Oppositional Defiant Disorder (A complete guide)

Oppositional Defiant Disorder: Everything you need to know (A comprehensive guide)

In this brief guide, we will discuss everything you need to know about oppositional defiant disorder, as well as other related concepts like oppositional defiant disorder treatment and causes. We will also take a brief look at some of the risk factors for oppositional defiant disorder.

Oppositional Defiant Disorder

Oppositional defiant disorder belongs to the category of disruptive behaviors and developmental disorder in the DSM and ICD respectively and it is characterized by the inability to regulate one’s behavior in accordance with the rules and norms of the culture of society of the child.

The primary feature of oppositional defiant disorder is that there is a frequent and persistent pattern of angry/irritable mood in the child, and they often tend to be argumentative or defiant towards the adult in their life.

Some people maintain that vindictiveness may also be present in the child, but there are milder cases where it may not be seen, or at the outset of the disorder when the child is young, this symptom may often be absent, although it still gets included in the diagnostic criteria.

Individuals with oppositional defiant disorder may sometimes show behavioral features of the disorder without problems of negative mood but in most cases the angry/irritable mood symptoms are present.

Sometimes the oppositional defiant disorder may be confined to only one setting, and most frequently it tends to be their home and the object of their anger tends to be their parents, or older siblings.

When ODD is present only in the home setting, the child may be significantly impaired in their

social functioning although in more severe cases, the symptoms of the disorder are present

in multiple settings. 

Usually, the pervasiveness of symptoms is an indicator of the severity of the disorder, and the more pervasive the symptoms of oppositional defiant disorder, the more important it is that the disorder be assessed across multiple settings and relationships. 

Another reason to fix this problem is that often the oppositional defiant disorder behaviors are common among siblings, and therefore, they must also be observed during interactions with persons other than siblings. 

Typically, symptoms of oppositional defiant disorder may be more evident in interactions with adults or peers whom the individual knows well, and they may often not become apparent during a clinical examination, and if the individual also has comorbid conditions like depression, anxiety, or ADHD, those symptoms may likely be more evident in the clinical settings.

Causes of Oppositional Defiant Disorder

There have been no particular known causes of oppositional defiant disorder, some studies show reduced function in the frontal lobe and the amygdala region and increased activity in the anterior cingulate gyrus, which is commonly seen in disorders where poor impulse control and emotionality are common symptoms.

Otherwise, most psychiatric etiology tends to be a combination of multiple factors like psychological, environmental and physical, and oppositional defiant disorder is no different, and these causes are discussed below:

  • Brain chemistry: ODD has been associated with some neurotransmitters, and when these are not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD and other mental illnesses. 
  • Temperament: Children with ODD have  trouble controlling their emotions, and this in turn makes them more likely to develop more severe ODD, and the converse is also true, that is, children who have trouble controlling their emotions are also more prone to developing ODD.
  • Family history: many young people with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. 
  • Family issues: very often a dysfunctional family life, or familial environment that includes substance abuse, and inconsistent discipline by parents or other authority figures may add to the development of behavior disorders.
  • Peers: problems with peers may also reinforce ODD behaviors.

Differential Diagnosis for Oppositional Defiant Disorder

Differential diagnoses are what else the symptoms in the individual might mean, and for oppositional defiant disorder the differential diagnosis most commonly include ADHD, Depression or Conduct Disorder.

Conduct disorder and oppositional defiant disorder are both types of conduct problems that cause conflict involving the child and adults or other authority figures like teachers in their life, and the difference between conduct disorder and oppositional defiant disorder is mainly that the symptoms of ODD are much less severe nature than those of conduct disorder.

Another chief distinction between conduct disorder and ODD is that ODD does not include aggression toward people or animals, destruction of property, or a pattern of theft or deceit.

ODD may also include emotional dysregulation that may not be present in conduct disorder (although there is a separate category for Depressed Conduct Disorder in the ICD)

ADHD is another condition that may either be a differential for ODD or it can also be comorbid with oppositional defiant disorder, and a clinician always needs to ensure that the failure to conform to requests of others is not solely in situations that demand sustained effort, because that can be a result of attention problems and not ODD.

