Oppositional Defiant Disorder

Definition and common characteristics of oppositional defiant disorder

Oppositional defiant disorder is a disturbance in impulse control usually seen in children and adolescents in which there is “a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures...” (Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Association, DSM-IV).

The DSM-IV provides some common characteristics of oppositional defiant disorder as seen in children and adolescents including the following:

  • Loss of temper
  • Arguing with adults
  • Defiance or refusal to comply with the requests or rules of adults
  • Deliberately doing things that annoy others (being naughty)
  • Blaming others for their own mistakes
  • Being irritable and easily roused to anger
  • Being revengeful

The DSM-IV states that the disorder usually become evident “before the age of 8 and usually not later that early adolescence”.

Individuals with opposition defiant disorder may have low self-esteem, low frustration tolerance, and fluctuations in mood. They are at risk for the precocious use of alcohol and drugs.

Conflict with authority figures, including parents and teachers, is commonly found in this condition.
There are important continuities, transitions, or associations which frequently occur among oppositional defiant disorder, conduct disorder, and antisocial personality disorder (Steiner & Dunne, 1997).

In a selected subsample of adults in a large epidemiological survey, 92.4% of those with oppositional defiant disorder have a coexisting disorder of some kind; 68.2% have another impulse control disorder; 62.3% have an anxiety disorder; 47.2% a substance use disorder; and 45.8% a mood disorder (Nock et al 2007).

Lifetime prevalence

The lifetime prevalence for oppositional defiant disorder was found to be 8.5% in a large US epidemiological study (Kessler et al 2005).

This is slightly lower than the lifetime prevalence for this disorder reported by Nock and his associates in 2007, probably due to the different sampling methods used in the two studies.

Using the results of the Kessler study Kessler et al 2005), it is clear that oppositional defiant disorder is one of the most prevalent impulse control disorders outranked only by conduct disorder with a lifetime prevalence of 9.5%.

It is followed in decreasing prevalence by attention deficit disorder at 8.1% and intermittent explosive disorder at just 5.2%.

Causation (Aetiology)

There is evidence that a variety of factors, individually or in a complex interaction, can be involved in the aetiology and maintenance of conduct disorder (Finch, Nelson, & Hart, 2006).

  • Genetics. There is evidence that genetics can play an important role in the causation of conduct disorder (Finch, Nelson, & Hart, 2006). Genetic causation seems to play a particularly strong role if the conduct disorder occurs along with attention deficit hyperactivity disorder and occurs across the life-span (Comings, 2000).
  • Family. Neglect, physical, emotional, or sexual abuse or rejection, inconsistent child rearing, or lack of supervision and love can all increase the risk of conduct disorder.
  • Peer interactions. Association with delinquent peer groups may contribute to the development of conduct disorder in vulnerable individuals.
  • Community and neighbourhood factors e.g. poverty, discrimination of any type.

Treatments Available

Oppositional defiant disorder with its high rate of comorbidity and high rate of subsequent disorders such as conduct disorder, is a serious psychiatric problem which deserves therapeutic attention by mental health professionals.

Moreover, there is evidence that the poor relationship with adults including parents and teachers can contribute to significant subsequent problematical behaviours e.g. early alcohol and drug use and various antisocial activities.

The serious consequences for individuals with this disorder, the pain to their families, and the financial costs to society, are all reasons why oppositional defiant disorder, along with conduct disorder as discussed elsewhere, quite rightfully deserve a lot of time and attention from mental health workers, and sufficient financial support by various levels of the government.

Some of the therapeutic approaches which have been used with varying degrees of success are:

  • Multisystemic. (Sprague & Thyer, 2003)
  • Psychotropic medications. (Cales Jr. & Nazeer, 2010)
  • Anger management (Sprague & Thyer, 2003)
  • Stress inoculation training. (Sprague & Thyer, 2003)
  • Assertiveness training. (Sprague & Thyer, 2003)
  • Rational emotive therapy. (Sprague & Thyer, 2003)

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., text rev.) Washington, DC: Author.

Calles Jr. J., & Nazeer, A. (2010). Oppositional defiant and conduct disorders. International Journal of Child and Adolescent Health, Vol 3(2), 207-212.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., Walters, E. E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Nock, M. K., Kazdin, A. E., Hiripi, E., & Kessler, R. C. (2007). Lifetime prevalence , correlates, and persistence of oppositional defiant disorder : Results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry, Vol 48(7), Jul 2007, 703-713.

Sprague, A. & Thyer, B. A. (2003). Psychosocial Treatment of Oppositional Defiant Disorder : A Review of Empirical Outcome Studies.

Social Work in Mental Health, Vol 1(1), 63-72.

Steiner, H. & Dunne, J. E. (1997). Summary of the practice parameters for the assessment and treatment of children and adolescents with conduct disorder . Journal of the American Academy of Child & Adolescent Psychiatry. 36(10), 1482-1485.


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