Health Provider Checklist for Adolescent and Young Adult Males

Mental Health

Disruptive, Impulse-Control and Conduct Disorders

Key Points

  • Disruptive, impulse control and conduct disorders include conditions involving problems in the sell-control of emotions and behaviors.
  • These 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.
  • Males with a diagnosis of conduct disorder frequently exhibit fighting, stealing, vandalism, and school discipline problems.
  • Oppositional Defiant Disorder (ODD) is more common in prepubescent boys than prepubescent girls.
  • Some clinical studies suggest that the majority (77–87.5%) of individuals with intermittent explosive disorder are males.

Questions to ask young male patients about Disruptive, Impulse-Control and Conduct Disorders

Overview

The chapter on disruptive, impulse-control, and conduct disorders is new to DSM-5. It includes oppositional defiant disorder, conduct disorder, disruptive behavior, impulse-control, disorders, intermittent explosive disorder, pyromania, and kleptomania. These disorders are all characterized by problems in emotional and behavioral self-control.

Disruptive, impulse control and conduct disorders include conditions involving problems in the sell-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 bring the individual into significant conflict with societal norms or authority figures.  These disorders includes oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, kleptomania and other specified and unspecified disruptive, impulse-control and conduct disorders.1

These 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. These disorders tend to have first onset in childhood or early adolescence.2

In childhood-onset conduct disorder, individuals are usually male, frequently display physical aggression toward others, have disturbed peer relationships, may have oppositional defiant disorder during early childhood, and usually have symptoms that meet full criteria for conduct disorder prior to puberty. Many children with this subtype also have concurrent ADHD.3 Males with a diagnosis of conduct disorder frequently exhibit fighting, stealing, vandalism, and school discipline problems.  Females tend to exhibit relatively more relationship aggression.4

Oppositional Defiant Disorder (ODD) is more common in prepubescent boys than prepubescent girls. After puberty the rates are about the same. However, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment.5

Intermittent explosive disorder is characterized by recurrent, significant outbursts of aggression, which result in assaultive acts against people or property, are disproportionate to outside stressors, and not better explained by another psychiatric condition (American Psychiatric Association, 2000). It is estimated that 4–7% of people in the United States have IED and usually meet diagnostic criteria during adolescence (ages 14–18; Coccaro et al., 2004; Kessler et al., 2006; Coccaro, 2010). Some clinical studies suggest that the majority (77–87.5%) of individuals with IED are males (Mattes, 2008; Coccaro et al., 2009)

The first outburst typically occurs in early adolescence and people with IED have an average of 43 lifetime attacks resulting in $1359 in property damage (Kessler et al., 2006). The majority (81.3%) also report significant psychosocial impairment due to IED symptoms (Coccaro et al., 2004). Individuals with IED consider their behavior distressing and problematic (McElroy et al., 1998), however, only 28.8% of people suffering from IED have ever received treatment (Kessler et al., 2006).

Approximately 82% of individuals with IED have co-occurring Axis I psychiatric disorders, most commonly mood (11–93%), anxiety (48–58.1%), and substance use (35.1–48%) disorders (Kessler et al., 2006; Grant, 2008). A recent family history study found that first-degree relatives of individuals with IED are more likely to have a psychiatric condition compared to control subjects, however specific rates of psychiatric conditions were not reported (Coccaro, 2010).6

Pyromania occurs much more often in males, especially those with poorer social skills and learning difficulties.7


1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. 2013. P 461.

2 Ibid

3 Ibid, P 471

4 Ibid, P 474.

5 Oppositional Defiant Disorder. Johns Hopkins Medicine.

6Schreiber, Liana, Odlaug, Brian L. and Grant, John E.  Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management. Front Psychiatry. 2011.

7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. 2013. P 477.