Disruptive, Impulse Control And Conduct Disorders Flashcards
What are the characteristics of disruptive, impulse-control and conduct disorders?
These disorders involve problems with self-control:
- emotions(anger)
- specific actions (e.g., setting fires, stealing) that relieve internal tension
-self control problems violate rights/societal Norns and/or causes conflict with societal norms or authority figures
What should be considered before diagnosing a disruptive, impulse control and conduct disorder(DICCDs)?
Before diagnosing a disorder, consider the frequency, persistence, pervasiveness across situations, and functional impairment relative to normative standards
Cam symptoms of DICCDs be in normally developing individuals ?
Symptoms of these disorders can occur to a lesser degree in normally developing individuals (e.g., oppositional behavior )
What are the diagnostic criteria of Opposition Defiant Disorder (ODD)?
Atleast 6 months of the following types of behaviors
- Angry/irritable mood (often loses temper, easily annoyed, resentful) - Argumentative/defiant behavior (often argues/refuses to comply with authority, deliberately annoys) - vindictiveness
Behaviors do NOT result in a serious violation of the rights of others
What are the diagnostic criteria of Conduct Disorder?
Repeated, serious violation of rights/societal norms
3 or more of the following symptoms occurring in or across any of the categories:
- Aggressive conduct: bullies, uses weapons, cruelty to people/animals, rape, stolen with confrontation
- Deliberate property destruction: by fire or other means
- Deceit or theft: broken in, lies, stolen without confronting
- Serious violation of rules: breaking curfew, running away, truancy
What are the sub-types of Conduct disorder?
Childhood-Onset type (before age 10)
- Usually boys
- Characterized by aggressive conduct
- Often have a history of ODD and are at higher risk of ASPD
Adolescent-Onset type(age 10 or older)
- Less of a bias towards boys
- Characterized by serious violation of rules(not aggressive conduct)
CD can be diagnosed in an adult if ASPD criteria are not met
What are the descriptive features of ODD and CD?
- typically male
- Behaviors worsen with familiar people
- Poor insight into problem and Minimizes involvement or responsibility
- Low self-esteem and interpersonal problems (and legal problems with Conduct disorder)
- ADHD and learning disorders
Give the etiology of ODD and Conduct disorder
Multi-factorial causes, possibly including:
- Part of a child’s constitutional temperament
- Childs overuse of “acting out”
- Child learns behavior via negative reinforcement of misconduct
- Living in a dysfunctional family (disorder typically found in a low socioeconomic family with inconsistent/harsh parenting )
How can ODD and Conduct disorder (CD) be treated?
Psychotherapy
- Train parents in behavior management techniques
- Teach appropriate anger expression and communication skills (both parents and child)
- In severe cases, child may be placed in an in-patient residential program for appropriate structure, therapy, and supervision
Contrast ASPD and Conduct Disorder
ASPD vs CD
- ASPD has an age requirement (18 years and above); CD doesn’t have an age requirement
- ASPD symptoms must start before age 15; CD doesn’t have an age of onset requirement
ASPD is co-listed under…
a DICCDs chapter and personality disorders chapter
What is the outcome ODD/CD?
Some mature out of these behaviors but often these behaviors are antecedents to serious societal violations (i.e., escalation from ODD-CD-ASPD)
Note:
- ODD and CD can occur independently and be diagnosed at any age
- CD doesn’t always develop into ASPD
- ASPD requires a history of CD (even if not diagnosed )
- outcome depends on several factors (e.g., the family’s response to the behavior’s, psychiatric co-morbidity)
What is the diagnostic criteria of Intermittent Explosive disorder?
Recurrent outbursts representing a failure to control aggressive impulses as manifested by either:
- Verbal aggression (e,g., tirades) or non-damaging physical aggression occurring frequently
- Damaging physical aggression occurring frequently
Aggression is:
- Grossly disproportionate to stressor
- Impulsive and/or anger-based (not instrumental)
- Not explained by other causes/disorders
Give the typical description of IED acts
- described as brief “spells”
- Precipitated by feeling frustrated
- Usually self-reproach afterwards
- Social, occupational, legal consequences
Explain ASPD and conduct disorder differentials
- CD and ASPD are characterized by habitual, pervasive and instrumental (for a purpose, not merely impulsive) antisocial behavior
- Those with IED are usually not aggressive between episodes and do not violate rights in-between explosive episodes
Explain Adjustment disorder with disturbance of conduct (violation of rules) differential
- Disturbed conduct begins after a causal external psychosocial stressor (not just being frustrated)
- Patient’s behaviors cannot be explained by another disorder such as CD or ASPD
Explain the differentials of DMDD
- severe temper outbursts disproportional to stressor but with irritable baseline mood
- Conceptualize DMDD as severe ODD patient
Nite: ODD is not diagnosed if DMDD fits
What are the diagnostic criteria of Kleptomania?
- Recurrent irresistible of unneeded objects
- Increasing tension before thieving
- Pleasure, gratification, or relief when thieving
- No other cause or motivating factor
Give the typical description of Kleptomania acts
- Theft of items typically of little value
- Unplanned and unassisted
- Items are hoarded, given away, or returned
What is the kleptomania differential?
“Ordinary” shoplifting (planned; often assisted; item is the goal, not the action itself
What is the diagnostic criteria of Pyromania ?
- Multiple episodes of deliberate fire setting
- with preceding tension or emotional arousal
- Fascination with fire and fire paraphernalia
- Pleasure, gratification, or relief when setting fire, witnessing/participating in the aftermath
- No other cause or motivating factor
What is the differential of Pyromania?
Arson: assess motivation for setting fire and whether true fascination with fire exists
What are the biochemical correlates of impulsivity (anger/action-based impulsivity) ?
- decreased serotonin associated with poor impulse control
- Imcreased dopamine associated with rewarding sensation during impulsive act
How can impulsivity be treated?
- Behavioral therapy
- Avoid or re-condition triggers
- Adversion therapy
- Exposure and response prevention
- Support groups: goals are to widen support system and provide an external impulse control through a buddy system
- Medications many types of medications have been tried (e.g., SSRIs) with variable succes
