Human bonding

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Human_bonding 

 

Human bonding is the process of development of a close interpersonal relationship between two or more people. It most commonly takes place between family members or friends, but can also develop among groups, such as sporting teams and whenever people spend time together. Bonding is a mutual, interactive process, and is different from simple liking. It is the process of nurturing social connection.

Bonding typically refers to the process of attachment that develops between romantic or platonic partners, close friends, or parents and children. This bond is characterised by emotions such as affection and trust. Any two people who spend time together may form a bond. Male bonding refers to the establishment of relationships between men through shared activities. The term female bonding refers to the formation of close personal relationships between women. Cross-sex friendships refers to personal relationships between men and women.

Early views

In the 4th century BC, the Greek philosopher Plato argued that love directs the bonds of human society. In his Symposium, Eryximachus, one of the narrators in the dialog, states that love goes far beyond simple attraction to human beauty. He states that it occurs throughout the animal and plant kingdoms, as well as throughout the universe. Love directs everything that occurs, in the realm of the gods as well as that of humans (186a–b).

Eryximachus reasons that when various opposing elements such as wet and dry are "animated by the proper species of Love, they are in harmony with one another... But when the sort of Love that is crude and impulsive controls the seasons, he brings death and destruction" (188a). Because it is love that guides the relations between these sets of opposites throughout existence, in every case it is the higher form of love that brings harmony and cleaves toward the good, whereas the impulsive vulgar love creates disharmony.

Plato concludes that the highest form of love is the greatest. When love "is directed, in temperance and justice, towards the good, whether in heaven or on earth: happiness and good fortune, the bonds of human society, concord with the gods above—all these are among his gifts" (188d).

In the 1660s, the Dutch philosopher Spinoza wrote, in his Ethics of Human Bondage or the Strength of the Emotions, that the term bondage relates to the human infirmity in moderating and checking the emotions. That is, according to Spinoza, "when a man is prey to his emotions, he is not his own master, but lies at the mercy of fortune."

In 1809 Johann Wolfgang von Goethe, in his classic novella Elective Affinities, wrote of the "marriage tie," and by analogy shows how strong marriage unions are similar in character to that by which the particles of quicksilver find a unity together through the process of chemical affinity. Humans in passionate relationships, according to Goethe, are analogous to reactive substances in a chemical equation.

Pair bonding

Main article: Pair bond

The term pair bond originated in 1940 in reference to mated pairs of birds; referring to a monogamous or relatively monogamous relationship. Whilst some form of monogamy may characterise around 90% of bird species, in mammals long-term pairing (beyond the brief duration of copulation itself) is rare, at around 3% (see animal monogamy). The incidence of monogamy in primate species is similarly low in contrast with polygyny (one male mating with two or more females), the most common pattern. However, regardless of mating patterns, primate life is typically characterised by long-lasting social relationships (whether sexual, care-giving, coalitionary or otherwise) formed in the context of living in durable social groups, and any such durable relationship (whether exclusive or not) is characterised by some degree of bonding. Similarly, whilst the 'naturalness' of monogamy in humans is debated, durable monogamous or polygamous relationships will typically be accompanied by affectional or emotional bonding (see next section).

Limerent bond

Main article: Limerence

According to limerence theory, posited in 1979 by psychologist Dorothy Tennov, a certain percentage of couples may go through what is called a limerent reaction, in which one or both of the pair may experience a state of passion mixed with continuous intrusive thinking, fear of rejection, and hope. Hence, with all human romantic relationships, one of three varieties of bonds may form, defined over a set duration of time, in relation to the experience or non-experience of limerence:

1. Affectional bond: define relationships in which neither partner is limerent.
2. Limerent–Nonlimerent bond: define relationships in which one partner is limerent.
3. Limerent–Limerent bond: define relationships in which both partners are limerent.

