Disruptive, impulse-control and conduct disorders refer to a group of disorders characterized by problematic behaviors involving emotions and self-regulation. The document discusses oppositional defiant disorder (ODD) in particular, outlining its symptoms, diagnostic criteria, epidemiology, risk factors, assessment tools and treatment. ODD involves a pattern of negativistic, defiant and hostile behaviors toward authority figures. The document provides details on diagnostic criteria from the DSM-IV and DSM-5, prevalence rates, common comorbidities, and tools used to assess and treat ODD such as questionnaires, interviews and parent management training programs.

1. NATIONAL UNIVERSITY OF MODERN LANGUAGES (NUML)
Subject: Psychodiagnosis 01
Presentation Topic: Disruptive ,impulse control and conduct disorders
Date of presentation: 8 May,2021
Submitted to: Mam Noureen Azad
Submitted by: Maham Zaib
ADCP evening, semester 01

2. DISRUPTIVE ,IMPULSE
CONTROLAND CONDUCT
DISORDERS

3. DEFINITION:
Disruptive, impulse-control and conduct disorders refer to a group of
disorders that include oppositional defiant disorder, conduct disorder,
intermittent explosive disorder, kleptomania and pyromania. These
disorders can cause people to behave angrily or aggressively toward
people or property. They may have difficulty controlling their
emotions and behavior and may break rules or laws.

4. DISRUPTIVE BEHAVIORS VS TYPICAL
BEHAVIORS
The angry, aggressive or disruptive behaviors of people with conduct and disruptive
disorders are more extreme than typical behaviors. The behaviors:
1) are frequent
2) are long lasting
3) occur across different situations
4) cause significant problems
Disruptive, impulse-control, and conduct disorders are characterized by disturbances in
behavioral and emotional self-regulation.

5. OPPOSITIONAL DEFIANT DISORDER
In children with oppositional defiant disorder (ODD), there is an
ongoing pattern of uncooperative, defiant, and hostile behavior
toward authority figures that seriously interferes with the child's day
to day functioning.

6. SYMPTOMS:
Symptoms of ODD may include:
o Frequent temper tantrums
o Excessive arguing with adults
o Often questioning rules
o Active defiance and refusal to comply with adult
requests and rules
o Deliberate attempts to annoy or upset people
o Blaming others for his or her mistakes or misbehavior
o Often being touchy or easily annoyed by others
o Frequent anger and resentment
o Mean and hateful talking when upset
o Spiteful attitude and revenge seeking

7. DIAGNOSTIC CRITERIA OF ODD
DSM IV
Disorder Class: Attention Deficit and
Disruptive Behavior Disorders
A. A pattern of negativistic; hostile,
and defiant behavior lasting at least 6
months, during which four (or more of
the following are present:
Often loses temper
• Often argues with adults
• Often actively defies or refuses to
comply with adults requests or rules
• Often deliberately annoys people
DSM 5
Disorder Class: Disruptive, Impulse-
Control, and Conduct Disorders
A. A pattern of angry/irritable mood,
argumentative/defiant behavior, or
vindictiveness lasting at least 6 months
as evidenced by at least four
symptoms 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 and annoyed
3. Is often angry and resentful

8. DIAGNOSTIC CRITERIA (CONT.)
• Often blames others for his or her mistakes
or misbehavior
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often vindictive
• 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.

9. DIAGNOSTIC CRITERIA (CONT.)
 B. The disturbance in behavior causes
clinically significant impairment in social,
academic, or occupational functioning.
 C. The behavior does not occur exclusively
during the course of a Psychiatric or Mood
Disorder.
 D. Criteria are not met for Conduct
Disorder, and, if the individual is age 18 or
older, criteria are not met for Antisocial
Personality Disorder
 B. The disturbance in behavior is
associated with distress in the individual
or others in his or her immediate social
context (e.g., family, peer group, work
colleagues) or it impacts negatively on
social, educational, occupational, or other
important areas of functioning.
 C. The behavior does 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.
 D. dropped

