Oppositional Defiant Disorder Causes & Effects

Learn about oppositional defiant disorder

Impulsive, disruptive, and defiant words and actions are far from uncommon, but for some people these actions rise above the level of temporary, unacceptable behavior. In such cases, the individual in question may have developed oppositional defiant disorder (ODD).

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5), oppositional defiant disorder is characterized by angry or irritable mood, argumentative or defiant behavior, or vindictiveness that occurs for at least six months. In order to meet the criteria that the DSM-5 has established for a diagnosis of ODD, a person must exhibit at least four of the following during interactions with someone other than a sibling:

• Often loses his or her temper
• Often easily annoyed
• Often angry and/or resentful
• Often argues with authority figures
• Often defies rules or refuses to comply with requests from authority figures
• Often acts in a manner designed to deliberately annoy others
• Often blames others for his or her mistakes and/or misbehavior
• Has acted in a spiteful or vindictive manner at least twice in the past six months

For a person’s behaviors to reach the threshold for an ODD diagnosis, these behaviors must have a negative impact on his or her functioning, or must cause distress within the afflicted individual or within his or her peer group, family, workplace, or other immediate social context.

It is important to emphasize that occasionally acting in a manner that is consistent with one or more of the descriptions above does not mean that a person has ODD. This diagnosis is called for in cases when the behaviors occur persistently and frequently for at least a six-month time frame.

Also, while ODD symptoms most commonly begin to become apparent during childhood or early adolescence, this disorder can impact individuals of all ages.

Effective treatment for oppositional defiant disorder often involves a variety of therapeutic and psychoeducational activities. Depending upon the specific needs of the individual, medication management may also be incorporated into treatment.

Oppositional defiant disorder statistics

Most experts estimate that the overall prevalence of oppositional defiance disorder is between 1% and 11%, with some sources putting the number as high as 16%. In children, ODD is more common among boys than among girls, but among adolescents and adults there does not appear to be a gender-based difference in the rate at which this disorder develops.

Causes and risk factors for oppositional defiant disorder

Mental health experts have not identified a clear cause of oppositional defiant disorder, but a variety of genetic and environmental factors are believed to influence the development of this disorder:

Physical: Researchers have identified several neurobiological traits, including lower heart rate and abnormalities in certain sections of the brain, that appear to be prevalent in children who have developed ODD. However, because studies in this area involve subjects who may also have conduct disorder, a definitive relationship between these markers and the development of ODD has not been established.

Environmental: People who were exposed to abusive, neglectful, or otherwise inappropriate parenting practices during childhood appear to be at increased risk for developing ODD. Inconsistent discipline by parents and rejection and/or bullying by peers have also been cited as a potential environmental precursor to the development of ODD.

Risk Factors:

• High levels of emotional reactivity
• Poor frustration tolerance
• Experiencing harsh, inconsistent, or neglectful child-rearing practices
• Having low heart rate and skin conductance reactivity
• Having reduced basal cortisol reactivity
• Having abnormalities in one’s prefrontal cortex and amygdala

Signs and symptoms of oppositional defiant disorder

Individuals who have ODD may demonstrate a variety of disruptive or defiant behaviors, with the following being among the more common signs and symptoms:

Behavioral symptoms:

• Outbursts of anger
• Acting in a manner that is deliberately designed to annoy others
• Acting in a spiteful or vindictive manner
• Persistently arguing with authority figures
• Refusing to comply with requests from authority figures
• Actively defying rules
• Blaming others for one’s own mistakes or unacceptable behaviors

Psychosocial symptoms:

• Heightened irritability
• Elevated anger and resentment

Effects of oppositional defiant disorder

Untreated oppositional defiant disorder can have a significantly negative impact on a person’s academic and occupational development, as well as on his or her social wellbeing. The following are among the negative effects of ODD:

• Academic failure and expulsion
• Strained or lost peer relationships
• Social ostracization
• Discord with siblings and/or parents
• Job loss and chronic unemployment
• Substance abuse
• Financial ruin
• Legal problems, including incarceration

Oppositional defiant disorder and co-occurring disorders

Individuals who have ODD have an increased likelihood of also experiencing the following co-occurring disorders:

• Attention-deficit/hyperactivity disorder (ADHD)
• Major depressive disorder
• Anxiety disorders
• Substance use disorder