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.