10. EPIDEMIOLOGY
Specify current severity:
Mild: Symptoms are confined to only one setting (e.g., at
home, at school, at work, with peers).
Moderate: Some symptoms are present in at least two
settings
Severe: Some symptoms are present in three or more
settings.
PREVALENCE
 Prevalence: 1-11% , with average prevalence estimate
of around 3.3%
 Boys > girls
 Symptoms decline after adolescence
 Rarely diagnosed in older children
 Estimates vary across countries
 Majority do not develop conduct disorder
 High rates of comorbidities

11. COMORBIDITY
 Rates of ODD are much higher in samples of children,
adolescents and adults with ADHD.
 ODD often precedes conduct disorder.
 Individual with ODD are also at increased risk of
anxiety disorders and MDD.
 Adolescents and adults with ODD also show higher rate
of substance use disorder.

12. RISK AND PROGNOSTIC FEATURES
Temperamental : factors related to emotional regulation
problems .
• High levels of emotional reactivity
• Poor frustration tolerance
• Different temperamental routes
Genetic and physiological:
• Gene-environment interplay
• Earlier age of onset of antisocial symptoms
• Callous and unemotional traits
Environment:
• Rejection by non-deviant peers
• Social and economic disadvantage
• Neighborhood violence
• Negative parenting
“Coercive family processes”

13. DIFFERENTIAL DIAGNOSIS OF ODD
• Phobias
• Other anxiety disorders
• Obsessive Compulsive Disorder
• ADHD
• Autism
• Depression
• ODD is common is disturbed families and where neglected
child rearing practices are common.
• Two most common co-occurring conditions with ODD are
ADHD and Conduct disorder
ASSOCIATED FEATURES

14. ASSESSMENT TOOLS
 Questionnaires
• Child Adolescent Disruptive Behavior
Inventory (CADBI)
• The Eyberg child behavior inventory (ECBI)
• The Child Behavior Checklist (CBCL)
• The Behavior Assessment for Children
(BASC-2)
• Conners Child Behavior Checklist
• Strengths and Difficulties Questionnaires
(SDQ)
 Semi-structured Interviews
• The Child ad Adolescent Psychiatric
Assessment
 Structured Interviews
• The Development and Wellbeing
assessment(DAWBA)
• The Diagnostic Interview Schedule for
Children (DISC)
 Observational Instrument
• The Disruptive Behavior Diagnostic
Observation Schedule

15. CADBI:
1) Total 25 items, a parent and teacher questionnaire to assess a range of problems.
2) Created by Julie Rusby
3) Age range mostly : 3-18 years
4) It is a screening and diagnostic tool
5) 3 subscales that assess; ODD, hyperactivity and inattention
6) 8-point Likert scale
ECBI:
1) Total 36-items measure, designed to assess and provides information about frequency and
severity of problem behaviors in children and adolescents.
2) Age range is 2-16 years
3) Two scales ; Intensity scale and Problem scale

16. CBCL:
1) Behavior Checklist (CBCL) is a checklist parents complete to detect The Child emotional and behavioural
problems in children and adolescents.
2) The CBCL is part of the Achenbach System of Empirically Based Assessment (ASEBA). There are two
other components of the ASEBA; the Teacher's Report Form (TRF) is to be completed by teachers and the
Youth Self-Report (YSR) by the child or adolescent.
3) The CBCL/6-18 is to be used with children aged 6 to 18.
4) It consists of 113 questions, scored on a three-point Likert scale.
5) The 2001 revision also added six DSM-oriented scales consistent with DSM diagnostic categories; affective
problems, anxiety problems, somatic problems, ADHD, oppositional defiant problems and conduct problems.

