Disruptive Behaviour Disorders
These are a group of disorders that are linked by varying difficulties in controlling aggressive behaviors, self-control, and impulses. Typically, the resulting behaviors or actions are considered a threat primarily to others’ safety and/or to societal norms. Some examples of these issues include fighting, destroying property, defiance, stealing, lying, and rule breaking.
These disorders are:
Problematic behaviors and issues with self-control associated with these disorders are typically first observed in childhood and can persist into adulthood. In general, disruptive, impulse-control, and conduct disorders tend to be more common in males than females, with the exception of kleptomania.
Behavioral issues are a common reason for referral to psychiatrists or other mental health providers. It is important to note that it can be developmentally appropriate for kids to become disruptive or defiant at times. However, disruptive, impulse, and conduct disorders involve a pattern of much more severe and longer-lasting behaviors then what is developmentally appropriate. For instance, these behaviors are frequent, occur in various settings, and can have significant consequences (including legal repercussions). It is also important to consider that anger and defiance can be manifestations of other disorders.
One difference between disruptive behavioral disorders and many other mental health conditions is that with behavioral disorders, a person's distress is focused outward and directly affects other people. With most other mental health conditions, such as depression and anxiety, a person's distress is generally directed inward toward themselves.
Types of Disorders
Oppositional Defiant Disorder
Oppositional defiant disorder is a common disorder in children and adolescents who are referred to mental health providers for behavioral issues. Individuals with this disorder experience varying levels of dysfunction secondary to oppositionality, vindictiveness, arguments, and aggression.
Symptoms of oppositional defiant disorder include a pattern of:
These behaviors are distressing to the individual and alarming to others. Anger, threatening behaviors, and spitefulness cause disruption at school or work and affect relationships with others. Of note, these behaviors do not include aggression towards animals or people, destruction, or theft. In other words, there are no violations to others or societal norms. Individuals with oppositional defiant disorder, will likely experience conflict with adults and authority figures.
To be diagnosed with Oppositional defiant disorder, the behaviors must occur with at least one individual who is not the person's sibling. Signs of the disorder typically develop during preschool or early elementary school but can also begin in adolescence. For children under age 5, the behaviors occur on most days for at least six months. For people 5 and older, the behaviors occur at least once per week for at least six months. The severity of this illness is based on the number of settings in which these behaviors are observed.
The cause of oppositional defiant disorder is not fully understood. However, it is believed that ODD might be secondary to several biological, psychological, and social factors. There are several risks associated with the development of oppositional defiant disorder: having poor frustration tolerance, high levels of emotional reactivity, neglect during childhood, and inconsistent parenting. ODD tends to be more common in children who live in poverty and is more common in boys than girls prior to adolescence. The prevalence of oppositional defiant disorder is about 3.3%.
Conduct disorder involves severe behaviors that violate the rights of others or societal norms. Behaviors may involve aggression towards others, animals, and/or destruction of property all of which could result in legal consequences. As stated in the oppositional defiant disorder section, many (but not all) children and adolescents with oppositional defiant disorder will eventually meet diagnostic criteria for conduct disorder. However, not all individuals who are diagnosed with Conduct Disorder were first diagnosed with ODD.
Symptoms of conduct disorder include varying patterns of:
Per the DSM-5, these behaviors can first be observed in pre-school. However, the more significant symptoms tend to appear between middle childhood and middle adolescents. It is rare for these symptoms to first appear after the age of 16. Conduct disorder is only diagnosed in children and youth up to 18 years of age. Adults with similar symptoms may be diagnosed with antisocial personality disorder. Early treatment can help prevent problems from continuing into adulthood.
Intermittent Explosive Disorder
Intermittent explosive disorder is a disorder associated with frequent impulsive anger outbursts or aggression—such as temper tantrums, verbal arguments, and fights. The observed behaviors result in physical assaults towards others or animals, property destruction, or verbal assaults. The aggressive outbursts:
It is important to note that these aggressive behaviors are not planned, they are impulsive and anger based. They happen rapidly after being provoked and typically do not last longer than 30 minutes. These outbursts must be associated with subjective distress or social or occupational dysfunction. Affected individuals tend to have poor life satisfaction and lower quality of life.
While fire setting can be a common issue among young individuals and a cause of significant destruction in the United States, it is different from pyromania which is a rare disorder that involves repeated impulses or strong desires to set intentional fires. Fire setting is typically motivated by curiosity and tends to occur in unsupervised children with access to lighters and matches. Individuals with pyromania, on the other hand, are fascinated by fire and its uses. Affected individuals engage in repeated and deliberate fire setting that is not motivated by external reasons. They experience strong urges to engage in dangerous fire setting. They also experience internal tension prior to setting fires that is followed by pleasure after fires are lit. These individuals set fires to release built-up inner emotional tension, not for any type of material gain or revenge.
Kleptomania is a rare disorder that involves involuntary, impulsive, and irresistible stealing of objects that are not needed for personal or other forms of use. This is different from shoplifting in that shoplifters steal for some form of gain and often plan out their actions. However, individuals with Kleptomania do not need what they have stolen. They often give away, return, hide, or hoard the stolen objects. People with kleptomania know what they are doing is wrong but cannot control the impulse to steal, leading to hasty and poorly thought-out stealing. They experience internal tension before stealing that is then relieved after the theft. While they experience pleasure or gratification from stealing, they tend to have guilt or sadness afterwards. Many people with this disorder may try to stop stealing but feel guilt and shame about their inability to do so. Unfortunately, many may be apprehended or jailed for these behaviors.
Signs and Symptoms of Disruptive Behavior Disorder:
The symptoms of disruptive behavior disorders will vary based on the age of the child and the type of behavioral disorder that he or she has. Children’s temperament, social skills, and coping mechanisms will also affect the severity of the symptoms. The following are some common examples of symptoms that people with DBD may exhibit:
· Social isolation
· Revenge-seeking behaviors
· Willful destruction of property
· Blaming others
· Actively defying or refusing to comply with rules
· Being cruel to animals
· Playing with fire
· Difficulty concentrating
· Frequent frustration
· Memory impairment
· Inability to “think before speaking”
· Lack of problem-solving skills
· Psychosocial symptoms:
· Lack of empathy
· Lack of remorse
· False sense of grandiosity
· Persistent negativity
· Chronic annoyance and irritability
· Low self-esteem
Causes of Disruptive Behavior Disorder
The development of DBD is theorized to be the result of a variety of contributing factors, including genetic, physical, and environmental components. The following are examples of what these factors might include:
Genetic: Children with DBD typically have family members who also suffer from some form of mental illness, including mood disorders, personality disorders, and anxiety disorders. This indicates that there is most likely a genetic component that leads kids to become more susceptible to developing and portraying symptoms of DBD.
Physical: Imbalances in the brain’s frontal lobe have been hypothesized to affect the onset of DBD. The frontal lobe is responsible for regulating people’s emotions and is said to be the “home” of personality development. When neurotransmitters (chemicals in the brain responsible for communication throughout the brain) are imbalanced, the result is an impairment in their ability to communicate properly. This communication dysfunction can lead to the onset of DBD symptoms.
Environmental: The environment that children grow up in can have an immense impact on whether or not they develop the behavioral patterns that define DBD. If children are surrounded by a chaotic home life, they may begin to act out simply because it allows them to have something that they can control since they have no power over the chaos around them. Similarly, children who are raised without any form of appropriate discipline or whose parents tend to be more absent than not can experience major impacts on the ways in which they begin to behave. Atypical mother-child interaction at the time of birth has also been theorized to have an effect on the onset of DBD.