Diagnosis: Oppositional Defiant Disorder, Conduct Disorder, and DMDD. What’s the Difference?

If you are the parent of a behaviorally challenging child, you may have seen therapists, psychiatrists, or other mental health providers looking for answers to your child’s behavior problems. I’ve been there.

Many kids, including mine, have difficult, oppositional, and explosive behaviors. These can range from milder behaviors–like refusing to acknowledge authority, disobeying rules, or arguing with parents and teachers–to more serious problems like destroying property and violence.

There are three diagnoses that professionals typically assign to these kids: oppositional defiant disorder (ODD), conduct disorder (CD), and disruptive mood dysregulation disorder (DMDD). On the surface, these diagnoses sound really similar, so parents can be confused about the difference between them. I’d like to help you understand your child’s diagnosis and what it means for them and your family.

On the surface, these diagnoses sound really similar, so parents can be confused about the difference between them. I’d like to help you understand your child’s diagnosis and what it means for them and your family.

Before we get into the differences between these three disorders, let’s discuss what each of them are. Here are the definitions and diagnostic criteria for ODD, conduct disorder, and DMDD, according to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5), the manual that psychologists use to diagnose mental illnesses.

What Is Oppositional Defiant Disorder?

According to the DSM 5, oppositional defiant disorder is a behavioral disorder that is usually first diagnosed in childhood. Parents often see the symptoms of ODD play out in one or more of these three primary areas: First, the child will often have an angry, irritable, or raging mood. Second, the child is often argumentative and combative with authority figures. And third, the child might have a spiteful or vindictive attitude.

According to the DSM 5, oppositional defiant disorder is a behavioral disorder that is usually first diagnosed in childhood.

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In addition, the symptoms can be mild, moderate, or severe.

In mild ODD, the symptoms are only present in one setting, like home, school, or with friends. Moderate ODD means that some of the symptoms (though not necessarily ALL of them) are present in at least two of those settings. And in Severe ODD, children experience symptoms in three or more settings.

The DSM V diagnostic criteria for oppositional defiant disorder require that the children show at least four of the following symptoms for at least six months:

1. The child often loses temper/has raging tantrums.
2. The child is easily annoyed or touchy.
3. The child is frequently angry and resentful.
4. The child often argues with authority figures or any adults.
5. The child actively defies or refuses to comply with requests/rules.
6. The child deliberately annoys others.
7. The child refuses to take responsibility for their own behavior, often blaming others for mistakes.
8. The child has been spiteful or vindictive at least twice within the past six months.

What Is Conduct Disorder?

Again, the DSM 5 defines conduct disorder as a behavioral disorder. It’s similar to ODD in that children and adolescents with conduct disorder often refuse to obey authorities or follow the rules. But conduct disorder symptoms also include a violation of the rights of others. So a kid with ODD might refuse to go to school, for example. But if your child slashes your tires to prevent you from driving him to school, he’s graduated to conduct disorder.

Here are the conduct disorder DSM 5 diagnostic criteria. In order to be diagnosed with conduct disorder, a child must meet at least three of the following 15 criteria. All three of the met criteria should have been present at some point in the past 12 months, but at least one of them should be present in the past 6 months.

Here are the conduct disorder DSM 5 diagnostic criteria.

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Aggression to People and Animals

1. The child or adolescent bullies, threatens, or intimidates others.
2. The child or adolescent frequently initiates physical fights.
3. The child has used a dangerous weapon that can cause serious physical harm, like a bat, broken bottle, knife, or gun.
4. The child has been physically cruel to other people.
5. The child has been physically cruel to animals.
6. The child has stolen property while directly confronting a victim, as in a mugging or armed robbery.
7. The child has committed sexual assault.

Destruction of Property

8. The child deliberately engages in fire setting with the intent of causing serious damage. This does not include accidental fire setting caused by carelessness.
9. The child has deliberately destroyed others’ property in some other way.

Deceitfulness or Theft

10. The child has broken into someone else’s house, building, or car.
11. The child frequently lies or “cons” others in order to obtain something or to avoid an obligation.
12. The child has stolen something valuable without confronting a victim, as in shoplifting.

Serious Violations of Rules

13. The child often stays out at night in violation of their parents’ rules.
14. The child has run way from home overnight at least twice, or at least once for a long period of time.
15. The child frequently skips school, beginning before age 13 years.

Again, the DSM 5 defines conduct disorder as a behavioral disorder. It’s similar to ODD in that children and adolescents with conduct disorder often refuse to obey authorities or follow the rules. But conduct disorder also includes a violation of the rights of others. So a kid with ODD might refuse to go to school, for example. But if your child slashes your tires to prevent you from driving him to school, he’s graduated to conduct disorder.

