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Oppositional Defiant Disorder (ODD): Symptoms, Causes, Treatment

Oppositional defiant disorder (ODD) is a diagnosis that is usually given to children and/or teenagers who engage in significant defiance of authority figures. This defiance may involve disobeying rules, starting arguments with parents, spiteful behavior, and/or intentionally annoying adults. Although some of this behavior is pretty normal for most kids and teens, if it becomes an ongoing problem that last over 6 months straight, it may be diagnosed as “oppositional defiant disorder.”

When diagnosing this condition, it is important to compare the individual to other people their age. Do they exhibit significantly more defiance than other people their own age? Does the defiant behavior interfere with school, work, or social relationships? If so, then they may have this condition. Before a diagnosis is made, it is important to understand that most kids and teens go through various phases of defiance. However, most kids and teens do not fit the formal diagnosis for oppositional defiant disorder.

There is a difference between occasional defiance and chronic defiance. ODD is a condition in which an individual has an ongoing set of uncooperative, hostile, annoying, or defiant behavior towards authority figures. Many people with oppositional defiant disorder also have comorbid behavioral problems such as ADHD, learning problems, mood disorders (e.g. depression, and possibly anxiety disorders.

Oppositional Defiant Disorder Symptoms (ODD)

  • Anger outbursts – It is very common for people with ODD to experience outbursts of anger. They may get extremely angry to the point of rage and become angry on a whim.
  • Blaming others for mistakes – Everyone makes mistakes, but people with ODD may blame others for mistakes that they make. For example, if a person with this disorder breaks a piece of furniture, they may come up with an excuse as to why it wasn’t their fault.
  • Easily annoyed/upset by others – They may get very annoyed with other people to the point that they avoid social interaction. Certain individuals such as siblings and other family members may upset them.
  • Frequent arguments with adults – It is not uncommon for people with ODD to let their defiance get the best of them. This may lead to frequent arguments with adults or individuals in authoritative positions.
  • Intentionally annoying others – When this disorder is not controlled, the person with it may intentionally try to annoy other people. In some cases they may think the annoyance is “funny” so they may keep doing it.
  • Low self-esteem – Many people with ODD have comorbid self-esteem issues. This may lead to them experimenting with alcohol and/or other drugs.
  • Mood swings – It is pretty commonplace for these individuals to experience mood swings. One minute they may be fine, the next they may erupt with anger or spiteful remarks towards another person that upset them.
  • Not complying with rules or requests – Individuals with this disorder may not follow any set rules or requests from other people. This makes them extremely difficult to work with because they may refuse to follow a simple set of instructions.
  • Saying mean things when upset – When upset, these individuals may “flip out” or start cursing out another person. They may dig deeper than the occasional retaliation and may really try to make another person feel worse than they should.
  • Spiteful / revenge seeking behavior – If something is said or done to these individuals and it upsets them, they may engage in some sort of revenge-seeking behavior. For example they may try to humiliate the person in front of others, they may damage property, or try to make the person feel bad if they feel entitled to revenge.
  • Swearing or frequent profanity – People with this disorder may swear a lot and think it’s completely okay.
  • Temper tantrums – In cases where anger gets the best of individuals or they feel as if they cannot cope with their emotions, they may throw temper tantrums.

Note: It should be noted that not everyone with ODD will experience all of the symptoms listed above. These are a general rule of thumb to go by. Many disorders have similar symptoms, but what distinguishes ODD is the anger-influenced disobedience, hostility and defiance towards authority figures. Below is the official DSM diagnostic criteria for ODD.

DSM diagnosis:

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults’ requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

What Causes Oppositional Defiant Disorder (ODD)?

There is no exact cause that can be pinpointed as causing oppositional defiant disorder, but there are various factors that are hypothesized to play a role. Many people believe that genetic factors, environmental triggers, and other individual biological factors play a role in its development. In many cases, ODD is linked to altered functioning of neurotransmitters and hypoactivated responses to stress and reward.

Biological factors – Some research indicates that various brain injuries or functional deficits can lead to the development of this disorder. In cases of ODD, researchers have found differences in levels of various neurotransmitters.

