How to write disruptive, impulse-control, and conduct disorders treatment plans

The DSM-V-TR section titled “Disruptive, Impulse-Control, and Conduct Disorders” includes the diagnoses of oppositional defiant disorder (ODD), conduct disorder, intermittent explosive disorder, kleptomania, and pyromania. There are a variety of treatment approaches that can be applied for these DICCDs.

Cognitive behavioral therapy (CBT)

CBT is a central treatment for DICCDs. Here, the focus is on identifying and changing distorted thoughts that lead to intense emotions and the impulsive actions that are causing problems. If clients can shift their thoughts towards more rational, grounded thoughts, they can reduce the intensity of their feelings and manage their behaviors more effectively.

Anger and emotion regulation therapy

This approach to treatment can include CBT as well as dialectical behavior therapy (DBT), mindfulness-based approaches, and relaxation techniques. The intent is to help clients focus on awareness and acceptance of their emotions, developing healthier alternative responses to those emotions, and thus reducing their impulsive reactions. 

Psychiatric evaluation and medication

A comprehensive evaluation is required to diagnose a DICCD, which can be conducted by a psychiatrist, psychologist, or therapist. While an evaluation is not required to be conducted by a psychiatrist, this can help determine if psychotropic medications should be prescribed to address impulsive behavior and emotion dysregulation. These medications can include selective serotonin reuptake inhibitors (SSRIs). Less frequently used are mood stabilizers, antiepileptic medications, and sometimes antipsychotics. No medications are FDA-approved specifically for DICCDs, but off-label use is common to address symptoms such as impulsivity or mood dysregulation. 

Support groups and peer accountability

One of the biggest benefits of support groups for DICCDs is helping clients ‌build self-efficacy, or the belief that they can create and sustain changes. Structured groups can also support goal-setting, skill building, and mutual accountability. This promotes encouragement, impulse management, and emotion regulation.

Psychoeducation on triggers and urges

Psychoeducation can help clients ‌gain insight into their triggers and urges. This may help them identify the escalation of their impulses and have a better chance of responding in a more effective way. Psychoeducation for family members can help them ‌recognize ‌triggers as well, and provide support through a positive environment that reinforces more positive behaviors. 

Lifestyle and behavioral modifications

A healthy, balanced lifestyle can make a major impact on trigger reduction and enhanced self-regulation. Adequate sleep, healthy meals, exercise, and stress reduction activities like meditation can all be part of this holistic approach. Setting achievable goals and avoiding triggering environments should also be included with this portion of the treatment plan. 

Crisis and risk management planning

A personalized crisis plan is necessary, especially for clients whose impulsive behaviors can cause harm to themselves or others. This plan can be developed collaboratively among the client, therapist, and family members. It should list triggers, de-escalation coping skills, monitoring plans, supportive medications if applicable, as well as crisis line phone numbers if situations escalate. The goal of these plans is to bring awareness, provide alternatives to the client, reduce harm, intervene early before damage is done, and maintain safety for everyone. 

Involving family or close relationships

Involving family in the treatment plan can impact outcomes of any DICCD. This is particularly true with ODD and conduct disorder because they are diagnosed only in children and adolescents. When families receive psychoeducation and participate in therapy, they can provide the client with greater emotional support, accountability, and barriers to impulsive behavior. It's also helpful to teach family members communication and de-escalation skills to apply in challenging moments. 

Addressing underlying trauma

Treating trauma can be an essential component for clients with a DICCD. The trauma may be underlying their emotional dysregulation and impulsive behaviors. A trauma-informed treatment plan can help guide the client and clinician to treatment approaches that help achieve better outcomes. Some possible approaches include EMDR, trauma-focused CBT, somatic experiencing, or CPT. Addressing trauma should always be done in a safe and structured way, ensuring the client is well prepared to do that work.