The constitution of these bonds may vary over the course of the relationship, in ways that may either increase or decrease the intensity of the limerence. A characteristic of this delineation made by Tennov, is that based on her research and interviews with over 500 people, all human bonded relationships can be divided into three varieties being defined by the amount of limerence or non-limerence each partner contributes to the relationship.

Parental bonding

Attachment

Main articles: Affectional bond and Attachment theory

Parental bonds often help children form their identity.

In 1958, British developmental psychologist John Bowlby published the paper "the Nature of the Child's Tie to his Mother," in which the precursory concepts of "attachment theory" were developed. This included the development of the concept of the affectional bond, which is based on the universal tendency for humans to attach, i.e. to seek closeness to another person and to feel secure when that person is present. Attachment theory has some of its origins in the observation of and experiments with animals, but is also based on observations of children who had missed typical experiences of adult care. Much of the early research on attachment in humans was done by John Bowlby and his associates. Bowlby proposed that babies have an inbuilt need from birth to make emotional attachments, i.e. bonds, because this increases the chances of survival by ensuring that they receive the care they need.Bowlby did not describe mutuality in attachment. He stated that attachment by mother was a pathological inversion and described only behaviors of the infant. Many developmental specialists elaborated Bowlby's ethological observations. However, neither Bowlby's proximity seeking (not possible for human infants prior to walking) nor subsequent descriptions of caregiver–infant mutuality with emotional availability and synchrony with emotional modulation include the enduring motivation of attachment into adult life. The enduring motivation is the desire to control a pleasantly surprising transformation that is the route of belief in effectiveness by humans. This motivation accounts for curiosity and intellectual growth of language, mathematics and logic, all of which have an emotional base of security.

Maternal bonding

Main article: Maternal bond

A mother breast feeding—a process that facilitates mother–infant bonding

Of all human bonds, the maternal bond (mother–infant relationship) is one of the strongest. The maternal bond begins to develop during pregnancy; following pregnancy, the production of oxytocin during lactation increases parasympathetic activity, thus reducing anxiety and theoretically fostering bonding. It is generally understood that maternal oxytocin circulation can predispose some mammals to show caregiving behavior in response to young of their species.

Breastfeeding has been reported to foster the early post-partum maternal bond, via touch, response, and mutual gazing. Extensive claims for the effect of breastfeeding were made in the 1930s by Margaret Ribble, a champion of "infant rights," but were challenged by others. The claimed effect is not universal, and bottle-feeding mothers are generally appropriately concerned with their babies. It is difficult to determine the extent of causality due to a number of confounding variables, such as the varied reasons families choose different feeding methods. Many believe that early bonding ideally increases response and sensitivity to the child's needs, bolstering the quality of the mother–baby relationship—however, many exceptions can be found of highly successful mother–baby bonds, even though early breastfeeding did not occur, such as with premature infants who may lack the necessary sucking strength to be successfully breastfed.

Research following Bowlby's observations (above) created some concern about whether adoptive parents have missed some crucial period for the child's development. However, research regarding The Mental and Social Life of Babies suggested that the "parent-infant system," rather than a bond between biologically related individuals, is an evolved fit between innate behavior patterns of all human infants and equally evolved responses of human adults to those infant behaviors. Thus nature "ensures some initial flexibility with respect to the particular adults who take on the parental role."

Paternal bonding

Father playing with his daughter—an activity that tends to strengthen the father–child bond

Main articles: Paternal bond and Fathers as attachment figures

In contrast to the maternal bond, paternal bonds tend to vary over the span of a child's development in terms of both strength and stability. In fact, many children now grow up in fatherless households and do not experience a paternal bond at all. In general, paternal bonding is more dominant later in a child's life after language develops. Fathers may be more influential in play interactions as opposed to nurturance interactions. Father–child bonds also tend to develop with respect to topics such as political views or money, whereas mother–child bonds tend to develop in relation to topics such as religious views or general outlooks on life.

