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and Conduct Disorders

Disruptive, impulse-control, and conduct disorders include conditions involving

problems in the self-control of emotions and behaviors. While other disorders in DSM-

5 may also involve problems in emotional and/or behavioral regulation, the disorders in

this chapter are unique in that these problems are manifested in behaviors that violate the

rights of others (e.g., aggression, destruction of property) and/or that bring the individual

into significant conflict with societal norms or authority figures. The underlying causes of

the problems in the self-control of emotions and behaviors can vary greatly across the disorders

in this chapter and among individuals within a given diagnostic category.

The chapter includes oppositional defiant disorder, intermittent explosive disorder, conduct

disorder, antisocial personality disorder (which is described in the chapter “Personality

Disorders”), pyromania, kleptomania, and other specified and unspecified disruptive, impulse-

control, and conduct disorders. Although all the disorders in the chapter involve

problems in both emotional and behavioral regulation, the source of variation among the

disorders is the relative emphasis on problems in the two types of self-control. For example,

the criteria for conduct disorder focus largely on poorly controlled behaviors that violate the

rights of others or that violate major societal norms. Many of the behavioral symptoms (e.g.,

aggression) can be a result of poorly controlled emotions such as anger. At the other extreme,

the criteria for intermittent explosive disorder focus largely on such poorly controlled emotion,

outbursts of anger that are disproportionate to the interpersonal or other provocation

or to other psychosocial stressors. Intermediate in impact to these two disorders is oppositional

defiant disorder, in which the criteria are more evenly distributed between emotions

(anger and irritation) and behaviors (argumentativeness and defiance). Pyromania and

kleptomania are less commonly used diagnoses characterized by poor impulse control related

to specific behaviors (fire setting or stealing) that relieve internal tension. Other specified

disruptive, impulse-control, and conduct disorder is a category for conditions in which

there are symptoms of conduct disorder, oppositional defiant disorder, or other disruptive,

impulse-control, and conduct disorders, but the number of symptoms does not meet the diagnostic

threshold for any of the disorders in this chapter, even though there is evidence of

clinically significant impairment associated with the symptoms.

The disruptive, impulse-control, and conduct disorders all tend to be more common in

males than in females, although the relative degree of male predominance may differ both

across disorders and within a disorder at different ages. The disorders in this chapter tend to

have first onset in childhood or adolescence. In fact, it is very rare for either conduct disorder or

oppositional defiant disorder to first emerge in adulthood. There is a developmental relationship

between oppositional defiant disorder and conduct disorder, in that most cases of conduct

disorder previously would have met criteria for oppositional defiant disorder, at least in

those cases in which conduct disorder emerges prior to adolescence. However, most children

with oppositional defiant disorder do not eventually develop conduct disorder. Furthermore,

children with oppositional defiant disorder are at risk for eventually developing other problems

besides conduct disorder, including anxiety and depressive disorders.

Many of the symptoms that define the disruptive, impulse-control, and conduct disorders

are behaviors that can occur to some degree in typically developing individuals.

Thus, it is critical that the frequency, persistence, pervasiveness across situations, and impairment associated with the behaviors indicative of the diagnosis be considered relative

to what is normative for a person’s age, gender, and culture when determining if they are

symptomatic of a disorder.

The disruptive, impulse-control, and conduct disorders have been linked to a common

externalizing spectrum associated with the personality dimensions labeled as disinhibition

and (inversely) constraint and, to a lesser extent, negative emotionality. These shared personality

dimensions could account for the high level of comorbidity among these disorders

and their frequent comorbidity with substance use disorders and antisocial personality

disorder. However, the specific nature of the shared diathesis that constitutes the externalizing

spectrum remains unknown.