What is… Oppositional Defiant Disorder

Mental Health @ Home Insights into psychology: Oppositional defiant disorder

In this series, I dig a little deeper into the meaning of psychology-related terms.  This week’s term is oppositional defiant disorder, which was suggested by Josh of Recovering Porn Addict.

Oppositional defiant disorder (ODD) is typically diagnosed by the early elementary school years.  In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), diagnosis requires at least six months of symptoms resulting in impaired functioning and/or distress for either the individual or those around them.  The symptoms are divided into three categories, and to count towards diagnosis these symptoms can’t be solely directed at a sibling:

  • angry/irritable
  • argumentative/defiant behaviour: refuses to follow rules/directions, deliberately annoys others, blames others for own mistakes
  • vindictive/spiteful

Treatment involves work on problem-solving skills and behavioural therapy, and typically the family would be involved as well.  Medications aren’t used specifically for ODD, but there are often comorbid conditions like ADHD, mood disorders, or anxiety disorders that could potentially benefit from medication.  As a secondary benefit, this may result in improvements in the ODD symptoms.

Conduct disorder is another commonly co-occurring condition.  It involves a pattern of repeatedly violating the rights of others and societal norms, and may include behaviours like theft or destruction of property.  This may end up evolving into antisocial personality disorder, but the DSM doesn’t allow for that to be diagnosed until age 18.

There is no single cause of ODD, and both biological and environmental factors may play a role.  There is some indication of a genetic component, and there is an increased risk when a parent has a mood disorder.  Other potential biological factors include nicotine use by parents, nutritional deficits while mom was pregnant, and developmental delays.

Possible environmental factors include poverty, lack of structure, rejection by peers, and violence in the community.  Parental behaviour can be a significant contributing factor, and may include abuse, neglect, lack of supervision, lack of involvement, and inconsistent discipline.

In about 70% of kids diagnosed with ODD, the disorder will resolve on its own by adulthood.  However, 90% of people with a history of ODD do end up getting another diagnosed mental illness as well.  Males and those with an earlier onset of ODD are more likely to not “grow out of” the condition, and they may go on to develop a more severe form of conduct disorder like antisocial personality disorder as an adult.

There’s not much information out there about oppositional defiant disorder in adults.  The studies that I did find looked at it as co-occurring with ADHD.  It looks like ODD doesn’t tend to hover statically into adulthood; either it resolves, it gets tangled up in another mental disorder, or it worsens to become a more severe conduct disorder.

Do you think ODD is something you’ve ever witnessed, or perhaps even been diagnosed with as a child?

 

You can find the rest of my What Is series here.

Sources:

 

book cover: Making Sense of Psychiatric Diagnosis by Ashley L Peterson

 

My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses.  It’s available on the MH@H Store, as well as Amazon and other major retailers.

 

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21 thoughts on “What is… Oppositional Defiant Disorder

    • ashleyleia says:

      That’s specifically for antisocial personality disorder; oppositional defiant disorder is diagnosed in childhood. In general personality disorders aren’t diagnosed until there’s been enough time for the personality to fully form. Antisocial PD has a set minimum age of 18 because it’s such a negative thing to have on one’s records.

  1. Michelle says:

    I did not know this was a disorder. I have never experienced this but a lot of these behaviors seem common in kids. My younger sister hated following the rules when she was a child.

  2. Melanie B Cee says:

    Upon reading this and the symptoms of ODD, doesn’t it also cross over with BPD? I know that each of those symptoms could describe my mother, even as an adult. I’ve found as I age I’m developing them, save the vindictive and spiteful or the deliberate part. But I don’t seem to have control over lashing out more and more, which is disturbing. I also do not blame anyone for my situation or moods. So there are variants. And one of my siblings is developing the same behavior patterns too, I don’t think it’s deliberate in his case either, but he never used to be so fractious and grumpy. Being raised by a person with probably BPD (undiagnosed), my therapist says I’m going to have or do have acquired BPD (if such a thing exists) because that’s how I was taught (through example) to behave. I was able to squash those tendencies for many years, but now? Nah.

    • ashleyleia says:

      ODD is something that starts young that people usually grow out of, and I suspect it’s probably a different phenomenon from people getting more crotchety with age. The increasing crotchetiness pattern is something I’ve definitely seen in some members of my own family.

  3. Meg says:

    Yeah, I was a horribly behaved child. I’d shriek my lungs out and throw godawful tantrums quite regularly, starting around age seven. I didn’t manage to get my temper under control for a few decades. I always thought I was a bad person, even at that age. And that’s why I think people who diagnose this should look closely at the parents and at least entertain the possibility that things aren’t as they seem in the home. You know how my mom was the “perfect parent who couldn’t understand why her children were so poorly behaved, because she gave them so much love,” right? There can be a second side to a kid who can’t behave well. On the other hand, you could be a great parent and be raising a future psychopath, so I guess as a family counselor, you’d have to be pretty open-minded and not quick to judge, at least not externally (out loud). ‘Cause I think all the kids I worked with at residential treatment facilities had these diagnoses, but they’d all been horrifically abused as well, in most cases. It’s a tough issue. Great blog post!

  4. Joshua Shea says:

    Thanks for covering this, I always wanted to know more. It was amazing how many of the younger men in jail seemed to suffer from this when I was there. I don’t think they could follow the rules if they wanted. The way I seemed unable to escape my addictions for so long reminded me of the way they couldn’t escape their maladjusted behaviors. It was fascinating, but also sad, because I can’t imagine what kind of a life that leads to in the end. Hopefully they did grow out of it.

  5. Hannah Celeste says:

    Fascinating post! I had never heard of this before, but I have known people who seemed to exhibit those symptoms (especially in middle and high school). My mom probably would have described me as having this disorder as a teenager…but I’m not sure that I was any more angry and disobedient than a stereotypical moody teenager?

    • ashleyleia says:

      This does seem like a disorder where it would be hard to different “normal” from abnormal. The moody teenager stereotype is one of those stereotypes that’s got quite a bit of basis in truth.

  6. kachaiweb says:

    Looking at the biological and environmental possible causes, that is quite something. I’m happy to read that family is involved in therapy because ‘labelling’ a young child takes a toll on their self-esteem and self-worth. On the other hand a lot of children are labeled ‘as just difficult’. Reading your post it feltfor me that a child, who is dependent for years on the adults in his life and the home, context they grow up in, could also be ‘expected’ to rebel in some sort of way. Because being too good isn’t the answer either. When a child doesn’t get the support he/she needs, it is gonna show.

    • ashleyleia says:

      Absolutely, and it’s so essentially to intervene properly when a child is young so they’re actually given a fighting chance to make something of their adult lives.

  7. Kerry says:

    My oldest son has an ODD diagnosis and it’s an absolute nightmare.

    You never know what is going to trigger him to completely lose his mind and smash everything in site. The language he uses is especially hard to deal with. I don’t even know where those types of words come from as I do not talk to anyone or use the language that he does.

    I’ve found that consistency is absolutely essential. You must also find a backbone of steel to stick to your guns and ensure that no means no and to not allow yourself to react to the behaviour.

    It’s definitely one of those disorders that impacts the entire family and often leads to self-isolation because it feels so much easier to not do things than to sit on pins and needles waiting for the next outburst.

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