In 2003, a researcher from Northwestern University in Illinois found that progesterone, a hormone more usually associated with pregnancy and maternal bonding, may also control the way men react towards their children. Specifically, they found that a lack of progesterone reduced aggressive behavior in male mice and stimulated them to act in a fatherly way towards their offspring.

Human–animal bonding

Main articles: Pet and Anthrozoology

A child bonding with a cat. Human to animal contact is known to reduce the physiological characteristics of stress.

The human–animal bond can occur between people and domestic or wild animals; be it a cat as a pet or birds outside one's window. The phrase "Human-Animal Bond" also known as HAB began to emerge as terminology in the late 1970s and early 1980s. Research into the nature and merit of the human–animal bond began in the late 18th century when, in York, England, the Society of Friends established The Retreat to provide humane treatment for the mentally ill. By having patients care for the many farm animals on the estate, society officials theorized that the combination of animal contact plus productive work would facilitate the patients' rehabilitation. In the 1870s in Paris, a French surgeon had patients with neurological disorders ride horses. The patients were found to have improved their motor control and balance and were less likely to suffer bouts of depression.

During the 1820-1870s, America's Victorian middle class used the human-animal bond to aid in children's socialization. This was an entirely gendered process, as parents and society believed only boys had an innate tendency towards violence and needed to be socialized towards kindness and empathy through companion animals. Over time pet keeping to socialize children became more gender neutral, but even into the 1980s and 90s there remained a belief that boys especially benefited from pet keeping due to the fact that it was one of only ways they could practice nurturing given the limiting gender norms.

An example of the Human-Animal Bond can be seen during World War I on the Western Front with horses. The use of this animal was widespread as over 24,000 horses and mules were used in the Canadian Expeditionary Force in World War I. The horse connection can be seen as horses were used to pull wagons for their drivers, as individual transport mounts for officers, and patients for veterinarians. When researching the human-animal bond, there is a danger of anthropomorphism and projections of human qualities.

In the 19th century, in Bielefeld, Germany, epileptic patients were given the prescription to spend time each day taking care of cats and dogs. The contact with the animals was found to reduce the occurrence of seizures. As early as the 1920s, people were starting to utilize the human-animal bond not just for healing, but also granting independence through service animals. In 1929, The Seeing Eye Inc. school formed to train guide dogs for the blind in the United States, inspired by dogs being trained to guide World War I veterans in Europe. Furthermore, the idea is that the human-animal bond can provide health benefits to humans as the animals "appeal to fundamental human needs for companionship, comfort, and security..." In 1980, a team of scientists at the University of Pennsylvania found that human to animal contact was found to reduce the physiological characteristics of stress; specifically, blood pressure, heart rate, respiratory rate, anxiety, and tension were all found to correlate inversely with human–pet bonding.

In some cases, despite its benefits, the human-animal bond can be used for harmful purposes. The 1990s saw an increase in social and scientific awareness of the use of companion animals as a tool for domestic violence. A 1997 study found that 80% of shelters reported women staying with them had experienced their abuser threatening or harming companion animals as a form of abuse.

A study in 2003, by the U.S. Department of Defense, based on human-animal bonding determined that there was an improvement and enrichment of life when animals were closely involved with humans. The study tested blood levels and noticed a rise in oxytocin in humans and animals which participated; oxytocin has the ability to lower stress, heart rate, and fear levels in humans and animals.

Historically, animals were domesticated for functional use; for example, dogs for herding and tracking, and cats for killing mice or rats. Today, in Western societies, their function is primarily bonding. For example, current studies show that 60–80% of dogs sleep with their owners at night in the bedroom, either in or on the bed. Moreover, in the past the majority of cats were kept outside (barn cats) whereas today most cats are kept indoors (housecats) and considered part of the family. Currently, in the US, for example, 1.2 billion animals are kept as pets, primarily for bonding purposes. In addition, as of 1995, there were over 30 research institutions looking into the potential benefits of the human–animal bond.

