Most kids will act up or become disruptive or defiant sometimes. Disruptive and conduct disorders, however, involve much more severe and longer-lasting behaviors than typical, short-lived episodes.

Disruptive, impulse-control and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania. These disorders can cause people to behave angrily or aggressively toward people or property. They may have difficulty controlling their emotions and behavior and may break rules or laws.

An estimated 6 percent of children are affected by oppositional defiant disorder or conduct disorder1. Each year, an estimated 2.7 percent of children and adults in the U.S. are affected by intermittent explosive disorder. Kleptomania and pyromania are rare, affecting 1 percent or fewer of people in the U.S. 2,3

The angry, aggressive or disruptive behaviors of people with conduct and disruptive disorders are more extreme than typical behaviors. The behaviors:

are frequent
are long lasting
occur across different situations
cause significant problems
One difference between conduct disorders and many other mental health conditions is that with conduct disorders, a person’s distress is focused outward and directly affects other people. With most other mental health conditions, such as depression and anxiety, a person’s distress is generally directed inward toward themselves.

Conduct disorders tend to begin in childhood or adolescence and are more common in males than females. Several factors make it more likely a person will have a conduct disorder, including harsh parenting, physical or sexual abuse, or parents with a history of addiction or problems with law enforcement4.

Types of Disorders
Oppositional Defiant Disorder

Symptoms of oppositional defiant disorder (ODD) include:

Angry/irritable mood—often loses temper, easily annoyed, often angry and resentful
Argumentative/defiant behavior—often argues with authority figures, often refuses to comply with requests or rules, deliberately annoys others, blames others for mistakes or misbehavior
Vindictiveness—spiteful or vindictive
These behaviors upset the individual or others around him/her or cause problems at school, work or social activities. Symptoms are more severe than normal misbehavior.

To be diagnosed with ODD, the behaviors must occur with at least one individual who is not the person’s sibling. Signs of the disorder often develop as early as the preschool years. For children under age 5, the behavior occurs on most days for at least six months. For people 5 and older, the behavior occurs at least once per week for at least six months.

ODD is diagnosed by a psychiatrist or other mental health professional based on information from the individual (child, adolescent, adult) and, for children/adolescents, from parents, teachers and other caregivers. The American Academy of Child and Adolescent Psychiatry (AACAP) notes that it’s important for a child to have a comprehensive evaluation to identify any other conditions which may be contributing to problems, such as ADHD, learning disabilities, depression or anxiety.

Treatment of ODD often involves a combination of therapy and training for the child, and training for the parents. For children and adolescents, cognitive problem-solving training can teach positive ways to respond to stressful situations. Social skills training helps children and youth learn to interact with other children and adults in a more appropriate, positive way.

Parent management training can help parents learn skills and techniques to respond to challenging behavior and help their children with positive behavior. The training focuses on providing supportive supervision and immediate, consistent discipline for problem behavior. According to ACAAP, on–time or short programs that try to scare or coerce children and adolescents into behaving, such as tough-love or boot camps, are not effective and may even be harmful.

If you’re concerned about your child’s behavior, talk to your child’s doctor or a mental health professional, such as a child psychiatrist or psychologist or a child behavioral specialist.

Conduct Disorder

Conduct disorder is a more serious disorder than ODD involving ongoing behavior that breaks social rules. It may involve acting aggressively toward people and animals (such as bullying, physical fights, use of a weapon), destroying other people’s property on purpose, lying or stealing, or violating important rules (such as running away overnight or often skipping school before age 13).

The behavior causes significant problems in school or social activities. People with conduct disorder may deny or downplay their behaviors. Conduct disorder is only diagnosed in children and youth up to 18 years of age. Adults with similar symptoms may be diagnosed with antisocial personality disorder. Early treatment can help prevent problems from continuing into adulthood.

Therapy can help children learn to change their thinking and control angry feelings. Treatment may include parent management training and family therapy, such as Functional Family Therapy. Functional Family Therapy helps families understand the disorder and related problems, teaches positive parenting skills and helps build family relationships. It can help families apply positive changes to other problem areas and situations.

Intermittent Explosive Disorder

A person with intermittent explosive disorder has frequent impulsive, aggressive, angry outbursts. These can be verbal or physical aggression toward property, animals or other people. The aggressive outbursts:

are out of proportion to the event or incident that triggered them
are impulsive
cause much distress for the person
cause problems at work or home.
Intermittent explosive disorder is not diagnosed in children under age 6. People who experienced physical and emotional trauma as a child or teenager are at greater risk of developing it.

Treatment typically involves cognitive behavioral therapy focusing on changing thoughts related to anger and aggression, and developing relaxation and coping skills. Sometimes, depending on a person’s age and symptoms, medication may be helpful.

Other Associated Disorders

Other disorders in the category include pyromania and kleptomania. These involve problems with controlling for specific behaviors.

Pyromania involves repeatedly setting fires on purpose. People with pyromania may have an unusual interest in or fascination with fires. They set fires to release built-up inner emotional tension, not for any type of material gain or revenge.

Treatment of pyromania usually involves cognitive behavioral therapy. The therapy can help people become more aware of the feelings of tension and find ways to cope.

Kleptomania involves stealing objects that are not needed. People with kleptomania know what they are doing is wrong but cannot control the impulse. The disorder often begins in teenage years and is three times more common among women than men.

Treatment
Treatment for conduct disorders typically involves therapy focusing on behaviors, thoughts and feelings. It can be individual, group or family therapy. For children, treatment also often involves training for the parents on how to respond to challenging behaviors and how to help their children. People with these disorders may be fearful and distrustful and may not want to participate in treatment.

Medications are generally not used to directly treat conduct disorders (but can be used for intermittent explosive disorder). However, medications may be used for other conditions that frequently occur along with these conditions. For example, if a child or teen also has as attention-deficit/hyperactivity disorder (ADHD) or depression, medication may be useful.

Related Conditions
Attention-deficit/hyperactivity disorder
Autism spectrum disorder
Disruptive mood dysregulation disorder
Social communication disorder

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 2013.
Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, et al. Mental Disorders and Disabilities Among Low-Income Children. Boat TF, Wu JT, editors. Washington (DC): National Academies Press; 2015 Oct 28.
Vaught, MG, et al. Prevalence and Correlates of Fire-Setting in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Compr Psychiatry. 2010 May–Jun; 51(3): 217–223.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. American Psychiatric Publishing. 2015.