Other disorders often comorbid or part of differential for ODD are:

  • Depressive and bipolar disorders. 
  • Intermittent explosive disorder
  • Disruptive mood dysregulation disorder. 
  • Intellectual disability
  • Language disorder.
  • Social anxiety disorder (social phobia)

Treatment of Oppositional Defiant Disorder

Treatment of Oppositional defiant disorder may include the following, depending upon the severity of the situation and the child’s age:

  • Behavior therapy
  • Cognitive Behavior Therapy
  • Play therapy
  • Medication
  • Family Therapy

ICD and DSM Criteria for Oppositional Defiant Disorder

The ICD 10 criteria for Oppositional Defiant disorder is given as follows:

“The essential feature of this disorder is a pattern of persistently negativistic, hostile, defiant, provocative, and disruptive behavior, which is clearly outside the normal range of behavior for a child of the same age in the same sociocultural context, and which does not include the more serious violations of the rights of others as reflected in the aggressive and dissocial behavior specified for categories F91.0 and F91.2.

Children with this disorder tend frequently and actively to defy adult requests or rules and deliberately annoy other people. 

Usually they tend to be angry, resentful, and easily annoyed by other people whom they blame for their own mistakes or difficulties. 

They generally have a low frustration tolerance and readily lose their temper. 

Typically, their defiance has a provocative quality, so that they initiate confrontations and generally exhibit excessive levels of rudeness, uncooperativeness, and resistance to authority.

Frequently, this behavior is most evident in interactions with adults or peers whom the child knows well, and signs of the disorder may not be evident during a clinical interview.

The key distinction from other types of conduct disorder is the absence of behavior that violates the law and the basic rights of others, such as theft, cruelty, bullying, assault, and destructiveness. 

The Definite presence of any of the above would exclude the diagnosis. However, oppositional defiant behavior, as outlined in the paragraph above, is often found in other types of conduct disorder. 

If another type (F91.0-F91.2) is present, it should be coded in preference to oppositional defiant disorder.”

Additionally, the diagnostic criteria for oppositional defiant disorder in the DSM 5 is given as follows:

  1. “A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. 

Angry/Irritable Mood

  • Often loses temper.
  • Is often touchy or easily annoyed.
  • Is often angry and resentful.

Argumentative/Defiant Behavior

  • Often argues with authority figures or, for children and adolescents, with adults.
  • Often actively defies or refuses to comply with requests from authority figures or with rules.
  • Often deliberately annoys others.
  • Often blames others for his or her mistakes or misbehavior.

Vindictiveness

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

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 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.”

Conclusion

In this brief guide, we discussed everything you need to know about oppositional defiant disorder, as well as other related concepts like oppositional defiant disorder treatment and causes. We also took a brief look at some of the risk factors for oppositional defiant disorder.

Oppositional defiant disorder can often go unidentified when the child is written off as just temperamental, or just thought of as being ill-behaved.

So many children also don’t get the help they need so desperately when they have oppositional defiant disorder because the adults in their life keep getting so exasperated with them and feeling like they are somehow not able to control someone younger to them, that they go on either rebuking the child or ignoring them.

On the complete opposite end, sometimes children who may actually be suffering from a completely different problem altogether can end up being labeled as having Oppositional defiant disorder, because the clinician or the adult giving them this diagnosis hasn’t really thought it through or bothered to get closer.

Therefore, it is important to consider everything before going ahead with a diagnosis like ODD because it can affect how the young person is viewed for the rest of their life.

If you have any questions or comments about Oppositional defiant disorder, please feel free to reach out to us at any time.

Frequently Asked Questions (FAQs): Oppositional Defiant Disorder

What causes Oppositional Defiant Disorder?

Causes of oppositional defiant disorder include environmental, biological or psychological, and in most cases there will not be one definite cause, and an interplay of all these factors may likely be the culprit in the case of any child that has oppositional defiant disorder.

While the cause of oppositional defiant disorder may not be just the one, the maintaining factor can often be how the people around the child react to their actions and behavior, which may often go on reinforcing bad habits and behavior.

What medication is used for Oppositional Defiant Disorder?

Medication commonly used for oppositional defiant disorder may include stimulants that are used for children with ADHD also, and it may also be seen that ADHD is often a comorbid condition with ODD, in which case medication like Atomoxetine may be prescribed.

Additionally, many children with oppositional defiant disorder may also have comorbid depression, in which case antidepressants like fluoxetine may be prescribed.

Are Oppositional Defiant Disorder and Conduct Disorder the same?

No, oppositional defiant disorder and conduct disorder are not the same, but they may belong to the same class of disorders, which are disruptive behavioral disorders.

The key difference between ODD and conduct disorders is that in ODD, there may not be truancy (running away from school), firesetting, or cruelty to animals or to those weaker/younger than the child, which are all features that may be seen in some cases of conduct disorder.

Citations

Diagnostic and Statistical Manual (DSM 5)

https://www.cdc.gov/childrensmentalhealth/behavior.html

https://www.webmd.com/mental-health/oppositional-defiant-disorder#1

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