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. 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.

When I think critically about these diagnoses, I again feel like the DSM here minimizes the “bio” and “social” in biopsychosocial, and that there probably are underlying reasons, biology, trauma or injustice, that often lead an individual to develop DICCDs.