Criteria

Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)[13]

The DSM-5-TR diagnostic criteria for diagnosis of ODD are: evidence of a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness for at least 6 months' duration, by demonstration of at least 4 from the following symptoms during interaction with at least one person who is not a sibling of the affected individual:

  • Chronic irritability (occurring on most days for a diagnosis in children under 5, and at least once weekly in people age 5 or over):

    • Frequent loss of temper

    • Often touchy or easily annoyed

    • Frequently angry and resentful

  • Argumentative/defiant behavior (occurring on most days for a diagnosis in children under 5, and at least once weekly in people age 5 or over):

    • Frequently arguing with authority figures (or with adults in the case of children or adolescents)

    • Often actively defying or refusing to comply with rules or requests from others

    • Often deliberately annoys others

    • Often blaming others for his or her own mistakes

  • Vindictiveness

    • Spiteful or vindictive behavior at least twice in the past 6 months.

DSM-5 notes that these criteria only provide guidance on a minimal level of frequency to define symptoms, and it should be noted if the intensity and frequency of behaviors are outside the ranges normally observed when adjusted for the person's developmental level, culture, and sex.

For the diagnosis to be made, the following criteria should also be met:

  • Disturbances in behavior should be associated with causing distress to the individual or to people that the affected individual interacts with, or have a negative impact on social, educational, occupational, or other important areas of functioning.

  • The behavior should not occur exclusively during the course of a psychotic, substance use, or depressive or bipolar disorder, and the criteria for disruptive mood dysregulation disorder should not be met.

International classification of diseases 11th revision (ICD-11)[14]

ICD-11 defines ODD as a pattern of markedly noncompliant, defiant, and disobedient behavior that is atypical for individuals of comparable age, developmental level, sex, and sociocultural content, and lists the following as essential features required for the diagnosis of ODD:

  • A pattern of markedly noncompliant, defiant, and disobedient behavior that is atypical for individuals of comparable age, developmental level, sex, and sociocultural context. The pattern of behavior may include:

    • Persistent difficulty getting along with others (e.g., arguing with authority figures, actively defying or refusing to comply with requests, directives, or rules, deliberately annoying others, blaming peers or co-workers for mistakes or misbehavior).

    • Provocative, spiteful, or vindictive behavior (e.g., antagonizing others; using social media to attack or mock others).

    • Extreme irritability or anger (e.g., being touchy or easily annoyed, losing temper, angry outbursts, being angry and resentful).

    • The behavior pattern has persisted for an extended period of time (e.g., 6 months or more).

    • The oppositional behaviors are not better accounted for by relational problems between the individual and a particular authority figure toward whom the individual is behaving in a defiant manner. Examples may include parents, teachers, or supervisors who act antagonistically or place unreasonable demands on the individual.

    • The behavior pattern results in significant impairment in personal, family, social, educational, or other important areas of functioning.

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