Disruptive Behavior Disorder

Disruptive behavior disorders are a group of disorders typically diagnosed in children. They primarily involve behavioral symptoms that disrupt other people, usually stemming from difficulty with self-control and impulse regulation.

Symptoms can range from having trouble following rules and obeying authority figures to displaying aggression and harming others. Disruptive behavior disorders can greatly impact children’s daily lives, making it challenging for them to form healthy relationships and succeed academically. They can also affect those around them, such as family members and peers.

Types of Disruptive Behavior Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists seven disruptive behavior disorders, which it refers to as “disruptive, impulse-control, and conduct disorders.” These include the following:^[1]

• Oppositional defiant disorder is characterized by a persistent, frequent pattern of argumentative or defiant behavior, vindictiveness, and an angry or irritable mood.
• Intermittent explosive disorder, which features frequent angry outbursts that typically last 30 minutes or less.
• Conduct disorder, in which individuals display a lack of respect for human rights, rules, and societal norms.
• Pyromania, involving multiple instances of deliberate fire-setting.
• Kleptomania, involving multiple instances of stealing unneeded items.
• Other specified disruptive, impulse-control, and conduct disorder, which is diagnosed when an individual has disruptive behavior disorder symptoms but doesn’t fully meet diagnostic criteria, and the clinician specifies why the individual doesn’t qualify for a specific diagnosis.
• Unspecified disruptive, impulse-control, and conduct disorder, which is similar to the diagnosis listed above, but the clinician does not specify the reason why the individual doesn’t qualify for a specific diagnosis.

This article will focus on the two most common types of disruptive behavior disorders, oppositional defiant disorder, and conduct disorder, as well as their behavioral symptoms, potential causes, diagnostic processes, and treatment options.

Signs and Symptoms of Disruptive Behavior Disorders

What disruptive behavior disorders have in common is that their symptoms disrupt others. Many mental health disorders involve symptoms that are expressed inwardly. Depression, for example, primarily impacts the person experiencing it rather than those around them. Disruptive behavior disorders frequently involve an infringement on other people’s rights and well-being.

Oppositional Defiant Disorder Symptoms

Below are several symptoms of oppositional defiant disorder (ODD):^[1][2]

• Frequent arguments with adults and authority figures.
• Temper tantrums that exceed the norm for the child’s age.
• Refusal to comply with requests from authority figures.
• Persistently questioning and/or refusing to follow rules.
• Vengeful behavior.
• Behavior meant to upset or irritate others.
• Lack of accountability for misbehavior; blaming others for mistakes.
• Frequent irritation with others.

Most children will occasionally display some of these symptoms. The frequency and intensity of these behaviors, combined with the number of settings in which they occur, determine whether a child qualifies for an ODD diagnosis.

There are also conversations happening among professionals right now about overdiagnosis of ODD in marginalized populations. It’s thought that cultural differences and systematic trauma can lead to more emotional dysregulation and, therefore, oppositional behavior in children. Then, clinician bias leads them to attribute it to ODD instead of potentially PTSD.

Conduct Disorder Symptoms

Conduct disorder (CD) is considered more severe than ODD. Symptoms of conduct disorder fall into four categories: aggressive conduct that threatens or causes harm to people or animals, nonaggressive conduct causing property damage or loss, theft or deceitfulness, and serious rule violations. Below are several examples of these types of behavior:^[1][2]

• Chronic lying without guilt.
• Aggressive behavior toward others (for example, threatening, intimidating, sexually assaulting, or bullying peers).
• Stealing and/or destroying property (vandalization, fire-setting, etc.).
• Substance misuse.
• Inability to tolerate rules, restrictions, and frustration.
• Use of weapons.
• Mistreating or harming animals.
• Physically fighting and/or attacking others.
• Repeatedly breaking curfew, running away, and/or being truant before age 13.

Behaviors associated with conduct disorder are characterized by a lack of respect for others’ rights and emotions, and parents need to take them seriously. Involving mental health professionals (and the authorities if violent threats or acts have occurred) can be crucial.

Causes of Disruptive Behavior Disorders

The specific causes of oppositional defiant disorder and conduct disorder haven’t yet been identified, but certain genetic and environmental risk factors may influence their development. Factors like inconsistent or permissive parenting, childhood neglect, low tolerance for frustration, strong will, and high levels of emotional reactivity may predispose a child to ODD.

Meanwhile, risk factors for conduct disorder include exposure to abuse during childhood, unstable upbringing, and harsh parenting styles. Parental criminal activity and/or substance use, maternal substance use during pregnancy, low birth weight, and poverty can also play a role. Those with conduct disorder often have family members with conditions like substance use disorder, schizophrenia, mood disorders, and antisocial personality disorder.^[2][3]

How Do Disruptive Behavior Disorders Affect Daily Life?

In general, disruptive behavior disorders involve behavior that disrupts others, from refusing to follow rules and listen to authority figures to constantly arguing with and deliberately annoying others. On the extreme end of the spectrum, children with conduct disorder can be aggressive, harming others, or otherwise violating their rights. These types of behavior can lead to interpersonal and educational struggles.

Children with disruptive behavior disorders may have difficulty relating to parents, siblings, teachers, and peers healthily. These children may have trouble fitting in at school, instigate conflict with their peers, and fail to meet academic expectations. They may purposely disrupt the classroom and bully others, which can lead to frequent disciplinary action. The parents and siblings of those with disruptive behavior disorders may become frustrated with the child’s behavior and experience familial strain.

