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OPPOSITIONAL DEFIANT DISORDER
 



SYNOPSIS

Oppositional Defiant Disorder F91.3 - ICD10 Description, World Health Organization

Conduct disorder, usually occurring in younger children, primarily characterized by markedly defiant, disobedient, disruptive behaviour that does not include delinquent acts or the more extreme forms of aggressive or dissocial behaviour. The disorder requires that the overall criteria for F91 be met; even severely mischievous or naughty behaviour is not in itself sufficient for diagnosis. Caution should be employed before using this category, especially with older children, because clinically significant conduct disorder will usually be accompanied by dissocial or aggressive behaviour that goes beyond mere defiance, disobedience, or disruptiveness.

    F91 Conduct disorders
    Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred.
    Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire-setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.
Oppositional Defiant Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with oppositional defiant disorder needs to meet all of the following criteria:

  • 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

    • Often loses temper.

    • Is often touchy or easily annoyed.

    • Is often angry and resentful.

    • Argumentative/Defiant Behavior

    • Often argues with authority figures or, for children and adolescents, with adults.

    • Often actively defies or refuses to comply with requests from authority figures or with rules.

    • Often deliberately annoys others.

    • Often blames others for his or her mistakes or misbehavior.

    • Vindictiveness

    • 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. For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted. While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual's developmental level, gender, and culture.

  • 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.

  • 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.

Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures. This behavior typically starts by age 8, but it may start as early as the preschool years. The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities. Ten years after diagnosis, the majority of these children no longer have this disorder. If this disorder perisists and worsens, it develops into Conduct Disorder in adolescence, and Antisocial Personality Disorder in adulthood.

Effective Therapies

Parent training and developing the child's skills in tolerating frustration, being flexible, and avoiding emotional overreaction has proven to be effective.

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