Oppositional defiant disorder

Abstract Oppositional defiant disorder (ODD) is identified by persistent defiant, noncompliant, and antagonistic behavior and by persisting irritability and anger. It typically has an onset early in childhood. Despite often being regarded as a disorder of childhood, ODD persists into adulthood. ODD pervasively impairs functioning over the life span, causing difficulties in interpersonal relationships and social functioning, academic and occupational functioning, and in familial relationships. Dimensions among the symptoms include distinct irritability and behavioral dimensions. The irritability dimension robustly predicts depression and anxiety, while the behavioral dimensions predict persisting and worsening behavioral psychopathology. This, along with the ability to distinguish ODD from normative behaviors as early as preschool, suggests that ODD may be a useful marker of risk for diverse outcomes. Genetic factors help to explain both ODD and its dimensions, and transactions with the environment, particularly in interpersonal contexts, contribute to the persistence of ODD and its impairments. Clinical assessment strategies for ODD are well established, although the concordance between specific ODD symptoms and item wording varies across measures in ways that might influence diagnostic conclusions. Assessment and treatment decisions are also complicated by the introduction of disruptive mood dysregulation disorder, which markedly overlaps with the irritability dimension of ODD. Effective treatments for ODD are well established, but suffer from confounding with age and behavioral severity, such that fewer validated treatments are available for older individuals with ODD who do not develop conduct disorder. This is particularly true regarding the treatment of adult ODD, which has received almost no attention. Established treatments for ODD may also not give sufficient attention to irritability as a distinct aspect of the disorder.