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:
- angry/irritable:
- quick temper
- easily annoyed
- often angry-resentful
- argumentative/defiant behaviour:
- refuses to follow rules/directions
- deliberately annoys others
- blames others for own mistakes
- vindictive/spiteful
To count towards diagnosis, the symptoms can’t be solely directed at a sibling
Treatment
Treatment involves work on problem-solving skills and behavioural therapy, and there would typically be family involvement. While medications aren’t used specifically for ODD, they may be used to treat common comorbid conditions like ADHD, mood disorders, or anxiety disorders. As a secondary benefit, treating these co-occurring disorders may result in improvements in the ODD symptoms.
Related disorders
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 later evolve into antisocial personality disorder, but the DSM requires waiting until after 18 to make that diagnosis.
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.
Contributing factors
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 such behaviours 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 into a more severe conduct disorder.
Do you think ODD is something you’ve ever witnessed, or perhaps even been diagnosed with as a child?
References
- American Academy of Child & Adolescent Psychiatry: Oppositional defiant disorder: A guide for families
- American Family Physician: Common questions about oppositional defiant disorder
- National Library of Medicine: DSM-IV to DSM-5 Oppositional Defiant Disorder Comparison
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
This is so interesting to read. I think what bothers me here is that there is not an earlier assessment done until a child is already at the age of 18. Why can’t a parental unit approved these assessments and diagnosis earlier on?
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.
Oh, okay. I misread that part. Sorry. Thank you for clearing that up for me.
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.
Yeah I imagine it could be hard to draw the line between “normal” kid behaviour and a disorder.
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.
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.
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.
It’s sad to see what long-lasting effects there can be from problems in childhood.
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?
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.
Well informed article, I learned something today. Thank you.
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.
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.
I wish I had a girlfriend like you
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.
It’s got to be especially hard when your ex isn’t willing to work with you and just undermines instead.