The DSM-V-TR and Disruptive, Impulse Control and Conduct Disorders

Emotional loss of control that translates into disruptions, conduct violations against social norms and laws, and the rights of others are the product of a variety of deeper seeding issues stemming in childhood.  While many of these disruptive, impulse control and conduct disorders manifest in early childhood, if left unchecked, they can continue to develop into early adulthood and root into a person’s personality.  In fact, conduct disorder itself, can be a precursor to anti-social disorder (DSM-V-TR, 2022).  With this in mind, it is important to teach, guide and when necessary reprimand children in accordance with morality, authority and law.  This is especially true for individuals who genetically have a predisposition to  impulse control, emotional outbreaks and defiance.

Disruptive, impulse control and conduct disorders develop during childhood but can cause impairment in adulthood. Please also review AIHCP’s Behavioral Health Certifications as well as its Anger Management Courses

Please also review AIHCP’s behavioral health certifications, including Anger Management Courses, as well as ADHD Consulting.

Types of Disorders

These types of disorders include issues with emotional control but especially when it infringes upon the rights of others.

Oppositional Defiant Disorder

This disorder tends to manifest early in childhood but can continue to persist in adulthood and hamper a person’s future relationships as well as one’s interaction with authority figures.  The DSM-V-TR points out that it is marked with a pattern of an overall angry and irritable mood that displays itself in an argumentative, defiant way, characterizing vindictiveness.  This mood persists for at least 6 months (DSM-V-TR, 2022).  It is important to evaluate this time frame because child development can sometimes mimic these behaviors short term and not necessarily constitute a long term disorder.  During this 6 month period, the individual must exhibit four of the below symptoms with at least one person who is not a sibling.

1.losing temper

2. touch or easily annoyed

3. often angry or resentful

4. often argues with authority figure

5. defies or refuses to comply with requests from an authority figure

6. deliberately annoys others

7. blames other for his or her mistakes or behaviors

8. exhibited spitefulness or vindictive behavior twice within the last 6 months

These symptoms can be specified as mild, moderate or severe (DSM. V-TR, 2022).

Intermittent Explosive Disorder

Loss of control and temporary rage can sometimes be more than a mere temper, loss of patience, or anger issue but can also be an emotional disorder that requires deeper care and therapy.  Intermittent Explosive Disorder emerges in childhood but can also persist into adulthood and cause serious relationship issues in all aspects of life and especially result in criminal charges.  The DSM-V-TR cites that IED exhibits frequent and recurrent outbursts due to a failure to control aggressive impulses (2022).  These outbursts can result in verbal aggression including temper tantrums, tirades, verbal arguments or even physical aggression towards property, animals or other people.  The outbursts can be limited to only verbal but also to physical confrontations that cause damage and injury.  The DSM-V-TR states that 3 serious infractions must occur within a 12 month period that result in damage or destruction, but frequent verbal aggression according to the first standard meets the first criteria.

Intermittent Explosive Disorder deals with sudden anger bursts that are not proportionate to the event

In addition to verbal or physical outbursts, the magnitude of the aggressiveness must not be proportionate with the provocation or to any of the causing stressors.  Individuals with IED react completely out of proportion to life events and daily stresses that others would not react to (DSM-V-TR, 2022).   In addition, these outbursts are not premeditated or meant to achieve some objective but are purely reactive.  In addition, these recurrent aggressions and outbursts cause considerable impairment to the person’s personal, professional, and interpersonal functioning.  Finally, the person must be at least 6 years of age.  This disorder manifests at a higher level in males and exist in both children and adults if left untreated (DSM-V-TR, 2022).  Please also review AIHCP’s Anger Management Consulting Certification.

Conduct Disorder

Conduct Disorder is a repetitive and persistent pattern of behavior which violates the rights of others, social norms and rules and laws of societal norms (DSM-V-TR, 2022). If 3 of the following 15 criteria is met over the past 12 months, with one having to be within 6 months, then an individual may be diagnosed with Conduct Disorder.  The categories of disorder include aggression, destruction of property, deceitfulness and theft, and serious violation of rules.

  1. Often bullies
  2. initiates physical fights
  3. uses weapons to cause harm
  4. cruel to other people
  5. cruel to animals
  6. stolen while confronting a victim
  7. fire setting
  8. destroying other’s property
  9. broken into another’s home
  10. lies to obtain goods or favors
  11. has committed non-violent theft
  12. defies curfews before age 13
  13. ran away from home at least twice
  14. truant from school

The DSM-V-TR points out that these acts constitute great inter-social impairment and have occurred before 18.  If over 18, the individual can qualify for diagnosis of Anti-Social Personality Disorder (2022).   Specifiers include childhood onset and adolescent onset.  In addition, specification can include with limited prosocial emotions, lack of remorse or guilt, callous or lack of empathy, unconcerned about performance, and shallow deficient affect (DSM-V-TR, 2022).   The condition can finally also be classified as mild, moderate or severe.

Within Conduct Disorder as well as Anti-Social Disorder, two other types of disorders can manifest.

Pyromania

This disorder leads to the deliberate and purposeful choice to set fires on more than one occasion.   The DSM-V-TR differentiates the setting of fire for reason or gain to that correlated with an affective arousal before the act that includes a fascination or interest about the attraction to fire.  Pleasure, gratification or relief is associated with setting the fire (2022).

