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Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes





Disruptive, Impulse-Control, and Conduct Disorders: Overview

Basic characteristics of disorders that fall within the category of disruptive, impulse-control, and conduct disorders are aggressive and self-destructive behaviors, destruction of property, conflict with authority figures, disregard for personal or social norms, and persistent outbursts of anger disproportionate to the situation (APA, 2013). Behaviors within this category are behaviors that infringe upon or violate the rights of others or vary significantly from the norms of society.

It is important to understand that nearly all children and adolescents experience symptoms of defiance, disobedience, and breaking rules at some point in their childhood development. In disruptive, impulse-control, and conduct disorders the behaviors are much more frequent, pervasive and result in impairment to the individual’s lives. These behaviors also significantly exceed the normative behaviors for their culture, age and gender.

Diagnostic Considerations:

Although the underlying cause of these disorders vary, they all seem to share the common characteristics of problems in regulating behaviors and emotions. All of these disorders result in significant impairment in daily functioning. These disorders are less common in females than males and the age of onset tends to be in childhood or adolescence. It is considered very rare for these types of behaviors to first manifest themselves in adulthood. There appears to be a developmental relationship between conduct disorder and oppositional defiant disorder in that individuals who receive a diagnosis of conduct disorder in their preadolescent years frequently have been diagnosed with oppositional defiant disorder at an earlier point in time. Approximately two thirds of children diagnosed with oppositional defiant disorder still meet the diagnostic criteria three years later. One of the higher risk indicators for conduct disorder is an earlier onset and diagnosis of oppositional defiant disorder. Researchers have concluded that children are three times more likely to receive a diagnosis of conduct disorder if they were previously diagnosed with oppositional defiant disorder. Also, mental health clinicians need to closely monitor clients with conduct disorder as there is a very strong connection between conduct disorder and antisocial personality disorder. Approximately 40% of individuals diagnosed with conduct disorder eventually meet the criteria for a diagnosis of antisocial personality disorder.




Developmental Causation:

There has been much research over the years related to the cause and/or etiology of disruptive, impulse control and conduct disorders. The most common causative factors include environmental, emotional, familial, and genetic factors. Although grouped together, there appear to be various and at times different developmental pathways to each disorder. Research has not currently identified many genetic factors associated with the disruptive behavior disorders although the genetic links to ADHD appear to be significant. Also, the biological contributions to disruptive or conduct disorders appear to be very limited. Most research and clinical experience seem to identify environmental causation to be the most significant. Negative experiences within the family including substance abuse by caregivers, caregiver criminality, low socioeconomic status, severe family dysfunction, negative interactions between parent and children, modeling of aggression, and abuse and neglect have been identified as some of the higher risk factors associated with the development of these disorders.

Some cognitive deficits have also been identified which include social-cognitive information processing and issues related to being rejected by peers. Neurological research has identified brain structures within the limbic system which is associated with the formation of emotions and memories in the frontal lobe, which is involved in planning and controlling impulses, and have also been identified as having some connection to disruptive and conduct disorders. In addition to the neurological irregularities, there has been some suggestion that imbalances in testosterone may also play some role in the development of disruptive behavioral and impulse control behaviors.

Treatment:

Treatment for the disruptive, impulse-control and conduct disorders can be very complex due to the various risk and etiological factors. Evidence-based treatments for these disorders usually falls within the categories of parent and family interventions, cognitive behavioral therapy and psychopharmacological treatment.

Psychosocial treatments or counseling related interventions usually seem to focus on parent training approaches which include improving positive time between parents and children, modeling behaviors, behavioral reinforcement of rewards and consequences and the development of positive coping skills for dealing with difficult behaviors.
Cognitive behavioral therapy can help to modify cognitive distortions which seem to underly disruptive behaviors. These therapeutic approaches assist children and adolescents to develop better problem-solving skills focused on improving control, recognizing social difficulties and triggers for their disruptive behaviors, and pursuing more effective alternatives. Interventions focusing on the parents and appropriate medications are also very common.
For very young children, parent training should be the primary treatment approach. For more chronic or severe behaviors, psychologists and mental health clinicians should consider a multidimensional treatment approach that involves teachers, parents, and mental health providers.

Individuals diagnosed with pyromania and kleptomania have been found to respond to psychopharmacological interventions. Also, cognitive behavioral therapy and dialectical therapy have been found to be helpful in some circumstances.

Individual diagnostic codes related to disruptive, impulse control and conduct disorders along with specific etiological and treatment information can be found on the following pages.

Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes

313.81 (F91.3) Oppositional Defiant Disorder
Specify current severity: Mild, Moderate, Severe

312.34 (F63.81) Intermittent Explosive Disorder

___.__ (___,__) Conduct Disorder

Specifiy whether:
312.81 (F91.1) Childhood-onset type

312.32 (F91.2) Adolescent-onset type

312.89 (F91.9) Unspecified onset

Specify if: With limited prosocial emotions
Specify current severity: Mild, Moderate, Severe

301.7 (F60.2) Antisocial Personality Disorder

312.33 (F63.1) Pyromania

312.32 (F63.3) Kleptomania

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (2013)