Source of information about DSM diagnoses: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

overview

Disruptive, impulse-control, and conduct disorders are characterized by difficulties in the self-regulation of emotions and behaviors. While emotional and behavioral dysregulation can occur in many mental health conditions, what distinguishes this group of disorders is that the individual’s symptoms consistently violate the rights of others and/or significantly conflict with societal norms or authority figures.

DSM Chapter Sections:

• Oppositional Defiant Disorder (ODD): A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, typically directed at authority figures.
• Intermittent Explosive Disorder (IED): Recurrent, sudden episodes of impulsive, aggressive outbursts that are grossly disproportionate to any provocation or stressor.
• Conduct Disorder (CD): A repetitive and persistent pattern of behavior where the basic rights of others or major societal norms are violated (e.g., aggression toward people or animals, property destruction, deceit, or theft).
• Antisocial Personality Disorder (APD): A pervasive pattern of disregard for, and violation of, the rights of others, beginning in childhood or early adolescence and continuing into adulthood (must be 18+ for diagnosis and have evidence of Conduct Disorder before age 15).
• Pyromania: A disorder characterized by deliberate and purposeful fire-setting on more than one occasion, accompanied by tension or emotional arousal before the act and pleasure or relief afterward.
• Kleptomania: A recurrent inability to resist urges to steal items that are not needed for personal use or monetary value, leading to gratification or relief when stealing.
• Other Specified and Unspecified Disruptive, Impulse-Control, and Conduct Disorders: Categories used when individuals have symptoms of these disorders causing significant distress or impairment but do not meet full criteria for any specific diagnosis.

oppositional disorder

Oppositional defiant disorder (ODD) is a consistent pattern of angry or irritable mood, defiant or argumentative behavior, or vindictiveness toward authority figures. Symptoms typically last for at least six months and are more frequent and severe than is developmentally expected. These behaviors often cause problems at home, school, work, or with peers and are not limited to interactions with siblings. The severity of ODD is based on how widespread the behaviors are across different settings.

Associated Features:

• ODD often co-occurs with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder.

• Children and adolescents with ODD are at an increased risk for suicide attempts, even when controlling for other co-occurring conditions.

• Many individuals with ODD do not view themselves as defiant; instead, they believe their actions are justified due to perceived unreasonable demands or unfair treatment.

• A history of hostile or neglectful parenting may be present but is not required for diagnosis.

• Symptoms are typically more obvious with familiar adults and may not be seen during brief clinical assessments.

Criteria:

A.A consistent pattern of angry or irritable mood, argumentative or defiant actions, or vindictive behavior, lasting for at least six months. The individual must show at least four symptoms from any of these categories during interactions with at least one person who is not a sibling.

Angry/Irritable Mood:
1. Frequently loses their temper.
2. Is easily annoyed or becomes upset quickly.
3. Often feels and expresses anger and resentment.

Argumentative/Defiant Behavior
4. Regularly argues with people in authority, or for young people, with adults.
5. Frequently refuses to comply with requests or rules from authority figures.
6. Purposely irritates or bothers others.
7. Blames others for personal mistakes or misbehavior.

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

Note:
For children under 5 years, behaviors should occur on most days for at least 6 months.
For individuals 5 years and older, behaviors should occur at least once per week for at least 6 months.
Cultural, developmental, and situational factors must be considered.

B.The behavior causes distress in the individual or others in their immediate social environment (e.g., family, peers, work) or leads to problems in important areas of functioning.
C. The behaviors do not occur exclusively during a psychotic, substance use, depressive, or bipolar disorder. Criteria for disruptive mood dysregulation disorder are not met.

Specify Severity:

• Mild: Symptoms occur in only one setting (e.g., home, school, work).

• Moderate: Symptoms are present in at least two settings.

• Severe: Symptoms are present in three or more settings.

intermittent explosive disorder

Intermittent explosive disorder (IED) is marked by sudden, repeated episodes of impulsive, aggressive behavior or angry verbal outbursts that are disproportionate to the situation. These reactions are not preplanned and usually come on quickly, often in response to minor provocations. Individuals with IED struggle to control their aggressive impulses, which can lead to significant personal, social, or legal problems. The disorder usually becomes evident in late childhood or adolescence.

Associated Features:

• Higher rates of depressive disorders, anxiety disorders, and substance use disorders.