17. TREATMENT
 Identify and treat comorbidities
 Address modifiable risks
 Parent management training
• The Incredible Years
• Triple P (Positive Parenting Program)
 Alternative approaches
 School-based interventions
 Individual therapy (anger management)
 Medication

18. CONDUCT DISORDER
Conduct disorder (CD) is a psychological disorder
diagnosed in childhood or adolescence that presents
itself through a repetitive and persistent pattern of
behavior in which the basic rights of others, or
major age-appropriate norms, are violated.
 Symptoms:
 Intimidating or bullying others
 committing rape
 using a weapon
 Lying
 stealing
 Skipping school
 Run away from home

19. SUBTYPES OF CONDUCT DISORDER
Conduct Disorder is divided into three subtypes based on the age of onset of the disorder.
1) Unspecified – onset disorder : is designated when there is insufficient information to determine the
age of onset.
1) Childhood- onset conduct disorder:
• Usually in males
• Frequently display of physical aggression toward others
• Usually have symptoms that meet the full criteria for conduct disorder prior to puberty
• Individual with this subtype onset are more likely to have persistent conduct disorder into
adulthood as compared to adolescent –onset subtype.
3) Adolescent- onset subtype: less likely to display aggressive behaviors and tend to have more
normative peer relationships

20. DIAGNOSTIC CRITERIA
DSM-IV
 Disorder Class: Attention deficit and
disruptive behavior disorders
 A. A repetitive 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
three (or more) of the following criteria in the
past 12 months, with at least one criterion
present in the past 6 months:
1) Aggression to people and animals
2) Destruction of property
3) Deceitfulness or theft
4) Serious violations of rules
DSM-5
 Disorder Class: Disruptive, Impulse-
Control, and Conduct Disorders
 A. A repetitive 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 three (or more) 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:
1) Same
2) Same
3) Same
4) Same

21. DIAGNOSTIC CRITERIA (CONT.)
 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.
 B. same
 C. same
Prevalence:
 2-10%, with average prevalence estimate of
around 4%
 Boys > girls
 Prevalence rates rise from childhood to
adolescent
 Rarely diagnosed in older children
 Estimates shows it as fairly consistent across
different countries

22. COMORBIDITY RISK FACTORS
 The DSM-5 indicates that CD is comorbid
with ADD/ADHD, and substance use
disorders.
 Conduct disorder may also co-occur with
one or more of the following mental
disorders:
Specific learning disorder
Anxiety disorder
Depressive or bipolar disorder
Substance –related disorder
 Temperamental:
• Difficult uncontrolled infant temperament
• Lower than average intelligence (verbal IQ)
• Dysregulation of neurotransmitter
 Environmental:
• Parental rejection and neglect ,parental
criminality, Harsh discipline, large family size,
Physical and sexual abuse
• Peer rejection , association with delinquent
peer group, neighborhood exposure to
violence
 Genetics and physiology:
• Parents with severe alcohol use disorder,
depressive and bipolar, parents with history of
ADHD or conduct disorder.
• Slower resting heart rate is a reliable marker
and is not characteristics of any other mental
disorder.

23. DIFFERENTIAL DIAGNOSIS ASSOCIATED
FEATURES
 ODD
 ADHD
 Depressive and bipolar disorders
 Intermittent explosive disorder
 Adjustment disorder
 Personality features of trait negative
emotionality and poor self –control,
irritability, temper outbursts, suspiciousness,
insensitivity to punishment, and thrill
seeking often co-occur with conduct
disorder.
 Substance misuse is also an associated
features.
 Suicidal ideation, suicidal attempts and
completed suicide occur at higher rate in
individuals with conduct disorder.

24. ASSESSMENT AND TREATMENT
TOOLS
 The Delinquent Activities Scale (DAS)
 Structured interviews: Diagnostic Interview
Schedule for Children (DISC).
 The Diagnostic Interview for Children and
Adolescents
 The Schedule of Affective Disorders and
Schizophrenia for School-Age Children
 Diagnostic Interview for Children and
Adolescents (DICA)
 Child Behavior Checklist (CBCL)
 Connors Continuous Performance Test
(CPT)
• CBT
• Family therapy (Parental management train
PMT, Family check-ups FCU)
• Peer group therapy
• Medicines (SSRI’s and Atypical
antipsychotics)
• Multisystematic therapy MST

