assistance
Susan W. Gray
Psychopathology: A Competency-Based Assessment Model for Social Workers
Chapter 13
Disruptive, Impulse-Control, and Conduct Disorders
?are distinguished by problems in emotional and behavioral self-control and tend to have first onset in childhood or adolescence
The diagnosis is unique in that the individual?s problems are shown in behaviors that violate the rights of others (for example, aggression or destruction of property) and/or bring the person into conflict with societal norms or authority figures
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
2
Guidelines to Explore Cultural Influences on the Symptom Picture
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Assess lifestyle behaviors, expected standards or behavior, and everyday activities relevant for cultural adaptation and survival
Comprehend meanings, labels, and interpretations commonly used to describe a child?s behavior or emotional problems
Evaluate the cultural context of what, on the face of it, appears as illness behaviors to determine whether they essentially support DSM diagnostic criteria
Determine whether DSM diagnostic criteria are valid for the specific population to be assessed
Consider the child?s and the parents? (and significant others in the child?s life) threshold of stress and how they cope with the child?s behavioral problems
Recognize how the client perceives the practitioner?s social position
Be self-aware and pay full attention (avoid stereotypes) to the client?s cultural background
Oppositional Defiant Disorder (ODD)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Characterized as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior
Must show at least 4 symptoms from any of 3 categories;
Angry/irritable mood – frequent loss of temper, touchy or easily annoyed, or often angry and resentful
Argumentative /defiant behavior – arguing with adults or other authority figures, being noncompliant, annoying others, or blaming others for mistakes or misbehavior
Vindictiveness – spiteful or malicious at least twice within the past 6 months
Behaviors must cause some level of impairment in key areas of functioning such as interpersonal relationships or in school
Symptoms of ODD Continued
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
These behaviors can be seen on most days for at least 6 months for children under 5 years of age
For those who are 5 years of age and older, the behavior should occur at least once a week for at least 6 months
A psychotic, substance use, depressive, or bipolar disorder does not better explain the symptom picture
Severity ? mild, moderate to severe
The case of Jerry Sheppard illustrates ODD
Intermittent Explosive Disorder (IED)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature of IED is distinct episodes of failure to resist aggressive impulses that are evident in verbal aggression (such as temper tantrums, tirades, arguments) or physical aggression (fighting with others) and:
Seen in explosive outbursts wherein the person is unable to control his (or less often her) aggressive impulses
Happens about twice a week for at least 3 months
Person may be involved in more serious assaultive acts that may cause injury or destroy property (over the past year)
Are out of proportion to any provocation or precipitating stressor
Not premeditated
Causes distress
Seen in individuals as young as 6 years of age
And not better explained by another mental disorder
Refer to Tommy Lusk?s story
Conduct Disorder (CD)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature of CD is a consistent pattern of violating the rights of others or major age-appropriate societal norms or rules are violated ? tend to be seen before age 15 (Note: if 18 years or older, criteria not met for antisocial disorder)
Requires the presence of any 3 of the following 15 symptoms (from 4 major categories) for at least 12 months – one symptom present over the past 6 months:
Aggression to people and animals ? 7 symptoms
Destruction of property ? 3 symptoms
Deceitfulness or theft ? 3 symptoms
Serious violation of rules ? 3 symptoms
Causing social, occupational, or occupational impairment
Specifiers ? onset, severity, and ?with prosocial emotions?
Refer to the case of Norman Gibson showing CD
A Lesser Known Disorder – Pyromania
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature is the deliberate and purposeful setting of a fire on more than one occasion and experiences of :
Tension or emotional arousal before setting the fire
Fascination, interest, curiosity about or attraction to fire and its situational contexts
A sense of relief experienced when setting fires, witnessing its effects, or participating in its aftermath
No motivation for setting a fire
And not better explained by conduct disorder, a manic episode or antisocial personality disorder
The nonfiction book, Fire Lover: A True Story, features someone with pyromania
Another Lesser Known Disorder – Kleptomania
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Central feature distinguishing kleptomania – a rare disorder – is the individual?s inability to resist stealing something that has no personal use nor any monetary value and:
Experiences a sense of tension just before the theft
Feels a sense of relief or gratification at the time of the theft
Not done to express anger or vengeance or part of a delusion
Comparing the DSM-IV-TR Multiaxial System and the DSM-5
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Oppositional defiant disorder and conduct disorder were moved from the DSM-IV chapter ?Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence?
?
Intermittent explosive disorder, pyromania, and kleptomania were moved to this chapter from the DSM-IV chapter of ?Impulse-Control Disorders Not Otherwise Specified?
While antisocial personality disorder is listed in this chapter, it is further elaborated in the chapter on ?Personality Disorders?
