Recent incidents in Singapore involving disruptive behaviour and conduct that violate the rights of others have riveted the country. A small number of normally law-abiding individuals appeared to be openly displaying defiant and disruptive behaviour, breaking laws such as refusing to wear face masks and challenging the authority, flouting the group size limit and holding parties, and showing blatant racism in public.
The cause of such behaviours is often complex and multifactorial and usually is a result of a combination of biological, environmental, and psychosocial factors. Such behaviours are frequently observed in children; however, people tend to be more forgiving towards children who have poorer self-control of emotions and behaviours due to their underdeveloped pre-frontal cortex, which governs important executive functions such as impulse control. Other factors such as impoverished family background, harsh or inconsistent parenting and developmental difficulties may also be associated with higher levels of disruptive behaviours.
A diagnosis of Oppositional Defiant Disorder (ODD) can be considered in children who display a frequent and persistent pattern of behaviours such as anger, irritability, being argumentative or defiance towards authority figures. However, because the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) provides clinical descriptions of ODD symptoms only for individuals up to 18 years of age, ODD in adults is less mentioned and understood (Reimherr et al., 2011), and generally less widely researched. Instead, adults who display a pattern of negative, hostile, and defiant behaviours are often diagnosed with personality disorders such as antisocial personality. Thus, a diagnosis of antisocial personality supersedes the diagnosis of ODD in adults.
Research has shown that the symptoms of ODD are relatively common in adults, and the results of longitudinal research show symptoms continue from childhood into adolescence for many who are diagnosed with ODD (Gadow et al., 2007). Like in children, ODD in adults can result in significant clinical and functional difficulties and impairment. Symptoms of ODD such as actively defying or refusing to comply with rules, regulations and requests can result in adverse consequences for these adults, for example:
- Individuals who knowingly flout COVID-19 rules and regulations such as mask-wearing and safety distancing measures have been reprimanded by the law.
- Family members who are argumentative, hold grudges, avoid taking responsibility for their behaviours, and blame others for their mistakes may suffer impaired relationships at home.
- Individuals may argue and violate the rights of others in ways that defy social norms and workplace policies, for example arguing with the boss or making derogatory comments at or outside the workplace. In the worst-case scenario, they may be terminated at work for their inappropriate and disruptive behaviours in public as evidenced in recent cases in Singapore.
Furthermore, these individuals often justify their behaviour as a response to unreasonable demands or circumstances, and do not regard themselves as angry or defiant.
Research has also indicated that adults with ODD reported more severe symptoms of other psychiatric disorders. For example, it was found that those with a life-long history of ODD had high rates of comorbid bipolar disorder, anxiety, and substance-use disorders, which is consistent with the patterns of comorbidity found in children with ODD (Harpold et al., 2007).
Negative feelings such as anger are normal human emotions, and they have considerable adaptive value; that is, they can be used to push for the change that we desire. Anger in the face of adversity, for example, can help to garner psychological resources, strengthen behaviours for corrective action and promote perseverance (Novaco & Taylor, 2006). It can also serve to protect one’s self-esteem and be used as a means to communicate negative sentiment and redress grievances. However, anger in individuals with ODD can become problematic when the stress from a trying situation — the current COVID-19 pandemic, for instance – overwhelms their capacity to cope effectively and adjust. Individuals with ODD are “dysregulated” such that they have very poor control over their emotions, which can result in inappropriate and disruptive responses and behaviours. Thus, the adverse consequences faced by individuals with ODD can viewed as a result of reciprocal links between stressful life circumstances (like the COVID-19 pandemic), psychiatric problems (ODD) and disruptive behaviours (Carr & McNulty, 2006).
Individuals with such behaviours usually do not seek help themselves, as they themselves are not distressed but people around them are.
Although children with ODD are often associated with breaking rules, adults with ODD can be perceived by others as controlling and angry if provoked. One of the most challenging issues in working with these individuals is that they often spark an argument in a provocative manner when they are crossed or when they reluctantly come for treatment. Moreover, individuals with such behaviours usually do not seek help themselves, as they themselves are not distressed but people around them are. Despite the challenges, similar strategies apply to working with adults with ODD as with children with ODD – avoid direct challenge and position the individual to be in control. This would allow treatment to continue which would otherwise end prematurely. Trust between the individual with ODD and the treatment provider is crucial in enhancing motivation for treatment.
To give two clinical vignettes, a client, named John (not his real name) in his 20s, was having problems with his wife and also had relationship problems with his colleagues. John sought therapy only on the insistence of his wife. John has had a difficult childhood and grew up with his single mother who spent most of her time working to care of her children. Several sessions were spent in building a trusting relationship with John from a non-judgmental stance yet providing firm strategies in regard to managing his behaviour in a more adaptive manner. Kai (not his real name) was diagnosed with ODD when he was 13. He was an adopted child and also spent time at a home for adolescents due to behavioural issues. He was 19 at the time of therapy as he got into trouble with the law after stealing a bicycle. It took several months before trust and rapport were built to allow deeper healing work to be done for him.
In conclusion, although having psychiatric diagnostic categories can be helpful in providing a more accurate diagnosis and treatment plan, it runs the risks of over-simplifying human conditions and behaviours, assigning narrow labels to individuals, and leading to increased stigmatisation in society. Moreover, it is important to note that individuals with ODD often have had difficult childhood and life experiences that may have led to their current predicament. Seeing them through the lens of compassion is an important first step in helping them integrate into the society.
Chad Yip is a registered clinical psychologist who provides psychological assessment and treatment for children, adolescents and adults. He is the Head of Psychology at Neurowyzr Pte Ltd, a neuroscience company specialising in brain health. He is involved in clinical work, product development and research. He is committed to serve the ever-changing needs of the individual and society.
- Carr, A., & McNulty, M. (Eds.). (2006). The handbook of adult clinical psychology: An evidence-based practice approach. Routledge/Taylor & Francis Group.
- Gadow, K. D., Sprafkin, J., Schneider, J., Nolan, E. E., Schwartz, J., & Weiss, M. D. (2007). ODD, ADHD, Versus ODD+ADHD in Clinic and Community Adults. Journal of Attention Disorders, 11(3), 374–383. https://doi:10.1177/1087054706295609
- Harpold, T., Biederman, J., Gignac, M., Hammerness, P., Surman, C., Potter, A., & Mick, E. (2007). Is Oppositional Defiant Disorder a Meaningful Diagnosis in Adults? The Journal of Nervous and Mental Disease, 195(7), 601–605. https://doi:10.1097/nmd.0b013e318093f448
- Novaco, R. W., & Taylor, J. L. (2006). Anger. In A. Carr & M. McNulty (Eds.), The handbook of adult clinical psychology: An evidence-based practice approach (pp. 978–1009). Routledge/Taylor & Francis Group.
- Reimherr, F. W., Marchant, B. K., Olsen, J. L., Wender, P. H., & Robison, R. J. (2011). Oppositional Defiant Disorder in Adults With ADHD. Journal of Attention Disorders, 17(2), 102–113. https://doi:10.1177/1087054711425774