Most of us can remember a time when we had difficulty controlling our emotions, lashed out, argued, opposed social norms, or were simply defiant. These are common behaviors and often reactions to stressors in our environment. However, in some cases, disruptive patterns of behavior develop into serious problems for both the individual and society.
Externalizing Versus Internalizing
The way we manifest emotions, the emotions that drive conduct disorder, differ across people, with two main channels to express negative emotions: externalizing and internalizing. These two categories describe how emotions are expressed, either turned outward toward the world, or inward toward the self.
Externalized emotions are those that are directed outward and often lead to observable behaviors. Anger, frustration, defiance, and impulsivity typically fall into this category. Children who externalize may show signs of aggression, rule-breaking, or frequent outbursts, behaviors that draw attention from adults, often in the form of discipline or concern. Disorders like Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are closely linked to these kinds of emotional expressions.
On the other hand, internalized emotions are turned inward. These include feelings like anxiety, sadness, guilt, or shame. Rather than acting out, children with internalizing tendencies might withdraw socially, become excessively self-critical, or struggle with somatic complaints like headaches or stomach-aches. These behaviors are often less visible, and as a result, internalizing disorders such as depression, anxiety, self-harm and eating disorders can go unnoticed for longer periods.
It’s important to remember that externalizing and internalizing emotions are not mutually exclusive. Many children experience both. For instance, a child may act out because they’re overwhelmed by internal feelings of fear or insecurity. Any mental health professional with the requisite Masters in Mental Health Counseling online or a similar degree can tell you that, when left unchecked, disruptive behavior disorder can greatly impact a child’s mental health.
In fact, understanding this emotional landscape helps caregivers and professionals respond with more empathy and targeted support, rather than simply focusing on the surface behavior.
Types of Disruptive Behavior Disorders
Disruptive Behavior Disorder (DBD) is a blanket term that encompasses several behavioral disorders currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Oppositional Defiant Disorder (ODD)
This disorder is significantly more common among young men and is characterized by a pattern of angry/irritable mood, argumentative/defiant behaviors lasting for more than 6 months.
Symptoms like losing one’s temper, irritability, anger, and resentment define the mood aspect, while repeated arguments with authoritative figures, deliberately ignoring others, and blaming others for one’s mistakes describe the oppositional defiant disorder. According to the DSM, rates are higher in people with ADHD.
Intermittent Explosive Disorder (IED)
Carefully abbreviating this one… IED describes recurrent, impulsive, and aggressive outbursts disproportionate to the situation, lasting less than 30 minutes. These episodes, which can involve verbal or physical aggression, occur at least twice weekly for three months or include three severe outbursts within a year.
IED often coexists with mood or anxiety disorders and is more prevalent in individuals with a history of trauma or ADHD, requiring careful diagnosis and management.
Conduct Disorder (CD)
CD is characterized by a pattern of aggressive and disobedient behavior towards others. Signs of conduct disorder are apparent in 80% of people before age 10, but the age of diagnosis ranges from around 8 to 16.
Criminal history or juvenile offending plays a big role in diagnosing conduct disorder, with criteria like aggression towards others, destruction of property, theft, running away, and more. CD is not a personality disorder, as those are only really diagnosed in people over 18, although CD and antisocial personality disorder are closely linked.
Anti-Social Personality Disorder (ASPD)
ASPD is closely linked to conduct disorder, and a proportion of young people with CD will go on to be diagnosed with ASPD. It is not exactly the ‘adult version’ of CD, but can only be diagnosed in people over 18. Nor is it the modern term for psychopathy (which is not a current DSM diagnosis), although psychopathic personality traits are linked to ASPD.
ASPD is defined similarly to conduct disorder by a pattern of impulsive, reckless, deceitful, irresponsible, aggressive, and unlawful behavior and a lack of remorse or indifference to the consequences of such actions. There must be evidence of these behaviors and evidence of conduct disorder with an onset before 15 (although not necessarily a diagnosis).
A differentiating diagnostic criterion for ASPD specifies that symptoms must not be due to a bipolar or schizophrenic episode; there is also overlap with BPD and other disorders, hence why a professional psychological evaluation is critical.
Causes and Risk Factors
There is no one cause for a disruptive behavioral disorder; for certain conditions like Anti-Social Personality Disorder, a family history increases the likelihood of the next generation struggling with the same issues. Instability in the home and a history of abuse are sadly common among young people with conduct disorder.
Oppositional defiance is another complex interplay of genetic predisposition, temperament, parenting practices, family dynamics, and environmental influences. Peer influences play a massive role in childhood development, and children with ODD and CD do not generally hang out with the ‘study group.’ Early drug usage, truancy, and law-breaking are seldom activities that kids do alone, which isn’t to say there is no individual responsibility, but friend choice matters.
Co-occurring issues like ADHD, substance abuse, PTSD, anxiety, and others are common in young people with Disruptive Behavior Disorders. The interplay of, say, attention issues due to ADHD, can compound underlying frustration in school and lead to increased outbursts.
Diagnosis, Treatment and Management
Behavior disorders are complex and require careful evaluation by a suitable professional, usually a psychologist or psychiatrist. These practised diagnosticians use a combination of structured interviews, behavioral checklists, and evaluations. They will likely want to talk to people close to the individual affected and look at their history.
Effective treatment for DBDs uses a combination of evidence-based strategies to address behavioral disruptions. Behavioral therapies like Parent-Child Interaction Therapy (PCIT) and Cognitive Behavioral Therapy (CBT) target emotional regulation, while family-based interventions like Multisystemic Therapy (MST) engage families and communities to improve parenting and environmental factors.
Medications, such as mood stabilizers, may support severe cases or co-occurring conditions like ADHD, but are always used alongside behavioral treatment and will only be prescribed by a psychiatrist or highly trained psychologist in some states.
In the long term, behavioral issues should be monitored, as issues like Conduct Disorder can progress into adulthood, although recent research has shown that the anti-social behavior associated with ASPD tends to peak in late adolescence. However, when psychological treatment is received, these disorders usually respond well.
A study conducted in Dalhousie University concluded that kids with Disruptive Behavior Disorders who took part in a short-term day program using proven therapeutic approaches started behaving much better at home. And the progress they made didn’t just disappear once the program ended. These improvements were relatively long lasting.
Moving Beyond Disruptive Behavior Disorders
Plenty of children and adolescents will show signs of a Disruptive Behavior Disorder, but do not meet the criteria for a diagnosis. Others will simply ‘outgrow’ disruptive tendencies. Many of us have and will go through tough periods in life where we externalize our emotions and act in a disruptive manner; this does not mean we need to be diagnosed with a disorder.
The bottom line is that behavior disorders should be taken very seriously, as they affect the individual, everyone close to them, and society as a whole; however, with proper treatment, care, and attention, they are treatable, especially when treatment begins early.
References:
Marzilli, E.; Cerniglia, L. & Cimino, S. (2021) Antisocial Personality Problems in Emerging Adulthood: The Role of Family Functioning, Impulsivity, and Empathy. Brain Sci.; 11(6):687.
Demmer, D. H. et. Al. (2017) Sex Differences in the Prevalence of Oppositional Defiant Disorder During Middle Childhood: a Meta-Analysis. J Abnorm Child Psychol; 45(2):313-325.
Clark, S. E. & Jerrott, S. (2012) Effectiveness of Day Treatment for Disruptive Behaviour Disorders: What is the Long-term Clinical Outcome for Children? J Can Acad Child Adolesc Psychiatry; 21(3):204-212.
APA (2002) DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Barcelona: Masson.
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