Neurobiology

There is evidence in a variety of species that the hormones oxytocin and vasopressin are involved in the bonding process, and in other forms of prosocial and reproductive behavior. Both chemicals facilitate pair bonding and maternal behavior in experiments on laboratory animals. In humans, there is evidence that oxytocin and vasopressin are released during labor and breastfeeding, and that these events are associated with maternal bonding. According to one model, social isolation leads to stress, which is associated with activity in the hypothalamic-pituitary-adrenal axis and the release of cortisol. Positive social interaction is associated with increased oxytocin. This leads to bonding, which is also associated with higher levels of oxytocin and vasopressin, and reduced stress and stress-related hormones.

Oxytocin is associated with higher levels of trust in laboratory studies on humans. It has been called the "cuddle chemical" for its role in facilitating trust and attachment. In the reward centers of the limbic system, the neurotransmitter dopamine may interact with oxytocin and further increase the likelihood of bonding. One team of researchers has argued that oxytocin only plays a secondary role in affiliation, and that endogenous opiates play the central role. According to this model, affiliation is a function of the brain systems underlying reward and memory formation.

Because the vast majority of this research has been done on animals—and the majority of that on rodents—these findings must be taken with caution when applied to humans. One of the few studies that looked at the influence of hormones on human bonding compared a control group with participants who had recently fallen in love. There were no differences for most of the hormones measured, including LH, estradiol, progesterone, DHEAS, and androstenedione. Testosterone and FSH were lower in men who had recently fallen in love, and there was also a difference in blood cortisol for both sexes, with higher levels in the group that was in love. These differences disappeared after 12–28 months and may reflect the temporary stress and arousal of a new relationship.

Prolactin

Main article: Prolactin

Prolactin is a peptide hormone primarily produced in the anterior pituitary gland. Prolactin affects reproduction and lactation in humans and other non-human mammals. It is also thought to mediate the formation of social bonds between mothers and their infants, much like the hormone oxytocin. In addition to prolactin's role in the formation of social bonds, it is thought to be involved in romantic attachment, especially in its early stages. Prolactin may also act to mediate well-being and the positive effects of close relationships on one's health. To do so, it alters an individual's neuroendocrine system to increase the probability of forming a strong social bond without requiring long gestation periods; this may enable bonding between mother and child in cases of adoption.

Prolactin can also influence both maternal and paternal behavior. The administration of prolactin to female rats initiates maternal behavior, and in bird and fish fathers, it can increase paternal behavior, whereas antagonists to prolactin decrease paternal behavior. In human studies, fathers with higher prolactin concentrations are more alert and nurturing towards their infants. In a different study where fathers and infants were observed over a six-months period after the child was born, the researchers found that fathers with higher prolactin levels were more likely to facilitate play with their infant. Moreover, following the birth of the child, prolactin promotes bonding between the father and the newborn.

Prolactin levels can also increase during socially stressful situations in humans. This has been seen by administering the Trier Social Stress Test (TSST), and then measuring blood serum prolactin concentrations. The TSST is a widely accepted stress test in which the research subject undergoes a mock job interview and then a mental arithmetic task in front of a three-person committee. This test is proven to simulate social psychological stress. After the administration of this test, significantly higher prolactin levels can be observed in the serum. There is a large variation in the amount prolactin levels increase in different individuals, however the effect is not significantly different between men and women.

Weak ties

Main article: Interpersonal ties

In 1962, while a freshman history major at Harvard, Mark Granovetter became enamored of the concepts underlying the classic chemistry lecture in which "weak" hydrogen bonds hold huge numbers of water molecules together, which themselves are held together by "strong" covalent bonds. This model was the stimulus behind his famous 1973 paper The Strength of Weak Ties, which is now considered a classic paper in sociology.

Weak social bonds are believed to be responsible for the majority of the embeddedness and structure of social networks in society as well as the transmission of information through these networks. Specifically, more novel information flows to individuals through weak than through strong ties. Because our close friends tend to move in the same circles that we do, the information they receive overlaps considerably with what we already know. Acquaintances, by contrast, know people that we do not, and thus receive more novel information. There are some demographic groups, such as alexithymics, who may find it very difficult to bond or share an emotional connection with others.

