462 Disruptive, Impulse-Control, and Conduct Disorders
pairment associated with the behaviors indica tive of the diagnosis be considered relative
to what is normative for a person’s age, gend er, and culture when determining if they are
symptomatic of a disorder. 
The disruptive, impulse-control, and conduc t disorders have been linked to a common
externalizing spectrum associated with the personality dimensions labeled as disinhibition
and (inversely) constraint  and, to a lesser extent, negative emotionality. These shared per-
sonality dimensions could acco unt for the high level of como rbidity among these disorders
and their frequent comorbidity with substanc e use disorders and antisocial personality
disorder. However, the specific nature of th e shared diathesis that constitutes the exter-
nalizing spectrum remains unknown. 
Oppositional Defiant Disorder
Diagnostic Criteria 313.81 (F91.3)
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting
at least 6 months as evidenced by at least four symptoms from any of the following cate-
gories, and exhibited during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or
with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.