Conduct disorder, in particular, is associated with the early onset of sexual behavior, reckless behavior, and alcohol, tobacco, and illegal substance use. Some young people with conduct disorder enter into the juvenile justice system.^[1]

Diagnosing Disruptive Behavior Disorders

There are notable differences between oppositional defiant disorder and conduct disorder, and their diagnostic processes tend to differ as well. While both involve in-depth psychiatric assessments, clinicians look for different criteria for each disorder.

Diagnosing Oppositional Defiant Disorder

Part of the diagnostic process for ODD is evaluating where the behaviors or symptoms take place. Mild ODD occurs in one setting (typically the home), moderate in two settings, and severe in three or more settings. Symptoms must be seen in interactions with people other than the child’s siblings, as the behaviors associated with ODD are very common among young people brought up in the same home.^[1]

Because all children tend to display some symptoms of ODD, multiple criteria must be met for an official diagnosis. A child must display at least four symptoms within the previous six months. These symptoms must exceed what is considered normal among other children of the same age, gender, and culture.^[1]

One challenge in diagnosing ODD is that most children with the disorder don’t view themselves as defiant or oppositional. Instead, they see their behavior as a reasonable response to unreasonable demands placed on them by authority figures. It can be difficult for clinicians to determine whether the child’s behavior is the result of harsh parenting, or if parents developed a harsh parenting style in response to the child’s oppositional behavior.^[1]

Clinicians must also perform a differential diagnosis, confirming that oppositional defiant disorder matches a child’s symptoms better than the following:^[1]

• Conduct disorder.
• Attention-deficit/hyperactivity disorder (ADHD).
• Depression.
• Bipolar disorder.
• Social anxiety disorder.
• Intermittent explosive disorder.
• Intellectual developmental disorder.
• Language disorder.
• Post-traumatic stress disorder (PTSD).

Diagnosing Conduct Disorder

Conduct disorder can be separated into childhood-onset, adolescent-onset, and unspecified-onset types. A specifier of “with limited prosocial emotions” is given to those who display callous and unemotional traits, thrill-seeking behavior, fearlessness, and insensitivity to punishment.^[1]

One of the biggest challenges in diagnosing conduct disorder is that individuals with the disorder aren’t always honest in their self-assessments. Reports from parents, teachers, and peers are often necessary to make an accurate diagnosis.

For an official CD diagnosis, individuals must display at least three symptoms over the past 12 months, and at least one symptom must be present in the last six months. The behaviors associated with conduct disorder must significantly impair the person’s academic, occupational, or social function.^[1]

The differential diagnosis for conduct disorder is similar to that of ODD. A licensed mental health professional must rule out the following disorders:^[1]

• Oppositional defiant disorder.
• ADHD.
• Depression.
• Bipolar disorder.
• Intermittent explosive disorder.
• Adjustment disorders.

Environmental Context and Gender

The DSM-5 notes that a diagnosis of conduct disorder may be mistakenly applied to those who live in settings where disruptive behavior patterns are viewed as normal, such as war zones or threatening high-crime areas. Clinicians must take their clients’ environmental context into account.

In addition, males and females with conduct disorder tend to display slightly different symptoms. Males tend toward physical aggression, stealing, fighting, vandalism, and school discipline problems, whereas females usually engage in more relational aggression, truancy, running away, lying, prostitution, and substance use.^[1]

Treating Disruptive Behavior Disorders

Oppositional defiant disorder is often effectively treated with parenting interventions. Teaching parents how to implement consistency into their child’s life, anticipate oppositional behavior, and manage outbursts can be very helpful. This, paired with teaching the child skills like identifying and managing their emotions, getting along with others, and making rational, thought-based decisions, often makes a significant difference.^[2]

In some cases, psychiatrists may prescribe medication for oppositional defiant disorder. However, this isn’t usually a standalone treatment method and should generally be used in conjunction with parenting interventions and emotion regulation skills training.^[4]

For both oppositional defiant disorder and conduct disorder, it can be crucial to treat any co-occurring mental health disorders, such as depression or anxiety. This normally involves mental health therapy, sometimes combined with medication.

Conduct disorder is most often treated with a combination of prescription medication and intensive psychotherapy. In some cases, residential treatment is recommended until the child’s behavior no longer poses harm to others.^[2]

Long-Term Outlook for Individuals with Disruptive Behavior Disorders

Many of those with disruptive behavior disorders who receive prompt treatment no longer qualify for a disruptive behavior disorder diagnosis later in life. Research suggests that approximately 70% of children diagnosed with ODD experience symptom resolution by the time they reach adulthood. However, those diagnosed with ODD have around a 90% chance of being diagnosed with a different mental health disorder during their lifetime.^[3]

A small percentage of those diagnosed with oppositional defiant disorder go on to develop conduct disorder, and a small percentage of those with conduct disorder go on to develop antisocial personality disorder as adults. However, most children diagnosed with conduct disorder experience symptom remission by the time they reach adulthood, similar to those with ODD.

Many children with conduct disorder go on to experience typical social and occupational function as adults, although they tend to be at higher risk of developing other mental health conditions throughout their lives.^[1]