126. CCA Study Notes: Disruptive, Impulse-Control, and Conduct Disorders

The Big Picture

Some clients have ongoing difficulties with anger, following directions, or controlling their actions. Their behaviour may include arguing, threatening others, or causing harm.

These behaviours can be part of different disorders. Some involve repeated defiance, some involve sudden angry outbursts, and others involve violating people’s rights.

As a Continuing Care Assistant (CCA), you need to recognize these behaviours, treat clients with respect, and know how to protect yourself and others when a situation becomes unsafe.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

Jump to:

Course Notes: Key Ideas You Need to Know

Understanding Disruptive, Impulse-Control, and Conduct Disorders

Disruptive, impulse-control, and conduct disorders involve difficult, disruptive, aggressive, or antisocial ⓘ behaviour.

These behaviours may cause physical or verbal harm to the client or other people, harm objects, or violate another person’s rights.

The behaviour can take different forms:

• Defensive: Behaviour that occurs in response to something the person experiences as a threat.
• Premeditated: Behaviour that is planned ahead of time.
• Impulsive: Behaviour that occurs without careful thought or planning.

There are three main behaviour groups associated with these disorders:

1. Angry or irritable mood: Frequent anger or becoming upset easily.
2. Argumentative or defiant behaviour: Frequently arguing, resisting directions, or challenging authority.
3. Vindictiveness: Behaviours involving spite or a desire for revenge.

These groups help describe the different ways disruptive behaviour may appear.

Aggression in Clients With Dementia

Clients with dementia may also behave aggressively, but there is an important difference.

Aggressive behaviour associated with dementia is not premeditated. It occurs as a response to the client’s environment rather than being planned ahead of time.

This is an important distinction when learning about different forms of aggression.

Oppositional Defiant Disorder (ODD)

Oppositional defiant disorder (ODD) involves a repeated pattern of defiant, disobedient, and hostile behaviour toward people in positions of authority ⓘ.

The behaviour begins in childhood. It is more serious than the usual misbehaviour expected for the child’s age.

Number to remember: The behaviour continues for at least 6 months.

Signs and Symptoms of ODD

A client with ODD may show several patterns of behaviour.

Problems with authority and other people:

• Resisting instructions or stubbornly refusing directions.
• Being unwilling to compromise ⓘ.
• Frequently arguing with, talking back to, or challenging authority figures.
• Provoking others through behaviour that appears mean, spiteful, or rude.
• Blaming other people for problems or denying responsibility.
• Frequently behaving cruelly or seeking revenge.

Mood and emotional behaviour:

• Becoming angry or resentful frequently.
• Having an irritable, negative, or resentful attitude.
• Showing frequent temper tantrums or angry outbursts.

School and social difficulties:

• Getting into trouble at school repeatedly.
• Having few friends or no friends.

Key fact: ODD involves an ongoing pattern of defiance and hostility. The behaviour begins in childhood, goes beyond age-appropriate misbehaviour, and lasts at least 6 months.

Intermittent Explosive Disorder

Intermittent explosive disorder involves repeated angry outbursts caused by difficulty controlling aggressive impulses.

The outbursts may involve words or physical actions.

A client may become angry because they cannot mentally cope with a situation. The anger may appear through sudden reactions or attempts to provoke other people.

Signs and Symptoms of Intermittent Explosive Disorder

Possible symptoms include:

• Intentional behaviour that physically or emotionally harms other people.
• Frequent impulsive actions.
• Frequent irritability.
• Repeated angry outbursts.
• Attempts to provoke other people or retaliate ⓘ against their behaviour.

What May Be Behind the Anger?

Some people who experience ongoing anger have unresolved emotional difficulties.

These may include:

• Feeling that they have lost control over whether their personal values are being respected.
• Having difficulty coping with negative emotions.
• Relying on ineffective ways of managing emotional distress.

Angry outbursts commonly lead to social, financial, or legal consequences.

Calming Anger

Some techniques used to manage negative emotions can also help with anger.

Examples include taking a deep breath and walking away to calm down.

These approaches focus on creating an opportunity to regain emotional control rather than continuing an angry reaction.

Conduct Disorder

Conduct disorder is a pattern of repeatedly violating the personal or property rights of others or the basic expectations of society.

