AssessmentsDisruptive, impulse control, and conduct disorders
Disruptive, impulse control, and conduct disorders
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
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?
The DSM-5 has a relatively new category called “Disruptive, Impulse Control, and Conduct Disorders”, or DIC for short; previously, these three categories were organized in different sections.
Brought together, 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 such as pyromania (the compulsive desire to start fires) and kleptomania (the compulsive desire to steal things).
The common thread running through all of these disorders is that they all involve impulsive behaviors, or a lack of self-control.
These disorders tend to begin in childhood or adolescence, and persist into adulthood.
Oppositional defiant disorder, or ODD, is defined by defiant behavior that is both persistent and willful, and can be thought of in terms of emotional, behavioral, and cognitive patterns.
Individuals with ODD have emotion dysregulation which can lead feelings of irritation and resentment towards others, which can further lead on to frequent arguments, angry outbursts, and the refusal to comply with the requests of authority figures like teachers.
Individuals with ODD might even deliberately annoy their family and friends, purposefully defying anyone who tries to control their behavior.
Cognitively, these individuals 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 behaviour towards people and animals.
For example, individuals with conduct disorder might violently destroy property, steal things, or inflicting deliberate harm on pets, causing grief and frustration to 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 begin before the age of 10, and adolescent-onset type, which starts between age 10 and age 18.
Typically, the earlier the symptoms, the more severe the behavioral problems.
Okay, onto antisocial personality disorder.
People with antisocial personality disorder disregard moral values and societal norms, have little empathy, and demonstrate 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.
Individuals with this disorder tend to be overrepresented in prison populations and have higher rates of substance use.
These individuals 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 personal gain.