DSM-5-TR Criteria for Oppositional Defiant Disorder (ODD)
Oppositional Defiant Disorder is defined as a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, characterized by oppositional, vindictive, negativistic, and hostile behavior toward authority figures that creates disturbance in social, academic, or occupational functioning. 1
Diagnostic Criteria
A. Pattern of behavior lasting at least 6 months with at least 4 symptoms from the following categories:
1. Angry/Irritable Mood
- Often loses temper
- Often touchy or easily annoyed
- Often angry and resentful
2. Argumentative/Defiant Behavior
- Often argues with authority figures or adults
- Often actively defies or refuses to comply with requests from authority figures or with rules
- Often deliberately annoys others
- Often blames others for his or her mistakes or misbehavior
3. Vindictiveness
- Has been spiteful or vindictive at least twice within the past 6 months
B. The disturbance in behavior:
- Causes clinically significant impairment in social, educational, occupational, or other important areas of functioning
- Is not exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder
- Does not meet criteria for Conduct Disorder or Antisocial Personality Disorder (if age ≥18)
Key Diagnostic Features
- Symptoms typically emerge by age 8 years 2
- Community prevalence ranges between 1% and 16%, depending on assessment methods 2
- The diagnosis requires that behaviors occur more frequently than typically observed in individuals of comparable age and developmental level 1
Severity Specification
- Mild: Symptoms confined to only one setting (e.g., only at home)
- Moderate: Some symptoms present in at least two settings
- Severe: Symptoms present in three or more settings
Important Diagnostic Considerations
- Multiple informants (parents, teachers, self-report) and standardized rating scales should be used in assessment 1
- Distinguish normative oppositionality from pathological behavior based on frequency, persistence, and impairment 1
- Consider developmental stage when making diagnosis 1
- Gender differences exist in presentation: girls may show less overt aggression and more covert, relational, or verbal aggression 2, 1
- Avoid common diagnostic pitfalls:
- Failing to distinguish normal developmental oppositionality from pathological behavior
- Not considering developmental context
- Missing comorbid conditions
- Overlooking that oppositional behavior can sometimes be used to manage anxiety 1
Comorbidities
- ADHD (14% of cases)
- Anxiety disorders (14%)
- Depressive disorders (9%)
- Learning disabilities
- Language disorders 1
When ODD co-occurs with ADHD, children tend to show more aggression, greater range of problem behaviors, and higher peer rejection 1.
Prognostic Implications
- Approximately 30% of children with ODD progress to conduct disorder
- About 10% may eventually develop antisocial personality disorder 1
- Adults and adolescents with a history of ODD have >90% chance of being diagnosed with another mental illness in their lifetime 3
- High risk for developing social and emotional problems as adults, including suicide and substance use disorders 3
The DSM-5-TR tripartite model of ODD (angry/irritable symptoms, argumentative/defiant behavior, and vindictiveness) has distinct associations with different types of psychopathology, with angry/irritable symptoms linked to internalizing problems and argumentative/defiant behavior and vindictiveness associated with externalizing problems 4, 5.