Disruptive behavioral disorders

The disruptive behavioral disorders (DBD) include: (1) oppositional defiant disorder (ODD); (2) three types of conduct disorders (CD), which are dependant on and defined by the age of onset; and (3) disruptive behavior disorder not otherwise specified (DBD-NOS) [1]. Most DBD cases are present and usually evident in early childhood or adolescence. Reviews of literature demonstrate that they represent one of the most frequently encountered groups of child and adolescent psychiatric disorders [2]. Numerous studies have found CD to be the most common reason for referral of children and adolescents for psychiatric evaluations [3]. The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revision (DSM-IV-TR) defines the essential feature of ODD as a recurrent pattern of behavior persisting at least 6 months with negativity, defiance, disobedience, and hostility directed toward authority figures. DSM-IV-TR defines the essential feature of CD as a persistent and repetitive pattern of behavior lasting at least 12 months in which the basic rights of others or major age-appropriate societal norms or rules are violated. DSM-IV-TR defines DBD-NOS as the diagnosis for those individuals who do not meet the criteria for ODD or CD with a pattern of significant oppositional and conduct behaviors [1]. Frequently, these behaviors create more disruption, disturbance, and distress for other people than for those who cause or create it. ODD behavior and symptoms present primarily as verbal (eg, verbal aggression and defiance). ODD crosses over to CD when behavior and symptoms become physical (eg, fighting, destruction, and stealing). Frequently, individuals with a CD diagnosis will meet diagnostic criteria for ODD. The reverse is not true; those individuals with a diagnosis of ODD are not able to meet diagnostic criteria for CD. Subsequently, as stated in DSM, if or when an individual demonstrates the ability to satisfy diagnostic criteria for ODD and CD, the CD diagnosis preempts the diagnosis of ODD, and therefore, only a CD diagnosis is given [1]. In clinics, an individual who meets criteria for CD will almost always meet criteria for ODD.