Disruptive mood dysregulation disorder. Oppositional defiant disorder shares with dis- ruptive mood dysregulation disorder the symptoms of chronic negative mood and temper outbursts. However, the severity, frequency, and chronicity of temper outbursts are more severe in individuals with disruptive mood dysregulation disorder than in those with oppositional defiant disorder. Thus, only a minority of children and adolescents whose symptoms meet criteria for oppositional defiant disorder would also be diagnosed with dis- ruptive mood dysregulation disorder. When the mood disturbance is severe enough to meet criteria for disruptive mood dysregulation disorder, a diagnosis of oppositional defiant dis- order is not given, even if all criteria for oppositional defiant disorder are met.
Intermittent explosive disorder. Intermittent explosive disorder also involves high rates of anger. However, individuals with this disorder show serious aggression toward others that is not part of the definition of oppositional defiant disorder.
Intellectual disability (intellectual developmental disorder). In individuals with intel- lectual disability, a diagnosis of oppositional defiant disorder is given only if the opposi- tional behavior is markedly greater than is commonly observed among individuals of comparable mental age and with comparable severity of intellectual disability.
Language disorder. Oppositional defiant disorder must also be distinguished from a failure to follow directions that is the result of impaired language comprehension (e.g., hearing loss).
Social anxiety disorder (social phobia). Oppositional defiant disorder must also be dis- tinguished from defiance due to fear of negative evaluation associated with social anxiety disorder.
466 Disruptive, Impulse-Control, and Conduct Disorders
Rates of oppositional defiant disorder are much higher in samples of children, adoles- cents, and adults with ADHD, and this may be the result of shared temperamental risk fac- tors. Also, oppositional defiant disorder often precedes conduct disorder, although this appears to be most common in children with the childhood-onset subtype. Individuals with oppositional defiant disorder are also at increased risk for anxiety disorders and ma- jor depressive disorder, and this seems largely attributable to the presence of the angry- irritable mood symptoms. Adolescents and adults with oppositional defiant disorder also show a higher rate of substance use disorders, although it is unclear if this association is in- dependent of the comorbidity with conduct disorder.
Diagnostic Criteria 312.34 (F63.81)
A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following: 1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals. or other individuals. occurring twice weekly, on average, for a period of 3 months. The physical aggression does not re- sult in damage or destruction of property and does not result in physical injury to animals or other individuals.
2. Three behavioral outbursts involving damage or destruction of property and/or ring within a 12-month period.
B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.
C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/ or anger—based) and are not committed to achieve some tangible objective (e.g., money, power, intimidation).
D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning. or are associated with finan- cial or legal consequences.
E. Chronological age is at least 6 years (or equivalent developmental level).