Oppositional Defiant Disorder

Oppositional Defiant Disorder treatment in Adolescents and Adults

Oppositional defiant disorder is typically seen where younger adults and children present with highly resistant patterns of opposition to authority, wilful non compliance, irritable mood, deliberately annoying others, blaming others for their own actions, being spiteful or resentful, and negative attention seeking behaviour. It is listed in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5).

Oppositional defiant disorder is a controversial topic since there is debate concerning how much of the condition is definable as within the subject, and how much is a product of the environment the subject inhabits. Many of the characteristics for example are often seen in abuse or neglect victims, or with young people (or later adults) who have suffered trauma, rejection or disruption in childhood.

Some young people however do appear to be nurtured well, and yet do display oppositional behaviour. Therefore I (Stuart) am not going to rule out the existence of the condition in some cases when forming my opinion.

This condition is considered a form of Personality Disorder and therefore NICE guidelines suggest DBT as a primary therapy option.



DBT Trained

DBT Trained

Mindfulness Informed Professional

Mindfulness Informed Professional

Treatment of Oppositional Defiant Disorder

There are some drug only treatments, but according to Curtis et al (2014) the gold standard of treatment in children is psychological. Methods include evidence based psycho-social interventions, parent training, problem solving training and breaking down situations to identify what really contributed to situations and outcomes (situational analysis).

In adults with long term depression there is often a tendency to present with oppositional defiance and in a recent study in the use of CBASP (cognitive behavioural system of psychotherapy) in Dundee most of the participants identified as both long term depressed and also with the disorder according to diagnostic criteria. (study reference see CBASP page – Dundee study).

It is therefore key to analyse situations and assist sufferers to understand how the actual outcome of their behaviours and interpretations may not be what they truly desire. Understanding the way this works and training them in understanding, behavioural changes and interpretations can allow the client to choose and then attain desired outcomes that work better for them. Effectively this means learning to identify cause and effect, and then modifying their contribution to the cause. Note that although the therapist may help the client to attain the new desired outcome, it is extremely important that the client themselves choose what they want themselves as an outcome. It is absolutely not about telling the client what is a “good” or “preferable” outcome.

What other conditions might you expect in a client with oppositional defiant disorder?

Because of the disruption of normal social, romantic, family, work and school based relationships due to the maladaptive behaviours, the client can often feel victimised, isolated, misunderstood and therefore angry, stressed, anxious or depressed. As with many conditions these issues may also need to be addressed.

What if the client is not suffering from oppositional defiant disorder? What if they are reacting to abuse or trauma?

If techniques like CBASP (cognitive behavioural analysis system of psychotherapy) or psychoanalysis and coaching are used, it does not matter “why” the person is turning up with maladaptive patterns, what matters is helping them to get the outcomes they want for a better and happier life, without attributing judgement or blame. Thus if a long term depressed person presents with oppositional behaviour, it is useful to adjust this behaviour so they can benefit from a healthier set of interactions, whatever the cause.

Obviously if it becomes clear that abuse or trauma has occurred, then additional therapeutic work may be required to help process this and help the individual to move on and heal.

The important thing to note is that the right interventions, provided non-judgementally are potentially helpful whether it is a “disorder” or post trauma / post abuse.

Who provides the therapy for adult and adolescent oppositional defiance disorder?

Stuart is an analyst (psychodynamic and cognitive behavioural), stress counsellor and clinical hypnotherapist with additional qualification and registration in psychotherapy, counselling, psychology and life coaching. Stuart uses a combination of cognitive behavioural analytic methods including situational analysis and other CBASP methods, as well as mindfulness, psychoeducation and coaching techniques.  His approach is integrative and additional models are employed according to the needs of the client.

Stuart also works extensively with post trauma and post abuse cases.

Curtis, Elkins, Miller, Areizaga, Brestan-Knight, Thornberry (2014) Oppositional Defiant Disorder. Chapter 6 of Treating Disruptive Disorders edited by Kapalka. Routhledge Press.

Key words:
disruptive behaviour, defiant disruptive behaviour, disruptive disorders, disruptive adults, defiant adults, anger management, attention seeking, vengeful adults, stress management, depression, anxiety, social interaction, relationship difficulties, couples counselling, manipulative behaviour, abuse, abusive behaviour, abuse survivor, trauma survivor, psychotherapy, psychoanalysis, CBASP, CBT, cognitive behavioural therapy, cognitive behavioural analysis, psychoeducation, mental health management, assertiveness, lifeskills coaching, counselling, psychotherapist, psychoanalyst, Edinburgh, Falkirk, Stirling, Glasgow

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