Debonding and loss

In 1953, sociologist Diane Vaughan proposed an uncoupling theory. It states that during the dynamics of relationship breakup, there exists a "turning point," only noted in hindsight, followed by a transition period in which one partner unconsciously knows the relationship is going to end, but holds on to it for an extended period, sometimes for a number of years.

When a person to which one has become bonded is lost, a grief response may occur. Grief is the process of accepting the loss and adjusting to the changed situation. Grief may take longer than the initial development of the bond. The grief process varies with culture.

Traumatic bonding

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Traumatic_bonding 

Trauma bonds (also referred to as traumatic bonds) are emotional bonds with an individual (and sometimes with a group) that arise from a cyclical pattern of abuse, perpetuated by intermittent reinforcement through rewards and punishments. The concept was developed by psychologists Donald Dutton and Susan Painter. A trauma bond usually involves a victim and a perpetrator in a unidirectional relationship wherein the victim forms an emotional bond with the perpetrator. This can also be conceptualized as a dominated-dominator or an abused-abuser dynamic.

Two main factors involved in the establishment of a trauma bond are: a power imbalance and intermittent reinforcement of good and bad treatment, or reward and punishment. Trauma bonding can occur in the realms of romantic relationships, platonic friendships, parent-child relationships, incestuous relationships, cults, hostage situations, managers versus their direct reports, sex trafficking (especially that of minors), or tours of duty among military personnel.

Trauma bonds are based on terror, dominance, and unpredictability. As the trauma bond between an abuser and a victim strengthens and deepens, it leads to conflicting feelings of alarm, numbness, and grief, which show up in a cyclical pattern. Oftentimes, victims in trauma bonds do not have agency and autonomy and do not have an individual sense of self. Their self-image is a derivative and an internalization of the abuser's conceptualization of them.

Trauma bonds have severe detrimental effects on the victim. Some long-term impacts of trauma bonding include remaining in abusive relationships, having adverse mental health outcomes like low self-esteem, negative self-image, an increased likelihood of depression and bipolar disorder, and perpetuating a generational cycle of abuse. Victims who traumatically bond with their victimizers are often unable to leave these relationships or are only able to do so under significant duress and difficulty. Even among those who do manage to leave, many go back to the abusive relationship due to the pervasiveness of the learned trauma bond.

Context

In the 1980s, Donald G. Dutton and Susan L. Painter explored the concept of the traumatic bonding theory in the context of abusive relationships and battered women. This work was then further studied in contexts of parent-child relationships, sexual exploitation, and more. Patrick Carnes described trauma bonding as "the misuse of fear, excitement, sexual feelings, and sexual physiology to entangle another person." A simpler and more encompassing definition is that traumatic bonding is: "a strong emotional attachment between an abused person and his or her abuser, formed as a result of the cycle of violence." Carnes also studied traumatic bonding theory, exploring it specifically in the context of betrayal, which involved the exploitation of the victim's trust and/or sense of power by the abuser.

Establishment

Trauma bonds are formed in abused-abuser or victim-victimizer dynamics. A victim can form a trauma bond with an abuser in the presence of a perceived threat from the abuser, the conviction that the abuser will follow through with the threat, perception of some form of kindness from the abuser, isolation from perspectives that do not serve to deepen the trauma bond, and perceived lack of ability or capacity to leave the situation.

The first incident of abuse is often perceived as an anomaly, as a one-off instance occurring at the beginning of a seemingly healthy and positive relationship that is often not very severe. Furthermore, the expression of affection and care by the abuser following the incident pacifies the victim and instills in them the belief that the abuse is not recurring. However, repeated instances of abuse and maltreatment later generate a cognitive shift in the victim's mind: that preventing the abuse is in their power. When the inescapability of the abuse becomes apparent, the emotional trauma bond is already strong.

