ODD/CD and Personality Disorder

This is one of the "labels" psychiatry uses to describe people who have traits
in their personality that cause them major problems. These are not things
that come and go but last for decades. A person's personality starts to form
as a teenager, and that is when we see personality disorders start to form.
We have all met people with these types of problems. They fit into a few big
categories that have lots of different names.

One group is people who are strange, different, and keep to themselves. This is called cluster A.  
Another group is people who are dramatic, have lots of mood problems, are forever getting into
trouble, and whose lives are quite mixed up. This is called cluster B. They are often very difficult to
get along with over the long run. Another group are people who are withdrawn, scared, and have
to do things a certain way. This is called cluster C.  When any of these problems screw up people's
relationships, ability to work, get them in trouble with the law, or make them miserable, we call it a
personality disorder.

Recent studies have shown that children who have certain psychiatric problems are much more
likely to get personality disorders as adults. Children who have multiple psychiatric problems are
even more at risk. Children who have ODD are about four times more likely to have a personality
disorder when they grow up, that is about a 15% chance. If they already have some signs of
personality disorder as a young teenager, they are 25 times as likely to have a personality disorder
as adults. What this tells us is that the longer these problems go on in childhood and as
teenagers, the more likely they are to lead to personality disorders as adults.

There are two types of Personality Disorder in Cluster B which are especially associated with
ODD/CD. These are Borderline Personality Disorder and Antisocial Personality Disorder.

Borderline Personality Disorder is called this because patients have many traits from different
psychiatric disorders. They have very unstable moods, like bipolar disorder. They often have
strange experiences, like people with schizophrenia. Their relationships with others are usually
quite unstable. They often don’t have much of a sense of who they really are or where they are
going. They often cut themselves. Most of the people with this problem are female. If you have
ODD/CD and are female, you have approximately a 15% chance of getting this.

Antisocial Personality Disorder is basically a continuation of Conduct Disorder. People with this
problem continue to not respect the rights of others or their property. They continue to get in
fights or worse. They often are stealing or cheating. Usually they are involved with the law. They
have extremely high rates of substance abuse and high rates of suicide and other unnatural
causes of death. This is primarily a male diagnosis. Almost 20% of teenagers with ODD/CD with
have Antisocial Personality Disorder as a result.

How bad are Personality Disorders?

If you have a personality disorder as a teenager, by the time you are a young adult, here are the
chances that these bad  things will happen to you:

1. Make a suicide attempt- 6-10%
2. Serious assault on another 25-35%
3. Not get as far in school as you should have been able to 25%
4. Difficulties with interpersonal Relationships 20-30%
5. Ending up with other Psychiatric problems 35-40%
6. Having at least one of the above bad outcomes 70-80%
7. Having at least two of the above bad outcomes 50% (25)

This seems really bad. Do people with personality disorders ever
get better?

Yes, some personality disorders are much more likely to improve over time. After 15-25 years,
only about 10% of adults who had Borderline Personality Disorder continue to have it. That means
90% got over it. Antisocial Personality disorder tends to improve, too. However,  about 25% of
people with Antisocial Personality Disorder die prematurely. Of those that do not die, most are
better, but few have recovered completely.

ODD leading to personality disorder


When Tina was four or five, she pretty much controlled the house. Somehow she had figured out
exactly what she could get away with. She also was able to figure out where her parent's weak
points were. More amazingly, she figured out where the weak points in their marriage were. This
got so bad that her parents went to marriage counseling and finally adopted a policy of "united we
stand, divided we fall" in regards to Tina. This certainly helped keep Tina in line in her elementary
school years. Tina also had ADHD, but it was never too severe. She only had to take medication
for a few years at the end of elementary school. As she became a teenager, she began to have
problems. The loss of a boyfriend led to cutting her wrists.

She always was in some sort of turmoil with her friends or the youth group. People were always
trying to "save" her. The school counselor and the youth group leader both "knew in their hearts"
that Tina needed a lot of attention and special care and encouraged her parents to be more
understanding on her sensitive nature. Tina's grandfather said that he "knew in his heart" that
Tina needed a swift kick in the rear. As the teenage years went on these problems just continued.
She got involved in some minor crimes like shoplifting, tried vomiting to lose weight, and smoked
pot. Each time she made such a big deal about the whole thing that her parents could hardly
stand it.

When she was 18, she moved in with an older guy who she thought "really understood her".
They have been separated about six times so far. Her life continues in turmoil.

This points out the fact that sometimes, even with great parenting, things don't turn out so well.
However, many times with aggressive intervention things go more like this:


Richard was always hyper and always quite the con artist. The neighborhood mom's never really
trusted him. He got referred after he hit the teacher hard enough to knock her down in second
grade. We did everything. He took medications for his ADHD. The parents followed through with
every type of intervention for ODD. He was very involved in cadets as a teenager. When he was
about 19, I met his mother in a store. She wanted to tell me how well he turned out. He was still
a bit of a hot head and was still on meds for ADHD, but he was working and had a steady
girlfriend. He was hoping to join the militia. Richard had turned out just fine.

Families and CD

It is not unusual to see signs of stress in the parents and other siblings
when a child has CD. One of the hardest questions is figuring out whether
or not difficulties in the family are causing CD or whether the stress of CD
is causing family problems. Often it is impossible to determine this or there
are reasons to suggest both the CD is casing the family problems and the
family is causing the CD to be worse. CD is a very difficult problem to live
with. It would be very unusual to see a family where it was not causing
grave distress. This obviously needs to be addressed in any treatment plan.

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Long-term Outcome of ODD/CD