Oppositional Defiant Disorder: The Quickie Version. And then I just go off...

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(All references are to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision unless hyperlinked. The little numbers out to the side are diagnosis codes. The DSM, written in America by Americans, roughly half of whom were on pharmaceutical company payrolls at some point. The rest of the world naturally has different standards. Americans: Narcissistic Personality Disorder. Wow. I've digressed and haven't even started. Doesn't bode well for you, does it?)

I hate the diagnosis. Hate, hate, hate it. And the reason I hate it is because I think it is vastly overused. In my mind, it's a sterile, acceptable way for a professional to say: "This kid is an unruly pain in the hiney". Here are the criteria, as guided by the DSM IV-TR, for Oppositional Defiant Disorder (ODD):

Throwing repeated temper tantrums
Excessively arguing with adults
Actively refusing to comply with requests and rules
Deliberately trying to annoy or upset others, or being easily annoyed by others
Blaming others for your mistakes
Having frequent outbursts of anger and resentment
Being spiteful and seeking revenge
Swearing or using obscene language
Saying mean and hateful things when upset
moodiness, easily frustrated, low self esteem

You only need to observe four of the above listed symptoms for six months to make the diagnosis. Gee....sounds like 90% of teenagers, right? Argumentative, being easily annoyed by others, temper tantrums, blaming others. And that's not even considering moodiness, frustration, and self esteem issues. They're ALL ODD. Except ODD usually, but not always, appears before a kid is eight years old (pg. 101)

And then let's look at kids who were in abusive families. Yeah....they're going to be a wee bit angry. And probably spiteful and have a difficult time with authority. For a really long time. This is a direct quote from the DSM (my own copy): "Oppositional Defiant Disorder is more common in families in which there is serious marital discord." (pg. 101) Well, duh. Here's a more comprehensive list of possible risk factors for the diagnosis.

I know. I KNOW. There are kids out there who genuinely meet criteria. Thoughtful clinicians who make the diagnosis correctly also consider other factors, like how well the kid does in school and how well the child interacts with authority in general. And I know there are tons of foster families out there dealing with kids day in and day out that are challenging on their best days. God love you for that.

As I stated before, I just think this one is used way too often and I have a difficult time taking it seriously. The DSM says the rate of occurrence is anywhere from 2% to 16% of the population "depending on the nature of the population sample and methods of ascertainment." (pg. 101, emphasis mine.) Seems like a pretty big window to me.

As an aside, it's such a shame when you see kids with more letters strung out behind their names than a therapist: Meet Little Johnny, ADHD, ODD, RAD, OCD, PPD and Depression NOS. This happens all the time. Why can't kids just be angry, confused and sad about their parents being utter schleps? Why do we have to slap a mental illness onto behavior that's completely justified considering the history?

For that matter, why is that people have to have some diagnosis slapped on to them if they're not functioning to the exact norms which society dictates? Sometimes I think the DSM is not so much a guideline for mental health professionals as it is a manual/bible for showing everyone exactly how screwed up they are. God forbid someone not have a sex drive: Hypoactive Sexual Desire Disorder, 302.71 (pg. 541) And if you have a fetish? Fetishism 302.81 (pg. 570). If you happen to be a transvestite, then it's Transvetic Fetishism 302.30 (pg 575).

Too much?

OK, how about this? If someone moves from one town to another or experiences some other major life upheaval and has a hard time getting used to things? Well, then they have Adjustment Disorder (with all kinds of qualifiers tacked on) 309.xx (pg 679). If someone is exposed to an especially traumatic event and has trouble getting over it? Acute Stress Disorder 308.30 (pg. 469). "Pervasive pattern of social inhibition"? Avoidant Personality Disorder 301.82 (pg. 721). If someone is a little anxious or has a few compulsions then it's Anxiety Disorder, Not Otherwise Specified 300.0 (pg. 484).

NOS: Oh, those magic letters! These enable professionals to impart to you that you're all wacky in a certain area, a certain way, but not REALLY wacky. Just sort of wacky. Sort of anxious. Sort of depressed. Sort of disruptive. Sort of bi-polar.* Sort of psychotic. You sort of have a personality or eating disorder. And they get to call you mentally ill as a result. Score one for Freud's descendants (or, you know, Proctor and Gamble satanic company.)

Hell, I can't even say someone was drunk when I see them. I have to diagnose them with Alcohol Intoxication 303.00 (pg. 214). And yes, there's one for every substance, including caffeine.

Oh, no. I'm not kidding.

Caffeine Intoxication 305.90 (pg. 232)

Let's slap that one on a high school junior after his fourth Red Bull.

Then things move from the ridiculous to surreal. A professional can actually give someone a diagnosis if that person chooses to not follow said professional's advice. It's called Noncompliance with Treatment V15.81 (pg. 739).

Right.

I think I've been walking around with that one since I was 12. Oppositional Defiant, you see.

And before you going judging me, I defy you to flip though that book and not find something that fits you like a glove. In essence, we're all diagnosable. In fact, I think there needs to be a diagnosis for .005 % of people who aren't completely daft in one way or another: Pervasive Normalness Disorder. Then when I have to visit someone in the ER who doesn't have a care in the world, I know to be incredibly frightened.

I can't help but think about "mental health disorders" that were in The Manual 40 years ago and no longer are now, to wit: Homosexuality.

What's not going to be there 40 years from now? ->

*I'm avoiding writing about this one like the plague. I probably never will. But here is something to consider: There are thirty-two separate bi-polar diagnoses in the DSM. Thirty-Two. That's crazy. No pun intended. Well, maybe it was a little bit. OK, pun intended.