This category applies to presentations in which symptoms characteristic of gender dys- phoria that cause clinically significant distress or impairment in social, occupational, 0r oth- er important areas of functioning predominate but do not meet the full criteria for gender dysphoria. The unspecified gender dysphoria category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for gender dyspho- ria, and includes presentations in which there is insufficient information to make a more specific diagnosis.
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D I S TU pIIVG, | m p U I SG-COIIIFOI, and conduct disorders include conditions involv- ing 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 dis- orders in this chapter and among individuals within a given diagnostic category.
The chapter includes oppositional defiant disorder, intermittent explosive disorder, con- duct disorder, antisocial personality disorder (which is described in the chapter ”Personality
Disorders”), pyromania, kleptomania, and other specified and unspecified disruptive, im- pulse-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 emo- tion, 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 opposi- tional defiant disorder, in which the criteria are more evenly distributed between emotions (anger and irritation) and behaviors (argumentativeness and defiance). I’yromania and kleptomania are less commonly used diagnoses characterized by poor impulse control re- lated to specific behaviors (fire setting or stealing) that relieve internal tension. Other speci- fied 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 di— agnostic 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 relation- ship between oppositional defiant disorder and conduct disorder, in that most cases of con— duct 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 prob- lems besides conduct disorder, including anxiety and depressive disorders.