuals must be over 18 years old and have a history of conduct disorder. Interestingly, this disorder fits into two categories, and can also be found in the personality disorders section of the DSM-5.

While there is certainly a relationship between oppositional defiant disorder, conduct disorder, and antisocial personality disorder, it is important to note that not all individuals with oppositional defiant disorder will go on to develop conduct disorder, and not all individuals with conduct disorder will go on to develop antisocial personality disorder.

Alright, another disorder is intermittent explosive disorder, or IED. IED is characterized by recurrent explosive outbursts of intense anger and violence, sometimes causing injury to themselves or others. These outbursts are usually brief and not premeditated, can appear in response to any real or perceived provocation, and are almost always out of proportion to the situation. To diagnose IED, an individual has to be over six years old to distinguish these from temper tantrums, and must have these outbursts twice a week for at least three months, or have three outbursts in a year that result in physical injury or property damage.

Sources
  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  3. "Impulse-Control Disorders in Gilles de la Tourette Syndrome" The Journal of Neuropsychiatry and Clinical Neurosciences (2012)
  4. "S.14.04 Impulse control disorder: prevalence and possible risk factors" European Neuropsychopharmacology (2009)
  5. "Epidemiologic and clinical updates on impulse control disorders: a critical review" European Archives of Psychiatry and Clinical Neuroscience (2006)
  6. "Harrison’s principles of internal medicine" McGraw Hill Education/ Medical (2018)
  7. "Diagnostic and Statistical Manual of Mental Disorders: DSM-5" American Psychiatric Association (2013)