25. Intermittent explosive disorder involves
repeated, sudden episodes of impulsive,
aggressive, violent behavior or angry verbal
outbursts in which you react grossly out of
proportion to the situation.
INTERMITTENT EXPLOSIVE DISORDER
Symptoms: Aggressive episodes:
• Rage
• Irritability
• Increased energy
• Racing thoughts
• Tingling
• Tremors
• Palpitations
• Chest tightness
The explosive verbal and behavioral outbursts:
• Temper tantrums
• Tirades
• Heated arguments
• Shouting
• Slapping, shoving or pushing
• Physical fights
• Property damage
• Threatening or assaulting people or animals

26. DIAGNOSTIC CRITERIA
DSM-IV
• Disorder Class: Impulse-Control Disorders
Not Elsewhere Classified
• A. Several discrete episodes of failure to
resist aggressive impulses that result in
serious assaultive acts or destruction of
property.
DSM-5
• Disorder Class: Disruptive, Impulse-
Control, and Conduct Disorders
• A. Recurrent behavioral outburst
representing a failure to control aggressive
impulses as manifested by either of the
following:
1) Verbal aggression, for a period of 3
months.
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.

27. DIAGNOSTIC CRITERIA (CONT.)
• B. The degree of aggressiveness expressed
during the episodes is grossly out of
proportion to any precipitating psychosocial
stressors.
• C. The aggressive episodes are not better
accounted for by another mental
disorder, and are not because of to the
direct physiological effects of a substance or
a general medical condition .
• B. The magnitude of aggressiveness
expressed during the recurrent outbursts is
grossly out of proportion to the provocation
or to any precipitating psychosocial
stressors.
• F. The recurrent aggressive outbursts are not
better explained by another mental disorder
and are not attributable to another medical
condition or to the physiological effects of a
substance.
For children ages 6 to 18 years, aggressive
behavior that occurs as part of an adjustment
disorder should not be considered for this
diagnosis.

28. DIAGNOSTIC CRITERIA OF DSM-5(CONT.)
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).

29. COMORBIDITY RISK FACTORS
• Intermittent explosive disorder is most often
diagnosed with depressive disorders,
substance use disorders and post traumatic
stress syndrome.
• Personality disorders, such as borderline
personality disorder and antisocial disorder
may also be comorbid with intermittent
explosive disorder.
• Individuals with the history of disorders
with disruptive behaviors (ADHD, conduct
disorder, ODD)
• Environmental:
History of physical or emotional trauma during
first two decades of life
• Genetics and physiological:
Neurobiological researches supports the
presence of serotonergic abnormalities,
specifically in area of limbic system and
orbitofrontal cortex of IED individuals.

30. DIFFERENTIAL DIAGNOSIS ASSOCIATED FEATURES
• Disruptive mood dysregulation disorder
• Antisocial or borderline personality disorder
• Delirium
• Substance intoxication or substance
withdrawl
• ADHD, ODD, conduct disorder or autism
spectrum disorder
• Mood disorders (unipolar) , anxiety
disorder, and substance use disorder are
associated with IED
Prevalence:
IED is more prevalent among younger
individuals (e.g., younger than 35-40 years)

31. ASSESSMENT TOOLS TREATMENT
• Intermittent explosive disorder screening
questionnaire (IED-SQ)
• Anger (PROMIS Emotional Distress)
• Social Skills Rating System (SSRS)
• Reynolds Adolescent Adjustment Screening
Inventory (RAASI)
• Medications
• Behavioral Therapies
• CBT
• Group therapy

32. RASSI:
1) The RASSI is a self- report measure that provides indications of the clinical severity of the most
meaningful domains of psychological adjustment problems.
2) Age range is 12-19 years
3) Total 32- items
4) Four factorial derived scales ( Antisocial behavior, Anger control, Emotional distress, and Positive
self)
SSRS:
1) SSRS has been replaced by the Social Skills Improvement Systems (SSIS) Rating scales.
2) The multi-rater SSIS Rating Scales helps measure:
Social behaviors (cooperation, empathy, assertion, self-control, and responsibility)
Competing Problem Behaviors (Externalizing, Bullying, Hyperactivity/Inattention, Internalizing,
Autism Spectrum)
Academic Competence (Reading Achievement, Maths Achievement, Motivation to Learn)
Age Range:
3) 3 years to 18 years

