Disruptive, Impulse-Control and Conduct Disorders

Disruptive, impulse-control and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania. These disorders can cause people to behave angrily or aggressively toward people or property. They may have difficulty controlling their emotions and behavior and may break rules or laws.

One difference between conduct disorders and many other mental health conditions is that with conduct disorders, a person’s distress is focused outward and directly affects other people. With most other mental health conditions, such as depression and anxiety, a person’s distress is generally directed inward toward themselves.

Conduct disorders tend to begin in childhood or adolescence and are more common in males than females. Several factors make it more likely a person will have a conduct disorder, including harsh parenting, physical or sexual abuse, or parents with a history of addiction or problems with law enforcement.

Symptoms of oppositional defiant disorder (ODD) include:

• Angry/irritable mood—often loses temper, easily annoyed, often angry and resentful
• Argumentative/defiant behavior—often argues with authority figures, often refuses to comply with requests or rules, deliberately annoys others, blames others for mistakes or misbehavior

Vindictiveness—spiteful or vindictive

Conduct disorder is a more serious disorder than ODD involving ongoing behavior that breaks social rules. It may involve acting aggressively toward people and animals (such as bullying, physical fights, use of a weapon), destroying other people’s property on purpose, lying or stealing, or violating important rules (such as running away overnight or often skipping school before age 13).

A person with intermittent explosive disorder has frequent impulsive, aggressive, angry outbursts. These can be verbal or physical aggression toward property, animals or other people. The aggressive outbursts:

• are out of proportion to the event or incident that triggered them
• are impulsive
• cause much distress for the person
• cause problems at work or home.

Intermittent explosive disorder is not diagnosed in children under age 6. People who experienced physical and emotional trauma as a child or teenager are at greater risk of developing it.

• Other disorders in the category include pyromania and kleptomania. These involve problems with controlling for specific behaviors.
• Pyromania involves repeatedly setting fires on purpose. People with pyromania may have an unusual interest in or fascination with fires. They set fires to release built-up inner emotional tension, not for any type of material gain or revenge.
• Treatment of pyromania usually involves cognitive behavioral therapy. The therapy can help people become more aware of the feelings of tension and find ways to cope.
• Kleptomania involves stealing objects that are not needed. People with kleptomania know what they are doing is wrong but cannot control the impulse. The disorder often begins in teenage years and is three times more common among women than men.

Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociative symptoms can potentially disrupt every area of mental functioning.

Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body, and loss of memory or amnesia. Dissociative disorders are frequently associated with previous experience of trauma.

There are three types of dissociative disorders:

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder

Depersonalization/derealization disorder involves significant ongoing or recurring experience of one or both conditions:

• Depersonalization – experiences of unreality or detachment from one’s mind, self or body. People may feel as if they are outside their bodies and watching events happening to them.
• Derealization – experiences of unreality or detachment from one’s surroundings. People may feel as if things and people in the world around them are not real.

Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

• The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.
• Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

Dissociative amnesia involves not being able to recall information about oneself (not normal forgetting). This amnesia is usually related to a traumatic or stressful event and may be:

• localized – unable to remember an event or period of time (most common type)
• selective – unable to remember a specific aspect of an event or some events within a period of time
• generalized – complete loss of identity and life history (rare)

Dissociative amnesia is associated with having experiences of childhood trauma, and particularly with experiences of emotional abuse and emotional neglect. People may not be aware of their memory loss or may have only limited awareness. And people may minimize the importance of memory loss about a particular event or time.