DSM-5 Diagnostic Criteria
Oppositional defiant disorder 313.81 (F91.3)
A. A pattern of anger/irritability, arguing/defiant or vindictive attitude that lasts at least six months, is manifested by at least four symptoms from any of the following categories, and is exhibited during interaction with at least one person. individual other than a brother.
Anger/irritability
1. He often loses his cool.
2. You are often touchy or easily upset.
3. He is often angry and resentful.
Arguments/challenging attitude
4. Argues often with authority or with adults, in the case of children and adolescents.
5. Often actively defies or refuses to comply with requests from authority figures or norms.
6. Often deliberately annoys others.
7. You often blame others for your mistakes or bad behavior.
Vengeful
8. You have been spiteful or vindictive at least twice in the last six months.
Note: The persistence and frequency of these behaviors must be considered to distinguish those that are considered within normal limits from those that are symptomatic. In children under five years of age the behavior should occur almost every day for a period of at least six months, unless otherwise observed (Criterion A8). In children five years of age or older, the behavior must occur at least once a week for at least six months, unless otherwise observed (Criterion A8). Although these frequency criteria are considered the minimum indicative degree to define the symptoms, other factors must also be taken into account, for example, if the frequency and intensity of the behaviors exceed the limits of what is normal for the degree of development of the individual, their sex and their culture.
B. This behavioral disorder is associated with discomfort in the individual or in other people in his or her immediate social environment (i.e., family, group of friends, coworkers) or has a negative impact in the social, educational, or professional areas. or other important ones.
C. The behaviors do not appear exclusively during the course of a psychotic disorder, a substance use disorder, a depressive disorder, or a bipolar disorder. Additionally, the criteria for disruptive mood dysregulation disorder are not met.
Specify the current severity:
Mild: Symptoms are limited to one environment (e.g., at home, at school, at work, with peers).
Moderate: Some symptoms appear in at least two settings.
Severe: Some symptoms appear in three or more settings.
The essential characteristic of oppositional defiant disorder is a recurrent pattern of oppositional, defiant, disobedient, and hostile behavior directed toward authority figures that persists for at least 6 months and is characterized by the frequent occurrence of at least 4 of the following behaviors:
Outbursts of anger, arguing with adults, actively defying or refusing to comply with adults’ demands or rules, deliberately carrying out acts that will upset other people, accusing others of their own mistakes or behavioral problems, being touchy or easily bothered by others, being angry and resentful, or being spiteful or vindictive. To qualify as oppositional defiant disorder, the behaviors must occur more frequently than typically observed in people of comparable age and developmental level, and must produce significant impairment in social, academic, or work functioning. The diagnosis is not established if the behavioral disorder appears exclusively in the course of a psychotic disorder or a mood disorder, or if criteria for conduct disorder or antisocial personality disorder are met (in a person over 18 years).
Negative and defiant behaviors are expressed by persistent stubbornness, resistance to commands, and reluctance to compromise, give in, or negotiate with adults or peers. Provocations can also include deliberate or persistent testing of established boundaries, usually ignoring commands, arguing, or not accepting being blamed for one’s actions. Hostility may be directed at adults or peers and is manifested by deliberately annoying others or verbally attacking them (usually without the more serious physical attacks seen in conduct disorder). The disorder almost invariably manifests itself in the family environment, and may not become evident at school or in the community. Symptoms of the disorder are often more evident in interactions with adults or peers whom the youth knows well, and therefore may not manifest during clinical examination. Typically, young people with this disorder do not consider themselves to be negativistic or defiant, but rather justify their behavior as a response to unreasonable demands or circumstances.
The symptoms and associated disorders vary depending on the age of the person and the severity of the disorder. It has been observed that in boys the disorder is more prevalent among those who, during the school years, have problematic temperaments (e.g., high reactivity, difficulty calming down) or high motor activity. During the school years there may be low self-esteem, emotional lability, low tolerance for frustration, use of profanity and early consumption of alcohol, tobacco or illegal substances. Conflicts with parents, teachers and classmates are frequent. A vicious cycle can develop in which parent and child bring out the worst in each other. Oppositional defiant disorder is more prevalent in families where the child’s care is disturbed by the succession of different caregivers or in families in which educational practices are harsh, incoherent or negligent.
Since transient oppositional behaviors are very common in preschool children and adolescents, caution is necessary when establishing the diagnosis of oppositional defiant disorder, especially during these periods of development.
Oppositional defiant disorder usually manifests itself before the age of 8 and generally no later than the beginning of adolescence. Negative symptoms usually emerge in the family environment, but over time they can occur in other environments. Their onset is typically gradual, and they usually persist over months or years. In a significant proportion of cases, oppositional defiant disorder constitutes an evolutionary antecedent to conduct disorder.
Treatment
Most explanations for the onset of the disorder refer to the development of an insecure attachment in the child as well as inconsistent family guidelines and limits.
The treatment of this disorder is carried out individually with the child and also with the family. The axes of the intervention revolve around:
-Increased social skills.
-Training in types of reinforcement aimed at parents.
-Establishment and maintenance of limits and standards, as well as contingencies.
-Training in techniques to recognize and manage anger and anxiety.
Sources:
American Psychiatric Association, APA (2002). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Revised text. Barcelona: Masson.