466 Disruptive, Impulse-Control, and Conduct Disorders
Comorbidity 
Rates of oppositional defiant disorder are mu ch higher in samples of children, adoles-
cents, and adults with ADHD, and this may be the result of shared temperamental risk fac-
tors. Also, oppositional defiant disorder of ten precedes conduct di sorder, although this
appears to be most common in children wi th the childhood-onset subtype. Individuals
with oppositional defiant disorder are also at  increased risk for anxiety disorders and ma-
jor depressive disorder, and this seems largel y attributable to the presence of the angry-
irritable mood symptoms. Adolescents and adul ts with oppositional defiant disorder also
show a higher rate of substance use disorders, al though it is unclear if this association is in-
dependent of the comorbidity with conduct disorder. 
Intermittent Explosive Disorder
Diagnostic Criteria 312.34 (F63.81)
A. Recurrent behavioral outbursts representing a failure to control aggressive impulses
as manifested by either of the following:
1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or
physical aggression toward property, animals, or other individuals, occurring twice
weekly, on average, for a period of 3 months. The physical aggression does not re-
sult in damage or destruction of property and does not result in physical injury to
animals or other individuals. 
2. Three behavioral outbursts involving damage or destruction of property and/or
physical assault involving physical injury against animals or other individuals occur-
ring within a 12-month period. 
B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly
out of proportion to the provocation or to any precipitating psychosocial stressors.