Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a behaviour disorder that involves a persistent pattern of irritability or anger, defiant behaviours, volatility and argumentative communication. Oppositional defiant disorder may progress to conduct disorder as the transition from teenager to young adult.

Psychotherapy, family therapy and parent education on management techniques are recommended in the treatment of oppositional defiant disorder. You may also be prescribed medication. ODD is often found to be present with other mental health issues; in particular ADHD, Drug and Alcohol misuse, depression/anxiety, trauma and is sometimes combined with learning disabilities. In some cases, residential treatment is recommended as a primary course of treatment. The Wave offers intensive programs in conjunction with family therapy to assist with ODD and Conduct Disorder. Our therapists and residential Psychiatrists will work in partnership with the family to reduce the impact of ODD and CD and prepare for a brighter future. 

Conduct Disorder

Conduct Disorder is a complex mental health issue. Research suggests that there is a developmental link between ODD and Conduct Disorder. This really means that those young people diagnosed with Conduct Disorder would have previously met the criteria for oppositional defiant disorder; this is most evident in young people who meet the threshold for diagnosis of ODD prior to adolescence.

Conduct Disorder is a relative and persistent pattern of behaviour that impacts the rights of others, normal societal ‘rules’ and negatively impacts those close to the young person or teen.

DSM-5 (American Psychiatric Association) lists the following criteria for diagnosis:

Aggression to People and Animals

• Often bullies threaten or intimidate others
• Often initiates physical fights
• Has used a weapon that can cause serious bodily harm to others (e.g. a bat, brick, broken bottle, knife, gun)
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim
• Has forced someone into sexual activity

Destruction of Property

• Has deliberately engaged in fire setting intending to cause serious damage
• Has deliberately destroyed other’s property (with the exception of fire starting)

Deceitfulness or Theft

• Has broken into someone else’s house, car, building or other
• Often lies to obtain goods or favours or to avoid obligations (‘cons’ others)
• Has stolen items of nontrivial value without confronting a victim (shoplifting, forgery, etc.)

Serious Violations of Rules

• Often ignores curfew times or parental prohibitions, starting prior to age 13
• Has run away from home at least twice from the parental home or at least once for a lengthy period
• Has been truant from school before the age of 13

Conduct disorder may be evident before the age of 10 or may be seen to begin in adolescence. It can have serious implications for the young person concerned and their family. It is imperative that mental health services are consulted, and a treatment plan agreed with the child and family.

Anger and Aggression

Aggression in young people can be part of a general agitation or something that is more pronounced. We may see aggression at home, with the young person losing their temper, being agitated, possibly damaging the home or objects within the home and occasionally having violent outbursts. Young people experiencing aggression might have been in trouble at school or find conflict within their peer groups. These problems can escalate quickly. Aggression can be linked to many challenges, and to addiction in particular. Periods of withdrawal or of obsession about the person’s drug of choice can cause high levels of agitation. 

This is an experience can be very frightening for families, especially as it often results in exclusion or suspension from school. It’s also worrying when there are siblings around, as they can be affected by the aggressive outbursts. Those with aggressive tendencies can also run into problems with the police or get involved in legal matters. Aggression may also have happened in previous treatment experiences when the person might have lashed out verbally or physically with medical or care staff.

Aggression can be the result of many different mental health concerns, but we commonly see something called Intermittent explosive disorder (IED), which is an oppositional defiant disorder that can lead to violent moods and outbursts. Under the umbrella of personality disorders, such as borderline personality disorder, we often see a low level of continuous rage which can result in outbursts. 

Intensive Residential Treatment Can Help Challenging Behaviours

This treatment has to be very respectful of the individual, and must go slowly, working towards providing a safe and secure environment. At The Wave, our philosophy is that all feelings and emotions are welcome in the treatment room – provided that no one’s going to get hurt or hurt themselves. We work in a very safe and structured manner which doesn’t exclude people from treatment but may mean that we need extra support for that individual in order to protect them and protect those around them.