  • Serotonin sensitivity: It has been found that various serotonin receptors are more sensitive among children with oppositional defiant disorder.
  • Reduced cortisol reactivityIt has also been thought that reduced cortisol reactivity to stressful events may play a role.
  • Amygdala hypoactivity: Hypoactivation of the amygdala to negative stimuli may be a contributing factor.
  • Neurotransmitter alterations: Alterations in serotonin and noradrenaline levels could lead to low sensitivity to punishment. This low punishment sensitivity may make it difficult for children and adolescents to judge inappropriate behavior and punishment. It is also thought that dopamine functioning is altered and leads a person to become hyposensitive to rewards.
  • Hypoactive sympathetic nervous systemHypoactivity (or underactivation) of the sympathetic nervous system (stress response) to incentives and a low basal heart rate along with hyporeactivity to rewards could play a role in this condition.
  • Poor moodsExperiencing unpleasant emotions are also thought to influence this disorder.
  • Impaired executive functions: Executive impairment in response to motivation and paralimbic system impairments in the orbitofrontal and cingulate cortex could contribute to lack of control over unstable emotional behavior.

Source: http://www.ncbi.nlm.nih.gov/pubmed/22800761

Genetics – It has been found that many mental illnesses and disorders run in families. If a child has a sibling with oppositional defiant disorder, his or her chances of having the same disorder significantly increase. Similarly, researchers have found that relatives (especially first-degree) with a form of mental illness including: attention-deficit disorder, depression, anxiety, and/or other personality disorders could increase likelihood of developing ODD.

Environment – Certain environmental factors are thought to contribute to “triggering” the disorder. For example, if the individual lives in a very stressful environment and/or has had to deal with excessive stress, they are more prone to developing ODD. Having a dysfunctional family life, poor parenting, and/or inconsistent disciplinary action by parents may contribute to a child or teen’s diagnosis of oppositional defiant disorder. Alcohol or drug abuse could also trigger ODD symptoms in a teenager. They may act excessively defiant while under the influence and/or it may trigger an underlying disorder.

Source: http://dare.ubvu.vu.nl/bitstream/handle/1871/17454/Burke_Journal?sequence=2

Oppositional Defiant Disorder Treatment

There is no single treatment that is thought to cure oppositional defiant disorder. However, if it isn’t properly treated during childhood or teenage years, it may develop into a more serious behavioral problem called “conduct disorder.” In many cases, a combination of psychotherapy with familial support can significantly improve the disorder. Medication may prove to be therapeutic if standalone therapy is ineffective.

  1. Cognitive Problem Solving Skills: This can help the individual learn what behavior is inappropriate and teaches them how to respond to stress. Many individuals with ODD do not know how to appropriately respond to real-life stressful situations. Cognitive problem solving skills can help teach them how they can deal with stressful situations without getting worked up.
  2. Parent-Management Training: In cases where there is a child dealing with ODD, it may be helpful for parents to learn about it and get trained as to how they can cope with it. This is a form of therapy that teaches techniques which use positive reinforcement and discipline for the child with ODD.
  3. Family Therapy: In some cases it is highly beneficial for the entire family of the individual with ODD to come in for therapy. During therapy, the individual with ODD’s behavior and opposition is addressed. The therapist will then come up with solutions that the whole family can agree upon in order to improve the current situation.
  4. Social Skills Training: This can help children and adolescents learn how to effectively communicate with peers in a positive manner. It may help them work on appropriate skills to help them improve relationships and school performance. Usually social skills training is best when done in a natural environment.
  5. Medication: In some cases, medication may prove highly beneficial for treating ODD. Among cases in which the ODD is comorbid with another condition such as: ADHD, anxiety disorders, and/or depression, the treatment will typically involve targeting the comorbid condition. In many cases once the other condition such as ADHD, depression, or anxiety is properly treated, the ODD symptoms are significantly reduced.
  6. Natural remedies: Some would suggest that adequate amounts of omega-3 fatty acids (e.g. fish oil) could help reduce symptoms. Along with a healthy diet, vitamins, and exercise, these can go a long way. Most people like to give some natural remedies a shot before diving into serious psychiatric drugs.

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