What Are the Symptoms of Oppositional Defiant Disorder in Adults?

Disorders of conduct refer to persistent antisocial behavior, aggressive behavior, and oppositional defiant behaviors in adolescents under 18 years of age. These abnormal behaviors seriously violate the social norms of the corresponding age, and are more serious than the mischievous behavior of normal children and the rebellious behavior of adolescents. The domestic survey found that the prevalence rate was 1.45% to 7.35%. Men were higher than women. The male to female ratio was 9: 1. The peak age of the disease was 13 years old. The British survey shows that the prevalence of children aged 10 to 11 is about 4%. The prevalence of men under the age of 18 in the United States is 6% to 16%, and the prevalence of women is 2% to 9%. The prevalence in urban areas is higher than that in rural areas.

Basic Information

Causes of conduct disorders

Disorders of conduct are caused by the interaction of biological factors, family factors, and social and environmental factors.

Biological factor

Studies on twins have found that antisocial behaviors are more common in twins than in twins. Fosters have found that if their biological parents violate the law or commit a crime, the child is fostered into a family with a low socioeconomic status Raising children has a high incidence of antisocial behavior. If one of the biological parents has a criminal history, the risk of committing a foster child is 1.9 times that of other people. Male children with high androgen levels have an increased tendency to appear aggressive and disruptive. Individuals with reduced central 5-HT levels have less control over impulses, and are prone to defiant and aggressive behavior. Factors such as low IQ and perinatal complications are also related to the occurrence of character disorder.

2. Family factors

Bad family factors are an important cause of conduct disorders. These factors include: parents suffering from mental illness, substance dependence, and mental retardation; lack of intimate emotional connections between parents and children; indifference or neglect of children, fussy, rough, and even abusive children; or excessive indulgence and unregulated children Parents are at odds with each other, often quarreling or fighting, separating or divorcing; parents are committing crimes.

3. Social environmental factors

Frequent exposure to violent or pornographic propaganda, acceptance of the surrounding people's incorrect moral values and values, and companionships with smoking, drinking, fighting, brawling, extortion, deception, theft, etc. are all related to the occurrence of behavioral disorders.

Clinical manifestations of conduct disorder

Antisocial sex

Refers to behaviors that do not meet ethical and social norms, such as stealing valuables or large amounts of money at home or outside multiple times; extorting or robbing others for money or looting; forcing sexual relations or indecent behavior with others; Physical abuse (such as tying, slicing, acupuncture, burning, etc.); deliberately hurting someone with a weapon; intentional arson; often lied to truancy and ran away or ran away from home without authorization; regardless of parents' bans, they did not return home all night long; participated in social ill Gangs do bad things together, vandalism or other public property.

2. Offensive behavior

Attacking others or animals, hurting, assaulting, threatening, intimidating others; cruelly treating small animals or children younger than him or disabled children; using knife, gun, stick, stick, stone or other hard objects or equipment to cause the body of others Injuries, boys are more likely to be physical attacks; girls are more likely to be verbal attacks, such as cursing, insults, etc .; robbery of money, robbing and extorting classmates when they are young. Robbery, etc .; under the influence of adverse factors, men can sexually assault women and force others to have sex with themselves. Women can be satisfied with their selfish desires by having sexual relations with the opposite sex, and even embark on the path of prostitution.

3. Oppositional defiant behavior

Refers to the apparent disobedience or provocation of adults, especially parents. It is more common in children under 10 years of age, and it often manifests as lying (not to avoid punishment), stealing, truancy, irritability and anger, and often hates others. , Hate or take revenge, destroy public facilities; often refuse or ignore adult requirements or regulations, long-term serious disobedience; often blame others for their negligence or misconduct; often quarrel with others, often with parents or teachers Confrontation; often deliberately interferes with others; often violates collective discipline and does not accept criticism.

4. Merge issues

It is often associated with ADHD, emotional depression or anxiety, emotional instability or irritability, and may also be accompanied by developmental disorders, such as poor language expression and receptive ability, reading difficulties, uncoordinated movement, and low IQ. People with character disorders are generally self-centered, blame or dominate others, deliberately draw attention, defend their mistakes, be selfish, and lack compassion.

