In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is oppositional defiant disorder.
Oppositional defiant disorder in the DSM-5
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, the symptoms can’t be solely directed at a sibling:
- argumentative/defiant behaviour: refuses to follow rules/directions, deliberately annoys others, blames others for own mistakes
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.
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 with 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 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.
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.
- American Academy of Child & Adolescent Psychiatry: Oppositional defiant disorder: A guide for families
- American Family Physician: Common questions about oppositional defiant disorder
- Pearson Clinical: Oppositional defiant disorder DSM-5 diagnostic criteria