What Is DMDD?

Disruptive mood dysregulation disorder, or DMDD, is a mood disorder that I’ve heard described as “pre-bipolar disorder in kids.” In fact, it was created to replace the diagnosis of “pediatric bipolar disorder.” This doesn’t necessarily mean that a child with DMDD symptoms will grow up to have bipolar disorder. Indeed, DMDD does not include manic or hypomanic episodes like bipolar does. It simply means that these kids have severe difficulty with regulating their emotions, and as a result, they are chronically irritable and have frequent, raging tantrums.

These are the DSM 5 diagnostic criteria for DMDD:

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A. Severe, repeated temper tantrums that include verbal rages and/or physical aggression.
B. The tantrums are inconsistent with the child’s developmental level.
C. The tantrums occur three or more times per week.
D. Between tantrums, the child’s mood is persistently irritable or angry most of the day.
E. Criteria A–D have been present for 12 months or longer.
F. The tantrums and irritable mood are present in at least two settings, and are severe in at least one.
G. The child is between the ages of 6 and 18 years old.
H. The clinician should take a history to ensure that the symptoms began before age 10.
I. The child has never had a manic episode.
J. The clinician has ruled out major depression and other mental disorders oppositional defiant disorder, intermittent explosive disorder, and bipolar disorder.
K. The symptoms are not caused by substance use or a medical or neurological condition.

ODD vs Conduct Disorder vs DMDD

Hopefully, the explanations above have already given you a good idea of the definitions of and differences between ODD, conduct disorder, and DMDD. But just for clarity’s sake, let’s take a look at the specific symptoms that help you differentiate between these three similar disorders.

We’ll start with oppositional defiant disorder and conduct disorder. These two diagnoses are best understood on a spectrum, with ODD on the less severe end and conduct disorder on the more severe end.

The symptoms of oppositional defiant disorder are just as they sound–oppositional and defiant. But they don’t violate the rights of others. They cause problems, for sure. They are frustrating, for one thing. When you need your child to get in the car so you can leave the park, but he just keeps on swinging and chanting that you can’t make him, that’s pretty darn annoying. If he shouts at his teachers and refuses to do his school work, his grades are going to suffer, and he might end up with detention and very few friends.

But he’s not actually harming a person, animal, or property. If the child starts physical fights, beats someone up, tortures an animal, steals from someone, or vandalizes property, he’s in conduct disorder territory. Even if the child is also oppositional and defiant (and he probably is), the addition of violent, aggressive behavior changes his diagnosis to conduct disorder.

It’s important to note that no child can have both ODD and conduct disorder. Either there is no violation of others’ rights, which portends a diagnosis of ODD, or there is a violation of others’ rights, which means he now has conduct disorder. It’s also noteworthy that ODD can lead to conduct disorder. Kids diagnosed with ODD are often younger, between the ages of 6 and 10. When they get a bit older, sometimes their symptoms become more aggressive, and their diagnosis is changed to conduct disorder.

Let’s move on to disruptive mood dysregulation disorder. DMDD symptoms might seem very similar to ODD and conduct disorder on the surface. However, what sets this diagnosis apart is the presence of mood instability. Like kids with ODD, kids with DMDD are frequently irritable and angry. But kids with DMDD also have extreme temper outbursts in response to situations that seem far out of proportion to the emotional reaction.

For example, let’s say it’s homework time. A kid with ODD might just say, “No, I’m not doing it.” He may act angry and irritable when you insist that he has to do it. He might even shout at you about it. For the ODD kid, it probably doesn’t matter what his homework assignment is or when you ask him to do it. He doesn’t acknowledge your authority to tell him he has to do the homework, and he digs in his heels.

For a kid with DMDD, homework might trigger problems too. But they’ll look different and be caused by different factors. He was probably already irritable before homework time. But once you said he had to get started on it, he felt some huge emotions that he couldn’t control. Maybe he’s anxious about his math skills, or he feels overwhelmed by the amount of homework. There could be any number of reasons for his big feelings. But when he has them, they are HUGE, and they come out like a giant tantrum.

Kids with DMDD are especially likely to have these outbursts when something changes in their routine. For example, he might normally do his homework after dinner. Then one day, he comes home from school and you tell him that the family is going out to dinner, so he needs to get his homework done beforehand. This might seem like a small deal to most people, but a kid with DMDD might react with an enormous, out-of-control, rage-filled tantrum.

During these tantrums, the child might hit, kick, or break things, similar to conduct disorder. But the difference here is that kids with DMDD do these things because of extreme mood swings.

I hope this information helps you understand your child’s diagnosis. I plan to write another blog post in the future about the various treatments for these disorders.