Comparing the DSM-IV-TR Multiaxial System and the DSM-5
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness; the conduct disorder exclusion has been deleted; criteria were also changed with a note on frequency requirements; and specifiers are included for severity
For the most part, diagnostic criteria for conduct disorder remain unchanged from the DSM-IV but a specifier was added for individuals with limited ?prosocial? emotions
Individuals over the minimum of at least 6 years of age may be diagnosed with intermittent explosive disorder without outbursts of physical aggression that are not better explained by another mental disorder, attributed to a medical condition, or the effects of a substance; criteria were added for frequency
Susan W. Gray
Psychopathology: A Competency-Based Assessment Model for Social Workers
Chapter 13
Disruptive, Impulse-Control, and Conduct Disorders
?are distinguished by problems in emotional and behavioral self-control and tend to have first onset in childhood or adolescence
The diagnosis is unique in that the individual?s problems are shown in behaviors that violate the rights of others (for example, aggression or destruction of property) and/or bring the person into conflict with societal norms or authority figures
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
2
Guidelines to Explore Cultural Influences on the Symptom Picture
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Assess lifestyle behaviors, expected standards or behavior, and everyday activities relevant for cultural adaptation and survival
Comprehend meanings, labels, and interpretations commonly used to describe a child?s behavior or emotional problems
Evaluate the cultural context of what, on the face of it, appears as illness behaviors to determine whether they essentially support DSM diagnostic criteria
Determine whether DSM diagnostic criteria are valid for the specific population to be assessed
Consider the child?s and the parents? (and significant others in the child?s life) threshold of stress and how they cope with the child?s behavioral problems
Recognize how the client perceives the practitioner?s social position
Be self-aware and pay full attention (avoid stereotypes) to the client?s cultural background
Oppositional Defiant Disorder (ODD)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Characterized as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior
Must show at least 4 symptoms from any of 3 categories;
Angry/irritable mood – frequent loss of temper, touchy or easily annoyed, or often angry and resentful
Argumentative /defiant behavior – arguing with adults or other authority figures, being noncompliant, annoying others, or blaming others for mistakes or misbehavior
Vindictiveness – spiteful or malicious at least twice within the past 6 months
Behaviors must cause some level of impairment in key areas of functioning such as interpersonal relationships or in school
Symptoms of ODD Continued
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
These behaviors can be seen on most days for at least 6 months for children under 5 years of age
For those who are 5 years of age and older, the behavior should occur at least once a week for at least 6 months
A psychotic, substance use, depressive, or bipolar disorder does not better explain the symptom picture
Severity ? mild, moderate to severe
The case of Jerry Sheppard illustrates ODD
Intermittent Explosive Disorder (IED)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature of IED is distinct episodes of failure to resist aggressive impulses that are evident in verbal aggression (such as temper tantrums, tirades, arguments) or physical aggression (fighting with others) and:
Seen in explosive outbursts wherein the person is unable to control his (or less often her) aggressive impulses
Happens about twice a week for at least 3 months
Person may be involved in more serious assaultive acts that may cause injury or destroy property (over the past year)
Are out of proportion to any provocation or precipitating stressor
Not premeditated
Causes distress
Seen in individuals as young as 6 years of age
And not better explained by another mental disorder
Refer to Tommy Lusk?s story
Conduct Disorder (CD)
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature of CD is a consistent pattern of violating the rights of others or major age-appropriate societal norms or rules are violated ? tend to be seen before age 15 (Note: if 18 years or older, criteria not met for antisocial disorder)
Requires the presence of any 3 of the following 15 symptoms (from 4 major categories) for at least 12 months – one symptom present over the past 6 months:
Aggression to people and animals ? 7 symptoms
Destruction of property ? 3 symptoms
Deceitfulness or theft ? 3 symptoms
Serious violation of rules ? 3 symptoms
Causing social, occupational, or occupational impairment
Specifiers ? onset, severity, and ?with prosocial emotions?
Refer to the case of Norman Gibson showing CD
A Lesser Known Disorder – Pyromania
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Essential feature is the deliberate and purposeful setting of a fire on more than one occasion and experiences of :
Tension or emotional arousal before setting the fire
Fascination, interest, curiosity about or attraction to fire and its situational contexts
A sense of relief experienced when setting fires, witnessing its effects, or participating in its aftermath
No motivation for setting a fire
And not better explained by conduct disorder, a manic episode or antisocial personality disorder
The nonfiction book, Fire Lover: A True Story, features someone with pyromania
Another Lesser Known Disorder – Kleptomania
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Central feature distinguishing kleptomania – a rare disorder – is the individual?s inability to resist stealing something that has no personal use nor any monetary value and:
Experiences a sense of tension just before the theft
Feels a sense of relief or gratification at the time of the theft
Not done to express anger or vengeance or part of a delusion
Comparing the DSM-IV-TR Multiaxial System and the DSM-5
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Oppositional defiant disorder and conduct disorder were moved from the DSM-IV chapter ?Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence?
?
Intermittent explosive disorder, pyromania, and kleptomania were moved to this chapter from the DSM-IV chapter of ?Impulse-Control Disorders Not Otherwise Specified?
While antisocial personality disorder is listed in this chapter, it is further elaborated in the chapter on ?Personality Disorders?
Comparing the DSM-IV-TR Multiaxial System and the DSM-5
? Susan W. Gray ? Chapter 13 Disruptive, Impulse-Control, and Conduct Disorders
Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness; the conduct disorder exclusion has been deleted; criteria were also changed with a note on frequency requirements; and specifiers are included for severity
For the most part, diagnostic criteria for conduct disorder remain unchanged from the DSM-IV but a specifier was added for individuals with limited ?prosocial? emotions
Individuals over the minimum of at least 6 years of age may be diagnosed with intermittent explosive disorder without outbursts of physical aggression that are not better explained by another mental disorder, attributed to a medical condition, or the effects of a substance; criteria were added for frequency
