Disruptive, Impulse-control and Conduct disorders

Question 1

Oppositional Defiant Disorder (ODD)

313.81 (F91.3)

Answer 1

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from 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, 4 children and adolescents, with adults
5. Often actively defies or refuses to comply with request from authority figures over the rules
6. Often deliberately annoys others
7. Often blames others for his/her mistakes or misbehavior

Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months

Note: The persistence of frequency of these behavior should be used to distinguish a behavior that is within normal limits from behavior that is symptomatic. For children younger than 5 years, the behavior should occur most days for period of at least 6 months unless otherwise noted (criterion A8). For kids 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 defiant symptoms, other factor should also be considered such as whether the frequency and intensity of the behaviors are outside read as normal for the individual’s developmental level, gender, culture
B. The disturbance in behaviors associated with distress in the individual or others in his or her immediate social context 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

Question 2

Intermittent Explosive Disorder (IED)

312.34 (F63.81)

Answer 2

A. Recurrent behavioral outburst representing a failure to control aggressive impulses as manifested by either of the following:
1. Verbal aggression (temper tantrums, verbal arguments/fights) or physical aggression towards property, animals or other individuals, occurring twice weekly on average for 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. 3 behavioral outburst 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 versus grossly out of proportion to the provocation or to any precipitating psychosocial stressors
C. The recurrent aggressive outbursts are not premeditated and are not committed to achieve some tangible objective
D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning or associated with financial or legal consequences
E. Chronological age is at least 6 years (or equivalent developmental level)
F. Recurrent aggressive outbursts are not better explained by another mental disorder and are not attributed to another medical condition or to the physiological effects of a substance. For children ages 6-18, aggressive behavior that occurs as part of adjustment disorder should not be considered for the diagnosis
Note: Can be made in addition to ADHD, conduct disorder, ODD, autism spectrum disorder when recurrent impulsive and aggressive outburst are in excess of those usually seen in these disorders and warrant independent clinical attention

Question 3

Conduct disorder

Answer 3

A. Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate sociateal norms or rules are violated, as manifested by the presence of at least 3 of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to people and animals

1. Often bullies, threatens, oriented based others
2. Often initiates physical fights
3. Has used a weapon that can cause serious physical harm to others
4. Has been physically cruel to people
5. Has been physically cruel to animals
6. Has stolen while confronting a victim
7. Has forced someone into sexual activity

Destruction of property

8. Has deliberately engaged in fire-setting within the intention of causing serious damage
9. Has deliberately destroyed others’ property

Deceitfulness or theft

10. Has broken into someone else’s house, building, car
11. Often lies to obtain goods/favors or avoid obligations
12. Has stolen items of nontrivial value without confronting a victim

Serious violation of rules

13. Often stays out at night despite parental prohibitions, beginning before age 13
14. Has run away 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 13

B. The disturbance in behavior causes clinically significant impairment and social, academic, occupational function
C. If the individual is 18 years or older, criteria not met for antisocial personality disorder

Question 4

Conduct disorder specifiers

Answer 4

Specify whether:
Childhood onset type 312.81 (F91.1)
Adolescent onset type 312.82 (F91.2)
Unspecified onset 312.89 (F91.9)

Specify if:
With limited prosocial emotions: To qualify, the individual must have displayed at least 2 of the following characteristics persistently over at least 12 months in an multiple relationship/settings
1.  Lack of remorse or guilt
2.  Callous (lack of empathy)
3.  Am concerned about performance
4.  Shallow or deficient affect

Question 5

Pyromania

312.33 (F63.1)

Answer 5

A. Deliberate and purposeful fire-setting on more than one occasion
B. Tension or affective arousable before the act
C. Fascination with, interesting, curiosity about, attraction to fire and its situational context
D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath
E. The fire-setting is not done for monetary gain, as an expression of socialpolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment
F. The setting is not been explained by conduct disorder, manic episode, antisocial personality disorder

Question 6

Kleptomania

312.32 (F63.3)

Answer 6

A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for monetary value
B. Increasing sense of tension immediately before committing the act
C. Pleasure, gratification, or relief at the time of committing at act
D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination
D. This time is not been explained by conduct disorder, manic episode, or antisocial personality disorder

Question 7

Other specified disruptive, impulse control, and conduct disorder
312.89 (F91.8)

Answer 7

This category applies to presentations in which symptoms characteristic of disruptive, impulse control and conduct disorder that caused clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the disruptive, impulse control and conduct disorders diagnostic class. The other specified categories use in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for a specific disorder. This is done by recording a specific reason (i.e. “recurrent behavioral outburst of insufficient frequency”).

Question 8

Unspecified disruptive, impulse control, and conduct disorder
312.9 (F91.9)

Answer 8

This category applies to presentations in which symptoms characteristic of disruptive, impulse control and conduct disorder that caused clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the disruptive, impulse control and conduct disorders diagnostic class. The unspecified categorie is used in situations in which the clinician chooses not to communicate the specific reason that the presentation does not meet the criteria for a specific disorder and includes presentations in which there is insufficient information to make a more specific diagnosis (ED)