Recently I was talking to a parent about her son's diagnosis with oppositional defiant disorder, and I was reminded about how much of a stigma these diagnoses are. In listening to this parent, it appeared that there was a lack of connection being made between her son's history to present and the diagnosis. Everyone seemed to be focused on him becoming more obedient and easy going, which only seemed to be generating the opposite effect. Which in turn seemed to lead to a doubling down in reminding him of the diagnosis, which he of course was resistant to accepting.
It reminds me of another young man whom I worked with years ago. He was abandoned by both parents, adopted at four years of age by a family and then subsequently returned to the state by the family who adopted him about five years later. On some days, it seemed that this kid only lived to fight authority figures and his peers.
One day, while pondering how I was going to address an incident in which he disrespected a staff member, it occurred to me that his life experiences with adult caregivers in his life had given him plenty of reason to distrust authority figures—especially when taking into account his chronic experiences with being abandoned by caregivers. From my assessment, based on his personality traits for being adventurous and a risk taker, it would make sense how he would develop hostility and aggression towards adults in position of authority. It was a defense mechanism: He didn't want to form connections to protect himself from being abandoned again. Sadly, his ODD was a maladaptive strategy which only served to recreate narratives of being rejected and abandoned.
That morning, my simply act of acknowledging his pain and suffering from being betrayed by the adults in his life softened him up a great deal. From there, he became willing to practice respect for others as part of his repertoire in addressing disagreements with others.
In the video below, I discuss the DSM V description about oppositional defiance disorder, and how in the absence of other clinical issues, a diagnosis of ODD is really a defense mechanism and coping strategy used by children and teens who have experienced a history of being betrayed by adults in their lives to varying degrees.
Ugo is a psychotherapist and life coach.