Oppositional Defiant Disorder 463
Moderate: Some symptoms are present in at least two settings.
Severe:  Some symptoms are present in three or more settings.
Specifiers
It is not uncommon for individuals with oppositional defiant disorder to show symptoms
only at home and only with family member s. However, the pervasiveness of the symp-
toms is an indicator of the severity of the disorder.
Diagnostic Features
The essential feature of oppositional defiant disorder is a frequent and persistent pattern
of angry/irritable mood, argumentative/defi ant behavior, or vindictiveness (Criterion
A). It is not unusual for individuals with oppositional defiant disorder to show the behav-
ioral features of the disorder without proble ms of negative mood. However, individuals
with the disorder who show the angry/irrita ble mood symptoms typically show the be-
havioral features as well. 
The symptoms of oppositional  defiant disorder may be confined to only one setting,
and this is most frequently the home. Indi viduals who show enough symptoms to meet
the diagnostic threshold, even if it is only at  home, may be significantly impaired in their
social functioning. However, in more severe cases, the symptoms of the disorder are pres-
ent in multiple settings. Given that the pervas iveness of symptoms is an indicator of the
severity of the disorder, it is critical that the individual’s behavior be assessed across mul-
tiple settings and relationships. Because these behaviors are common among siblings, they
must be observed during interactions with  persons other than siblings. Also, because
symptoms of the disorder are ty pically more evident in intera ctions with adults or peers
whom the individual knows well, they may not be apparent during a clinical examination. 
The symptoms of oppositional defiant disord er can occur to some degree in individu-