Disruptive Behavioral Disorders
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection the chapter on Disruptive, Impulse-Control, and Conduct Disorders (DICCD) from the DSM-5. I have included my reflection below.
Disruptive Behavioral Disorders
This week, I read the chapter Disruptive, Impulse-Control, and Conduct Disorders (DICCD) from the DSM-5-TR. The chapter opens by describing DICCDs generally as conduct that violates the rights of others or brings the individual into conflict with societal norms or authority figures. These disorders seem to stem from two problems related to self-control, with anger and irritation coming about from constricted emotional self-control and argumentativeness and defiance as a result of poor behavioral self-control. The main DICCDs include Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder (IED), Conduct Disorder (CD), Antisocial Personality Disorder (ASPD), as well as others like Pyromania or Kleptomania.
The DSM presents DICCDs as a spectrum of sorts, with ODD being among the mildest, including an angry mood that disrupts social connections, then stepping up to CD, which includes violating the rights of others, for example, aggression to people or animals, destruction of property, theft or breaking the rules for example. IED sits midway on the spectrum, representing emotional outbursts that are more uncontrolled than ODD but not as damaging typically as CD. Each of these usually has a childhood developmental onset. If disorders persist into adulthood, they may be better diagnosed as ASPD, although each can be comorbid. Pyromania and Kleptomania are also discussed as compulsive behaviors, done mainly for the release of tension and the gain of pleasure for the individual, not for material gain or revenge.
My initial reaction to this piece was that physically hurting people or animals is not good, and I felt sympathy for those affected by physical violence and a desire to help stop it. Quickly after this reaction, though, was a recognition that a child who is displaying aggression or other DICCD symptoms is probably trying to fight for their well-being in the only way they know how. So, I also have sympathy for the child who acts out. I can see that they quite possibly are fighting against an upbringing or society that is causing them incredible pain, and their acts of violence are their way of showing strength to stop whatever is hurting them. I can also extend this sympathy to adults who are displaying these characteristics. However, I firmly side with physical restraint of anyone being violent and then remediating education to prevent violent actions.
This piece very much made me think of my childhood. I possibly had ODD as a child; I very much did not like being told what to do and acted out against perceived injustices. Occasionally, this turned physical; I can think of two occasions where I got into fights with classmates in school. In both instances, though, I had been bullied for extended periods by these individuals, called names (“faggot”), and excluded from social situations. In one case, an individual purposefully urinated on me when I was sleeping at a party; I did not realize this had happened until the morning. My classmates explained why I was wet, and a perpetrator had thought it funny to urinate on me before scattering my belongings around the backyard. I was so angry the next day that I went up to him and attacked him physically. In these cases where I was involved in fights, I believe the perpetrators deserved it, and I am still glad I did it because they did not bully me anymore after standing up for myself this way.
I also grew up in the 80’s and 90’s and went to school during these decades. At school, I remember that there was not as much support or awareness around violence. My father would beat our family continually. We called the police, and they did not do anything. My school did not seem to have the resources to attend to bullying or violence. In two cases, when I got into fights, nothing actually happened; the school simply ignored it, and potentially, they were glad that I, a nerdy kid, finally punched a bully back. I ask myself, would I encourage my future children to act out violently today? The answer is no unless it was in clear self-defense. Would I encourage my children to show defiant behavior? Well, in this case, it really depends. I think we need defiance in many cases. There are many situations, overt and covert, where individuals can manipulate and oppress people in an unjust way. If my child stood up for injustice by being defiant, I may very well be proud of them. We used to have drapetomania as a clinical illness given to a slave who ran away. In hindsight, we can see how ridiculous this is and how right and natural it is for a slave to run away; in some sense, I feel this way about DICCDs.
When I think critically about these diagnoses, I again feel like the DSM here forgets about the “social” in biopsychosocial, and that there probably are underlying reasons, I bet trauma and injustice, that often lead an individual to develop DICCDs. If I met with an individual with one of these disorders, I believe I could have empathy and sympathy. One exception, though, would be the torture of animals or humans. I can definitely see how, in a moment of anger, someone explodes and gets into a fight, or even after a long period of injustice, someone gets a gun and goes on a rampage; I really can understand this. My understanding stops at torture, though; anyone who derives sustained pleasure from hurting others in a prolonged way is sickening to me, and I would struggle a lot in my clinical practice to deal with a client like this.
