Disruptive, impulse control, and conduct disorders

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Disruptive, impulse control, and conduct disorders

Psychological disorders

Psychological disorders

Psychological disorders


Disruptive, impulse control, and conduct disorders


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USMLE® Step 1 questions

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Disruptive, impulse control, and conduct disorders

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USMLE® Step 1 style questions USMLE

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A 9-year-old girl is brought to the pediatrician’s office by her parents for evaluation of irritability. The patient has been having 3-4 temper tantrums each week, which consist of breaking small objects and throwing books and papers around for 30 minutes. The parents describe the inciting event as typically something small such as “being unable to operate the TV remote control.” Additionally, the patient has a baseline irritable mood most days of the week, and as a result, her teachers and classmates have found it difficult to engage with her. Past medical history is noncontributory. Vitals and physical examination are within normal limits. Which of the following is the most likely diagnosis?  

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Cognitive behavioral therapy (CBT) p. 580

conduct disorder p. 580

oppositional defiant disorder p. 580

Conduct disorder p. 580

early onset disorder p. 588

Oppositional defiant disorder p. 580


conduct disorder p. 580

oppositional defiant disorder p. 580


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.


  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)

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