• Impaired serotonin functioning and abnormalities in certain brain areas (especially the limbic system and orbitofrontal cortex).

• Increased amygdala reactivity to anger-related stimuli.

• Decreased gray matter volume in frontolimbic brain regions associated with emotional regulation.

• Individuals may experience feelings of regret or embarrassment following outbursts.

Criteria:

A. Repeated aggressive outbursts that show a failure to control impulses, shown by either:

• 1. Verbal or physical aggression (e.g., yelling, fights) happening, on average, twice a week for at least three months, without causing injury or damage,
     OR

  2. Three separate incidents within a year where property is damaged or people/animals are injured.

B. The intensity of aggression is significantly out of proportion to any provocation or stressor.
C. The outbursts are impulsive and anger-driven, not preplanned or motivated by gaining a tangible reward (e.g., money, power).
D. The outbursts cause major distress, or impair work and relationships, or lead to financial or legal problems.
E. The individual is at least 6 years old developmentally.
F. The behavior is not better explained by another mental disorder, medical condition, or substance use.

• For children ages 6–18, if outbursts occur only during an adjustment disorder, IED should not be diagnosed.

Note: IED can be diagnosed alongside disorders like ADHD, conduct disorder, ODD, or autism apectrum disorder if the aggressive behavior is more extreme than typical for those conditions.

conduct disorder

Conduct disorder is characterized by a pattern of behavior where an individual repeatedly violates the rights of others and major societal norms or rules. This behavior can involve aggression toward people or animals, destruction of property, deceitfulness or theft, and serious rule-breaking. Symptoms must persist over time, cause significant problems in functioning, and cannot be explained by another disorder like antisocial personality disorder in adults.

Associated Features:

• Individuals often misinterpret others’ intentions as hostile, leading to aggressive responses.

• Traits like irritability, low frustration tolerance, recklessness, and thrill-seeking are common.

• Substance misuse, especially in adolescent girls, frequently co-occurs.

• Poor self-control and insensitivity to punishment are often seen.

• Personality features may include suspiciousness and emotional detachment.

Criteria:

A. A repeated, persistent pattern of violating others’ rights or societal rules, shown by at least 3 of the following behaviors in the past 12 months, with at least 1 present in the last 6 months:

Aggression to People and Animals:

1. Bullies, threatens, or intimidates others.

2. Initiates physical fights.

3. Has used a dangerous weapon.

4. Physically cruel to people.

5. Physically cruel to animals.

6. Steals while confronting a victim (e.g., mugging).

7. Forces someone into sexual activity.

Destruction of Property:
8. Engages in deliberate fire setting.
9. Intentionally destroys property.

Deceitfulness or Theft:
10. Breaks into homes, buildings, or cars.
11. Frequently lies to gain favors or avoid obligations (“cons” others).
12. Steals items of nontrivial value without confrontation (e.g., shoplifting, forgery).

Serious Violations of Rules:
13. Stays out at night before age 13 despite parental rules.
14. Runs away from home overnight at least twice (or once for a long time).
15. Is often truant from school before age 13.

B. The behavior causes significant impairment in social, academic, or occupational areas.
C. If the individual is over 18 years old, they do not meet criteria for antisocial personality disorder.

Specifiers:

• Onset Type:

  • Childhood-Onset (before age 10)

  • Adolescent-Onset (no symptoms before age 10)

  • Unspecified Onset (unknown age of first symptoms)

• With Limited Prosocial Emotions (Optional):
  Displays at least two of the following consistently over 12 months and in different relationships:

  • Lack of remorse or guilt

  • Callousness/lack of empathy

  • Unconcerned about performance

  • Shallow or insincere emotional expression

• Severity:

  • Mild: Few problems, minor harm to others.

  • Moderate: Between mild and severe.

  • Severe: Many problems, serious harm (e.g., assault, forced sex).

Key Differences: ODD, IED, and CD

antisocial personality disorder

Antisocial personality disorder (ASPD) is a long-term pattern of disregarding or violating the rights of others. Individuals with ASPD often behave deceitfully, impulsively, and irresponsibly, without remorse for their actions. It typically starts with symptoms of conduct disorder before age 15 and continues into adulthood. Behaviors often include lying, aggressive acts, law-breaking, and manipulating others for personal gain.

Associated Features:

• Higher rates of substance use disorders, especially alcohol use.

• Increased risk for depression, anxiety disorders, and other impulse-control disorders.