The behaviour usually begins during childhood.

Unlike a single incident of misbehaviour, conduct disorder involves repeated harmful or antisocial actions.

How Conduct Disorder May Develop

Conduct disorder may begin with less severe behaviours, such as:

• Lying.
• Shoplifting.

As the child develops, the behaviour may progress to more serious actions, such as burglary or stealing a vehicle.

This progression may occur as the person develops greater physical strength, thinking abilities, and sexual maturity.

Possible Causes and Contributing Factors

The causes of conduct disorder vary.

Possible contributing factors include:

• Serious family difficulties, including constant or aggressive arguments between parents.
• Limited financial or emotional resources.
• Instability within the family.
• Disturbances in family values.
• Rejection by peers ⓘ.
• Poor performance in school.

These circumstances may contribute to the development of conduct disorder.

Signs and Symptoms of Conduct Disorder

Conduct disorder can involve several kinds of harmful behaviour.

Aggression toward people or animals:

• Bullying, threatening, or intimidating other people.
• Frequently starting physical fights.
• Using weapons or tools capable of causing serious physical harm to people or property.
• Being physically cruel to people or animals.
• Using serious physical violence against others, including rape, assault, or murder.

Stealing, deception, and property damage:

• Stealing while directly confronting another person, such as mugging, purse snatching, or armed robbery.
• Destroying property, such as deliberately starting fires or breaking windows.
• Frequently deceiving, manipulating, or lying to obtain things or favours.
• Deceiving others to avoid debts or responsibilities.

Other behavioural difficulties:

• Engaging in antisocial behaviour.
• Having difficulty with authority figures.
• Staying out at night against parental curfew ⓘ rules before the age of 13.
• Running away from home repeatedly or remaining away for a long period.
• Abusing alcohol or drugs.

Key fact: Conduct disorder involves repeated violations of other people’s rights or society’s expectations. The behaviour can become more serious as the child develops.

Recognizing the Differences Between the Three Disorders

The disorders can involve similar behaviours, but their main patterns are different.

Disorder	Main Pattern
Oppositional defiant disorder	Repeated hostility, disobedience, and defiance toward authority figures
Intermittent explosive disorder	Repeated verbal or physical outbursts involving difficulty controlling aggressive impulses
Conduct disorder	Repeated violations of personal or property rights and society’s basic expectations

Remember the main distinction:

• ODD focuses on ongoing defiance toward authority.
• Intermittent explosive disorder focuses on repeated aggressive outbursts.
• Conduct disorder focuses on repeated violations of rights and expectations.

Supporting Clients With Disruptive, Impulse-Control, and Conduct Disorders

Clients experiencing these disorders may have difficulty understanding their own feelings or managing those feelings in the moment.

Your approach should remain caring, respectful, and nonjudgmental ⓘ.

The client deserves respectful treatment, even when their behaviour is difficult.

Approach the Client Safely

When approaching a client who may become aggressive:

• Maintain a safe distance. A client who feels threatened may strike out.
• Keep an exit path open. Make sure you can leave if the client’s behaviour becomes aggressive.
• Avoid increasing the tension. Do not do anything that might make the situation worse.
• Do not touch the client. Touching may escalate the situation.
• Stay calm and professional. Do not respond to yelling by yelling back.

You have the right to ask a client to speak to you politely as a professional.

Keep your own response calm rather than becoming involved in an argument.

What to Do When a Client Becomes Aggressive

Your main concern is your safety and the safety of others.

The required response depends on what is happening.

If the client is verbally aggressive:

1. Leave the situation.
2. Immediately call your supervisor.

If the client threatens to physically harm you:

1. Get to a safe place.
2. Call the police immediately.

Safety: Do not allow an attempt to understand the client’s anger to take priority over protecting yourself or others.

Understand Possible Reasons for Anger

When a client is verbally aggressive but not physically aggressive, try to understand what may be causing the anger.

Possible reasons include:

• Feeling cold.
• Feeling hungry.
• Experiencing pain.
• Being frightened by something.

Anger may also need to be understood within the client’s cultural context ⓘ.

For example, some men may express fear or pain through yelling rather than openly saying they feel frightened or hurt.