Conduct disorder diagnosis

As long as the diagnosis of conduct disorder is not difficult according to the characteristics of children's behavior disorders, if the patient's clinical performance of antisocial behavior, aggressive behavior and opposite defiant behavior continues for more than half a year, and seriously affects peers, teachers and students, parent-child relationship Or schoolwork can be diagnosed as an antisocial conduct disorder. If a patient under 10 years of age only exhibits antagonistic defiant behavior, and does not have antisocial and aggressive behavior, then a contraceptive defiant disorder is diagnosed.

Differential diagnosis of conduct disorder

1. Attention deficit hyperactivity disorder (ADHD)

Due to hyperactivity and impulsiveness, ADHD patients often experience problems such as fighting and disputes with their peers, non-compliance with school discipline, etc., and may also experience resistance and aggressive speech due to frustration. However, patients with ADHD also have obvious attention deficits, and their symptoms can be improved after treatment with central nervous system stimulants to distinguish them from conduct disorders. If patients with ADHD have clinical manifestations of conduct disorder, two diagnoses should be made.

2. Mood disorders

Mood disorders may have aggressive or destructive behaviors during the onset of mania or depression. However, patients with significant mood rise or depression mood abnormalities are only one aspect of clinical manifestations, and all symptoms can be disappeared after corresponding drug treatment.

3. Childhood schizophrenia

Children with schizophrenia can have behavioral problems before, during, and after the illness, but this is only part of the clinical manifestation. The patient also has the basic symptoms of schizophrenia, such as hallucinations, delusions, thinking disorders, sensory disturbances, and Speech disorders, etc. After treatment with antipsychotic drugs, various symptoms, including behaviors, will alleviate or disappear completely.

4. Mental retardation

Because mentally retarded patients have poor thinking and judgment skills, they are also prone to aggressive behaviors, and some illegal and antagonistic behaviors may occur. However, patients with mental retardation have low intelligence and poor social adaptability, which can be distinguished from conduct disorders. If both types of problems exist in the patient, and the severity of the behavior problem cannot be completely attributed to mental retardation, it should be diagnosed as mental retardation combined with conduct disorder.

5. Cerebral organic mental disorder

Cerebral organic mental disorders may cause behavioral disorders due to brain tissue damage and impaired brain function. Brain trauma and epilepsy can be aggressive or anti-social, such as impulsiveness, injury, destruction, and difficulty in management. Some patients may also exhibit behavioral disorders such as lying, theft, and sexual assault, but their history of brain damage and positive signs of the nervous system can be distinguished from behavioral disorders.

Disorders of conduct

Disorders of conduct are dominated by psychotherapy and, if necessary, short-term medication. The specific treatment methods are as follows:

Home treatment

Family therapy requires the active participation and cooperation of parents to achieve and achieve results. Family therapy revolves around the following: coordinating the relationship between family members, especially parent-child relationships; correcting the blind or severe punishment adopted by parents for their children's bad behavior; training parents to learn to communicate with their children in appropriate ways, and using discussions The method of negotiation and consultation, the strengthening of positive behaviors and the method of mild punishment educate children, reducing the life events in the family and the parents' bad behaviors.

2. Behavioral Therapy

Mainly for patients, according to the patient's age and clinical manifestations, positive reinforcement method, regression method and game therapy can be selected. The purpose of treatment is to gradually eliminate bad behaviors, establish normal behavior patterns, and promote the development of social adaptive behaviors.

3. Cognitive Therapy

The focus is on helping patients discover their problems, analyze their causes, consider the consequences, and find solutions to their problems.

4. Drug treatment

Disorders of conduct have not been treated with special drugs, and symptomatic treatment can be given separately according to specific conditions. Those with severe impulsive and aggressive behaviors choose low-dose chlorpromazine, haloperidol, and carbamazepine. Those with attention deficit hyperactivity disorder can choose methylphenidate, tomoxetine and other drugs. People with depression and anxiety can take antidepressants and anxiolytics.

Conduct disorder prevention

Because juvenile conduct disorder, especially juvenile delinquency, is a complex social and historical issue involving a wide range of contents, not just a medical issue, it is necessary to prevent the occurrence and development of conduct disorder. Avoiding bad family factors and staying away from social factors that can cause or aggravate conduct disorders are key.