• Difficulty sustaining relationships or employment due to deceitful and aggressive behavior.

• Tendency to rationalize or minimize harmful behaviors (“they deserved it” thinking).

• May appear charming or engaging on the surface but manipulative underneath.

Criteria:

A. A consistent pattern of ignoring and violating the rights of others since age 15, shown by at least three of the following:

1. Breaking laws repeatedly, acts that can lead to arrest.

2. Deceitfulness, such as lying, using aliases, or conning others.

3. Impulsivity or failure to plan ahead.

4. Irritability and aggressiveness, often leading to fights or assaults.

5. Reckless disregard for the safety of self or others.

6. Consistent irresponsibility (e.g., poor work behavior, not paying debts).

7. Lack of remorse, shown by being indifferent to or rationalizing hurting, mistreating, or stealing from others.

B. The individual is at least 18 years old.
C. There is evidence of Conduct Disorder with onset before age 15.
D. The antisocial behavior does not occur exclusively during schizophrenia or bipolar disorder episodes.

pyromania

Pyromania is a rare impulse-control disorder where individuals intentionally and repeatedly set fires. These acts are not motivated by financial gain, revenge, or political statements but instead by a fascination with fire and the emotional relief or pleasure it brings. People with pyromania often feel a buildup of tension before setting a fire and experience gratification afterward. Their behavior is deliberate and purposeful, not accidental or due to impaired judgment.

Associated Features:

• Individuals may carefully plan fire-setting acts in advance.

• There may be an indifference to the damage caused or a sense of satisfaction from destruction.

• Some individuals are fascinated with fire departments, firefighting equipment, or emergency response scenes.

• Legal trouble, property loss, injury, or even death can result from the behavior.

• A history of alcohol use disorder is commonly associated with fire-setting behavior, whether or not full criteria for pyromania are met.

Criteria:

A. Intentional and purposeful setting of fires on more than one occasion.
B. Feeling tension or emotional excitement before starting the fire.
C. An intense fascination with fire and everything related to it (e.g., equipment, aftermath, fire trucks).
D. Experiencing pleasure, satisfaction, or emotional relief when setting fires, watching them, or being involved afterward.
E. The fire setting is not done for reasons such as financial gain, revenge, covering up a crime, sociopolitical goals, or because of hallucinations, delusions, or impaired judgment (such as intoxication).
F. The behavior is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

Note: Pyromania requires fascination and gratification from fire, not revenge, money, or crime cover-up.

kleptomania

Kleptomania is an impulse-control disorder where a person repeatedly steals objects that they do not need and that have little personal or financial value. The behavior is driven by rising internal tension before the theft and feelings of pleasure, relief, or gratification afterward. The stealing is not planned to express anger, achieve revenge, or gain money, and it is not better explained by another mental disorder.

Associated Features:

• Individuals are usually aware that stealing is wrong and may feel intense guilt or shame afterward.

• Theft often occurs impulsively without full planning or regard for the risk of being caught.

• Stolen items are often discarded, hoarded, or given away rather than used.

• Individuals often fear being apprehended and attempt to resist their impulses.

• Neurobiological factors involving serotonin, dopamine, and opioid systems may contribute to kleptomania.

Criteria:

A. Repeated failure to resist the urge to steal items that are not needed for personal use or monetary value.
B. Rising tension immediately before the theft.
C. Feeling pleasure, gratification, or relief when committing the theft.
D. The stealing is not an act of anger, revenge, or the result of a hallucination or delusion.
E. The behavior is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

other specified disruptive, impulse-control, and conduct disorder

Other specified disruptive, impulse-control, and conduct disorder is used when a person shows significant symptoms of a disruptive, impulse-control, or conduct disorder, but does not fully meet the criteria for any specific disorder within the category.

In this diagnosis, the clinician clearly specifies why the full criteria are not met. An example would be “recurrent behavioral outbursts of insufficient frequency,” meaning the person has outbursts but not often enough to qualify for intermittent explosive disorder.

unspecified disruptive, impulse-control, and conduct disorder

Unspecified disruptive, impulse-control, and conduct disorder is used when a person shows significant symptoms of a disruptive, impulse-control, or conduct disorder, but does not fully meet the criteria for any specific disorder in the category.

In this diagnosis, the clinician chooses not to specify the reason, often because there is insufficient information. This is common in emergency situations or when a full evaluation is not possible.

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