Children and adolescents with behavioral disturbances commonly come to the attention of primary care physicians. Although disruptive behaviors can be associated with any number of psychiatric disorders, this chapter will focus on three diagnoses wherein behavioral symptoms are key diagnostic criteria: oppositional defiant disorder (ODD), conduct disorder (CD), and intermittent explosive disorder (IED). A fourth diagnosis, attention-deficit/hyperactivity disorder (ADHD), is usually included in the disruptive behavior disorder (DBD) category, but will not be included in this chapter (see Chapter 4 for details about the treatment of ADHD).

Definition

The disorders covered in this chapter are considered disruptive, in that individuals diagnosed with them evidence behaviors that have a negative effect on their immediate environment and elicit negative responses from others. A common element of the negative behavior is aggression, which can be verbal or physical. Verbal aggression includes loud, profane, or threatening speech that intimidates others. Physical aggression includes damage to property or person, the latter also known as violence. Violent behavior exists in two basic forms: proactive aggression, which is premeditated and fairly dispassionate; reactive aggression is impulsive and affectively driven. The distinction between proactive and reactive aggression is an important one, since it is the reactive type that tends to respond to pharmacotherapy.

The disruptive aspect of ODD comes from the conflict that the individual has with rules and authority figures. Legal problems associated with ODD are relatively minor, e.g. truancy and running away.