Kleptomania

Like fire setting, the act of stealing in Kleptomania is not tied to gain or need but a recurrent failure to resist the impulse to steal due to the sense of tension to commit theft.   From this theft, comes gratification and relief that is not associated with any motive or need (DSM-V-TR, 2022).

The Role of ADHD in Many Disruptive, Impulse Control and Conduct Disorders

ADHD is not listed with these types of disorders in the DSM-V-TR but is listed under neurodevelopmental disorders, but it does cross lines with many impulse disorders and is commonly comorbid with those who also possess them (DSM-V-TR, 2022. Obviously man individuals with ADHD are not criminals, or have rage, but symptoms of ADHD can contribute to the inner turmoil of those.  This may have something to do with the lack of control of impulses and constant inability to maintain focus on one thing.

ADHD effects both attention and hyperactivity. Although diagnosed before 12, it does exist in adulthood. Please review AIHCP’s ADHD Consulting Program

For purposes of analysis, the DSM-V-TR states that ADHD causes persistent lack of ability to focus attention and/or possess hyperactivity or impulsiveness in behavior.  Some may exhibit only inattentiveness, while others may just display hyperactivity, while some may be burdened with both sets of symptoms.  These symptoms emerge before age 12 and can persist into adulthood.  Some elements of it are later controlled by a more developed brain in adulthood and manifest in other ways.  Inattentive symptoms include at least 6 of the following over a 12 month span

  1. failure to give attention to details resulting in careless mistakes
  2. difficulty sustaining attention
  3. does not seem to listen to instruction
  4. does not follow through on instructions
  5. difficulty organizing tasks
  6. reluctant to engage in tasks involving concentration
  7. loses things
  8. easily distracted by external stimuli
  9. often forgetful

Hyperactive symptoms must include 6 of the following over a 12 month period

  1. fidgets physically
  2. cannot remain seated
  3. runs, moves, climbs on things
  4. cannot engage in leisure activities
  5. unable to relax
  6. talks excessively
  7. blurts out answers without impulse
  8. difficulty waiting turns
  9. interrupts and intrudes

Again, according to the DSM-V-TR, these symptoms can be predominantly inattentive or hyperactive or consist of both symptoms.   It can also be classified as mild, moderate or severe (DSM-V-TR, 2022). It is no wonder then that many of these issues also correlate with various disruptive, impulse control and conduct disorders or later can possible develop into it.  Please also review AIHCP’s ADHD Consulting Program.

Etiology and Treatment of Disruptive, Impulse Control and Conduct Disorders

Many of these disorders include both nature and nurture.  ADHD exists at a level of 4 to 5 percent worldwide within children (Barlow, et al., 2023).  Genetically, individuals can be prone to higher risk taking within the brain that inhibits fear or punishment (Barlow, et al,.2023).  Biologically, levels of serotonin and epinephrine can be low with higher levels of testosterone (McRay, et al, 2016),.  In addition, lack of family discipline, family dysfunction, divorce, and lack of family involvement can lead to deeper seeded issues that manifest in the child’s behavior and if not treated later manifest in adulthood (McRay, et al., 2016).

Treatment for conduct and impulse control issues include behavioral strategies that try to correct the operant conditioning previously experienced in life.  Others include training for parents to better manage the child and teach the child structure.  Also important, includes various forms of CBT that look to help empower the child  with better social cognition skills and problem solving strategies.  For anger issues, sometimes peer groups can help.  Anger Management skills can help many find solutions to their temper.  Finally, stimulant medication can be beneficial due to these disorders high comorbidity with ADHD (McRay, et al., 2016).

Conclusion

Self control is important but is harder for those with impulse and disruptive disorders. Please also review AIHCP’s Healthcare Certification Programs

Ultimately, disorders are not justifications for poor behaviors but they are explanations why some children, and even adults, are more inclined to react and behave certain ways.  Merely because someone feels an urge or a stronger intense feeling to do wrong or be cruel is never a justification but with therapy and sometimes medication, individuals can be taught to better control and maintain disruptive and impulse control behaviors.

A strong moral conviction of right and wrong is always a powerful deterrent in life.  Understanding within one’s conscience that a feeling or urge does not justify a certain behavior is the first step to finding the help one needs.  Obviously at an earlier age, parental guidance and discipline is essential to prevent these disorders from completely transforming an individuals personality into habitual chaos.  Anger, lack of impulse control, defiance of authority and rage lead to many crimes and broken lives.  It is hence important to maintain control in these situations and if one cannot to find the necessary guidance and help to learn how to control one’s inner disorders.

Please also review AIHCP’s Behavioral Health Certifications as well as AIHCP’s Anger Management Consulting Certification as well as its ADHD Consulting Program

Additional Blogs

Intermittent Explosive Disorder.  Access here

ADHD.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

“What are Disruptive, Impulse Control and Conduct Disorders?” APA.  Access here

IED.  Mayo Clinic.  Access here

ODD. (2026). Cleveland Clinic.  Access here

“Oppositional Defiant Disorder”. Psychology Today.  Access here

Bhandari, MD, (2024). “Mental Health and Conduct Disorder”. WebMD.  Access here