psychology 101 class, 9wks tasks

Delirium, major neurocognitive disorder, and personality change due to another med­ ical condition, aggressive type. A diagnosis of intermittent explosive disorder should not be made when aggressive outbursts are judged to result from the physiological effects of an­ other diagnosable medical condition (e.g., brain injury associated with a change in personality characterized by aggressive outbursts; complex partial epilepsy). Nonspecific abnormalities on neurological examination (e.g., "soft signs") and nonspecific electroencephalographic changes are compatible with a diagnosis of intermittent explosive disorder unless there is a di­ agnosable medical condition that better explains the impulsive aggressive outbursts. Substance intoxication or substance withdrawal. A diagnosis of intermittent explosive disorder should not be made when impulsive aggressive outbursts are nearly always as­ sociated with intoxication with or withdrawal from substances (e.g., alcohol, phencyclidine, cocaine and other stimulants, barbiturates, inhalants). However, when a sufficient number of impulsive aggressive outbursts also occur in the absence of substance intoxication or withdrawal, and these warrant independent clinical attention, a diagnosis of intermittent explosive disorder may be given. Attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disor­ der, or autism spectrum disorder. Individuals with any of these childhood-onset dis­ orders may exhibit impulsive aggressive outbursts. Individuals with ADHD are typically impulsive and, as a result, may also exhibit impulsive aggressive outbursts. While indi­ viduals with conduct disorder can exhibit impulsive aggressive outbursts, the form of ag­ gression characterized by the diagnostic criteria is proactive and predatory. Aggression in oppositional defiant disorder is typically characterized by temper tantrums and verbal ar­ guments with authority figures, whereas impulsive aggressive outbursts in intermittent explosive disorder are in response to a broader array of provocation and include physical assault. The level of impulsive aggression in individuals with a history of one or more of these disorders has been reported as lower than that in comparable individuals whose symptoms also meet intermittent explosive disorder Criteria A through E. Accordingly, if Criteria A through E are also met, and the impulsive aggressive outbursts warrant inde­ pendent clinical attention, a diagnosis of intermittent explosive disorder may be given.

Comorbidity Depressive disorders, anxiety disorders, and substance use disorders are most commonly comorbid with intermittent explosive disorder. In addition, individuals with antisocial personality disorder or borderline personality disorder, and individuals with a history of disorders with disruptive behaviors (e.g., ADHD, conduct disorder, oppositional defiant disorder), are at greater risk for comorbid intermittent explosive disorder.

Conduct Disorder Diagnostic Criteria A. A repetitive and persistent pattern of behavior in which the basic rights of others or ma­

jor age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the cate­ gories below, with at least one criterion present in the past 6 months: A ggression to People and Anim als

1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat,

brick, broken bottle, knife, gun).

4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion,

armed robbery). 7. Has forced someone into sexual activity. Destruction of Property

8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). Deceitful ness or Theft

10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting,

but without breaking and entering: forgery). Serious Violations of Rules

13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or pa­

rental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years.

B. The disturbance in behavior causes clinically significant impairment in social, aca­ demic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Specify whether: 312.81 (F91.1) C hildhood-onset type: Individuals show at least one symptom char­ acteristic of conduct disorder prior to age 10 years. 312.82 (F91.2) A dolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years. 312.89 (F91.9) Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

Specify if: With limited prosocial emotions: To qualify for this specifier, an individual must have dis­ played at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple infor­ mation sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers).

Lack of rem orse or guilt: Does not feel bad or guilty when he or she does some­ thing wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules. Callous—lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others.