Disruptive, Impulse control and conduct disorders (DIAMOND- KID ONLY) Flashcards
Intermittent Explosive Disorder
A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following:
1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.
2. Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.
B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.
C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g.,
money, power, intimidation).
D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences.
E. Chronological age is at least 6 years (or equivalent developmental level).
F. The recurrent aggressive outbursts are not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation
disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma, Alz-
heimer’s disease) or to the physiological effects of a substance (e.g., a drug of abuse, a medication). For children ages 6-18 years, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.
Note: This diagnosis can be made in addition to the diagnosis of attention-deficit/hyper-
activity disorder, conduct disorder, oppositional defiant disorder, orautism spectrum dis-
order when recurrent impulsive aggressive outbursts are in excess of those usually seen
in these disorders and warrant independent clinical attention.
Oppositional Defiant Disorder
A. Apattern of angry/irratable mood, argumentable/defiant behavior, or vindictivness lasting at least 6 moths as evidenced by at least four symptoms fom any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
Angry/irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. 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 onmost days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the
behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). 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.
B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context(e.g., family, peergroup,work colleagues),or it impacts negatively on social, educational, occupational, or other important areas of functioning.
C. 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.
Specify current severity:
Mlid: Symptoms areconfined to only onesetting (e.g., at home, at school, atwork, with
peers).
Conduct Disorder
A. Arepetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence
of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past6 months:
Aggression to People and Animais
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
7. Has forced someone into sexual activity.
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage.
9. Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
10. Has broken into someone else’s house, building, or car.
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
14. Has runaway from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13years.
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.
Specify whether:
312.81 (F91.1) Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior toage 10 years.
312.82 (F91.2) Adolescent-onset type: Individuals show nosymptom characteristic of conduct disorder prior to age 10 years.
312.89 (F91.9) Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of
the first symptom was before or after age 10years.
With limited prosocia lemotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and
in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional
occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to
consider reports by others who have known the individual forextended periods of time (e.g., parents, teachers, co-workers, extended family members, peers).
Lack of remorse or guilt: Does not fee! bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing
punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful
after hurting someone or does not care about the consequences of breaking rules.
Callous- lack of empathy
Disregards and is unconcerned about the feelings of
others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than
their effects on others, even when they result in substantial harm to others.
Unconcerned about performance: Does not show concern about poor/problematic performance at school, at work, or inother important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance.
Shallow or deficient affect:
Does not express feelings or show emotions to others,
except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off’ quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others).
Specify current severity:
Mild: Few if any conduct problems in excess of those required to make the diagnosis
are present, and conduct problems cause relatively minor harm to others (e.g., lying,
truancy, staying out after dark without permission, other rule breaking).
Moderate: The number of conduct problems and the effect on others are intermediate
between those specified in “mild” and those in “severe” (e.g., stealing without confront-
ing a victim, vandalism).
Severe: Many conduct problems in excess of those required tomake the diagnosis are
Present, or conduct problems causeconsiderableharm to others (e.g., forced sex, physical
cruelty, use ofa weapon,stealing while confronting a victim, breakingandentering).