33. Pyromania :
Pyromania is an impulse control disorder in
which individuals repeatedly fail to resist
impulses to deliberately start fires, in order to
relieve some tension or for instant
gratification.
Symptoms:
Symptoms include:
an uncontrollable urge to set fires
fascination and attraction to fires and its paraphernalia
pleasure, a rush, or relief when setting or seeing fires
tension or excitement around fire-starting

34. DIAGNOSTIC CRITERIA
The DSM-5 defines pyromania as requiring the following criteria:
A. Deliberate and purposeful fire setting on more than one occasion.
B. Tension or affective arousal before the act.
C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g.,
paraphernalia, uses, consequences).
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 sociopolitical 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 (e.g., major neurocognitive disorder,
intellectual disability, substance intoxication).
F. The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality
disorder.
G.Rule Out Conduct Disorder, Manic Episode, Antisocial Personality Disorder

35. PREVALENCE COMORBIDITY
• Pyromania as a primary diagnosis is very
rare to be appear.
• 1.13% in a population sample
• High co-occurence of substance abuse
disorder
• Gambling disorder
• Depressive and bipolar disorders
• Other disruptive, impukse control disorders

36. ASSESSMENT TOOLS TREATMENT
• Fire Setting Scale
• Fire Proclivity Scale
• St Andrews Fire and Risk Instrument
(SAFARI)
• Treatments with selective serotonin
reuptake inhibitors, antiepileptic
medications, lithium, antiandrogens, or
atypical antipsychotics have been proposed .
• CBT

37. KLEPTOMANIA
A person with kleptomania has a recurring drive to
steal that he or she cannot resist, stealing items for
the sake of stealing, not because they need or want
the items, or because they cannot afford to buy
them. It is quite rare, and not the same thing as
shoplifting.
Symptoms:
•Inability to resist powerful urges to steal items that you
don't need
•Feeling increased tension, anxiety or arousal leading up
to the theft
•Feeling pleasure, relief or gratification while stealing
•Feeling terrible guilt, remorse, self-loathing, shame or
fear of arrest after the theft
•Return of the urges and a repetition of the kleptomania
cycle

38. DIAGNOSTIC CRITERIA
The DSM-5 criteria for a diagnosis of kleptomania include:
A. Recurrent impulses to steal—and instances of stealing—objects that are not needed
for personal use or financial gain
B. Feeling increased tension right before the theft
C. Feeling pleasure, gratification, or relief at the time of the theft
D. Thefts are not committed in response to delusions or hallucinations, or as
expressions of revenge or anger
E. Thefts cannot be better explained by Antisocial Personality Disorder, Conduct
Disorder, or a manic episode

39. PREVALENCE ASSOCIATED FEATURES
• 4%-24% arrested for shoplifting
• Prevalence in general population is very
rare, appox. 0.3% - 0.6%
• Females outnumber the males at a ratio of
3:1
• Neurotransmitter pathways associated with
behavioral addictions
• Associated with serotonin , dopamine,
opioid systems, appear to play a role in this
disorder.

40. DIFFERENTIAL DIAGNOSIS COMORBIDITY
• Ordinary theft
• Malingering
• Antisocial personality disorder and conduct
disorder
• Manic episodes
• Kleptomania is often co-diagnosed with
anxiety disorders, eating disorders, bipolar
and other depressive disorders, personality
disorders, substance abuse, compulsive
buying disorders, and, of course, other
disruptive, impulse control, and conduct
disorders.

41. ASSESSMENT TOOLS TREATMENT
• Diagnosis of kleptomania is often based on
a combination of patient reports, diagnostic
scales, and legal records pertaining to
instances of the kleptomaniac being caught
during thieving.
Psychometric scales:
• Yale Brown Obsessive Compulsive Scale,
Modified for Kleptomania (K-YBOCS)
• Kleptomania Symptom Assessment Scale
(K-SAS)
• Cognitive behavioral therapy
• Lithium, anti-epileptics, and opioid
antagonists have proven effective
• Selective serotonin reuptake inhibitors
(SSRIs) and Antidepressants may ease the
common feelings of shame and self-loathing

42. THANK YOU