Oppositional defiant disorder (ODD) is a psychiatric disorder classified in the DSM-5 among disruptive, impulse control, and conduct disorder. The core features of ODD include a pervasive and impairing pattern of anger, irritability, inflexibility, defiance, malevolence, and aggression. Symptoms of ODD typically present during preschool. ODD can be a harbinger of conduct disorder. Isolated, transient symptoms of ODD are normal during development. Mood disorders, attention-deficit/hyperactivity disorder, and neurodevelopmental disorders are important considerations in differential diagnosis. However, ODD frequently co-occurs with other psychiatric diagnoses. Complex interactions with temperamental emotional dysregulation, family stress, early life stress, inconsistent parenting, and genetic and physiologic factors likely underlie the risk, pathophysiology, and prognosis of ODD. Unfortunately, these interactions and the neurobiological underpinnings of ODD are still poorly characterized. Although first-line treatments for ODD involve behavioral and psychosocial interventions, a thoughtful consideration of pharmacotherapy for co-occurring disorders and severe symptoms is an important component of treatment planning. Herein we review the epidemiology, etiology, pathophysiology, diagnostic evaluation, and treatment planning of ODD. Recent applicable controversies such as dimensional conceptualization of psychiatric disorders and the potential intersection of ODD and disruptive mood dysregulation disorder are also summarized.
This review contains 5 figures, 4 tables, and 44 references.
Key words: aggression, attention-deficit/hyperactivity disorder, conduct disorder, defiance, disruptive behaviors, disruptive mood dysregulation disorder, DSM-5, irritability, oppositional defiant disorder, parent management training
DSM-5: Disruptive mood dysregulation disorder