Understanding a possible reason for anger does not replace the safety instructions for verbal aggression.

Helping Clients Think About Anger Differently

Understanding a client’s important life values may help you better understand their anger.

Some clients may also lack confidence in their ability to feel happy or manage difficult emotions.

Supportive approaches may include:

• Helping the client recognize new ways of thinking about a situation.
• Encouraging the client to consider different responses to anger.
• Reminding the client that developing happiness involves mental control, skill, and effort.

Supervisor approval is required before gently discussing the idea that anger is a choice and that blaming others or themselves is not helpful.

For some clients, remaining angry may feel like the easiest response.

Keep this guidance within the approach approved by your supervisor.

Training for Managing Disruptive Behaviour

Employers who provide support to clients with anger-management difficulties often offer or encourage training in managing aggressive behaviour.

For example, a course called Managing Disruptive Behaviours may help support workers learn ways to respond to aggression without confrontation.

The purpose of this training is to develop skills for managing difficult interactions in a nonconfrontational manner.

Managing Your Own Anger as a Support Worker

Support workers may also experience anger.

Understanding your own emotions can help you develop greater control over how you respond to difficult situations.

Recognize the Feelings Behind Anger

Anger may develop from fear, hurt, or a sense of helplessness.

A person may feel angry because they believe they are losing control of a situation.

Sometimes the deeper concern is different from the issue that first caused the angry reaction.

For example, being upset because someone is late may reflect a deeper fear of not being important to that person or of being mistreated.

Recognizing feelings of fear and hurt may help you identify the underlying issue.

Try to Understand Another Person’s Point of View

Empathetic understanding means making an effort to understand another person’s feelings, experiences, and perspective.

When you want to reduce your anger toward someone, the first step is to try to see the situation from that person’s point of view.

You may do this by:

• Asking the person to explain their perspective.
• Trying to understand their circumstances.
• Considering the reasons behind their beliefs and actions.

Difficulty understanding another person’s perspective can be a major barrier to managing anger.

Forgiveness does not require forgetting what happened. It involves remembering the experience while letting go of the anger.

Assume Good Intentions When Possible

Try to believe that other people have good intentions unless repeated behaviour gives you reason to think otherwise.

This approach encourages you to consider a more positive explanation rather than immediately assuming someone meant to cause harm.

Accept That Life Is Not Always Fair

People experience different opportunities and hardships.

Some people grow up in supportive, financially secure families, while others experience difficult living conditions and suffering.

Recognizing that unfair circumstances exist can help you focus on making the most of what you have rather than remaining angry about things you cannot change.

Do Not Use Anger as Motivation for Revenge

Holding on to anger to punish someone or get even can hurt you.

Instead:

1. Give yourself time to calm down.
2. Wait until you can discuss the situation calmly.
3. Explain the reasons for your actions without responding through anger.

A calm discussion is more effective than trying to punish someone because you feel angry.

Examine Your Expectations

Anger may develop when another person does not meet your expectations.

Consider whether your expectations are realistic.

Ask yourself:

• What am I expecting from this person?
• Is that expectation reasonable in this situation?
• Am I expecting the person to behave differently from who they are?

Accepting people and circumstances as they are may help reduce anger related to unrealistic expectations.

Choose Thoughts That Support Happiness

Repeatedly choosing to remain angry can contribute to an unhappy and frustrated life.

Remind yourself that you can work toward changing the thoughts that keep anger going.

The goal is to develop greater control over your emotional responses instead of allowing anger to continue.

Common Mix-Ups

These distinctions are worth reviewing because some behaviours and responses can look similar.

Wrong Idea	Better Idea
ODD and conduct disorder describe the same pattern.	ODD involves ongoing defiance toward authority. Conduct disorder involves repeated violations of rights or society’s expectations.
All aggressive behaviour is planned.	Aggressive behaviour can be defensive, premeditated, or impulsive.
Aggressive behaviour in dementia is premeditated.	Aggression associated with dementia is a response to the environment, not a planned action.
Verbal aggression and threats of physical harm require the same call.	Verbal aggression requires leaving and immediately calling the supervisor. A threat of physical harm requires getting to safety and calling the police immediately.