Two main factors facilitate forming and continuing a trauma bond: a power imbalance and an intermittent reinforcement.

Power imbalance

For a trauma bond to persist, a power differential must exist between the abuser and the victim such that the abuser is in a position of power and authority whereas the victim is not. Inequity in power can produce pathologies in individuals that can fortify the trauma bond. Upon experiencing intermittent punishment from the abuser/dominator, who is in a position of high power, the victim may internalize the abuser's perception of themselves. This may result in a tendency for the victim to self-blame him/herself in situations of violence perpetrated by the abuser, which can negatively impact the victim's self-concept.

A negative self-appraisal can maximize emotional dependency on the abuser and the cyclical nature of this dependency. Negative self-concept can eventually lead to the formation of a strong emotional bond from the victim to the abuser (i.e. towards the person who is in a position of power and authority, from the person who is not). Furthermore, physical, emotional, and sexual abuse can be used to maintain the power differential. This dynamic is also maintained via the interaction of the abuser's sense of power and the victim's sense of powerlessness and subjugation.

Intermittent reinforcement

Intermittent reinforcement of rewards and punishments is crucial to establishing and maintaining a trauma bond. In trauma bonding, the abuser intermittently maltreats the victim through physical, verbal, emotional, and/or psychological abuse. This maltreatment is interspersed with positive behaviors like expressing affection and care, showing kindness, giving the victim gifts, and promising not to repeat the abuse. Alternating and sporadic periods of good and bad treatment serve to reinforce the victim intermittently.

The pervasiveness of learning something through intermittent reinforcement can be elucidated by drawing from learning theory and the behaviorist perspective. In the presence of an aversive stimulus, reinforcement through rewards in unpredictable ways is a key component of learning. When the learner is unable to predict when they will get the reward, learning is maximized. Similarly, the intermittent expressions of affection and care are unexpected, and the inability to predict them makes them more sought after. Intermittent reinforcement produces behavioral patterns that are tough to terminate. Thus, they develop incredibly strong emotional bonds.

Maintenance

A trauma bond can be maintained by keeping the power imbalance and the intermittency of abuse intact.

Trauma bonds can also be maintained if the victim is financially dependent on the abuser or has some investment in the relationship, such as a child with the abuser.

Cognitive dissonance theory can also explain the maintenance of a trauma bond, it postulates that when individuals experience a conflict between their beliefs and action, they are motivated to reduce or eliminate the incongruence to minimize the psychological discomfort. In this vein, victims may distort their cognitions about the trauma and violence of the relationship to maintain a positive view of the relationship. This can involve rationalizing the abuser's behavior, justifications, minimizing the impact of the abuser's violence, and/or self-blaming.

Furthermore, research shows that the memory of instances wherein abuse was experienced is dissociated or state-dependent, meaning that the memories of abuse only fully resurface when the situation is similar in intensity and experience to the original situation of terror.

If and when the victim finally decides to leave the abusive relationship, the immediate relief from the traumatizing violence will begin to abate and the underlying, deep attachment formed from intermittent reinforcement will begin to surface. This current period of vulnerability and emotional exhaustion will likely trigger memories of when the abuser was temporarily affectionate and caring. In the desire to receive that affection once more, the victim may try to return to the abusive relationship.

Strong social support, however, can be a protective factor in preserving the victim's functioning and providing a buffer in traumatic situations.

The role of attachment

John Bowlby maintained that a secure attachment was an evolutionarily sound human need that superseded even the need for food and reproduction. Attachment has been explored in depth in caregiver-child dynamics but recent research has shown that the principles that explain attachment between caregivers and infants can also explain attachment throughout one's lifespan, specifically in the context of intimate relationships and romantic bonds.

Attachment bonds formed during early life lay the foundation for interpersonal relationships, interactions, personality characteristics, and mental health in the future. Infants usually form attachments with their parents or immediate caregivers. Harlow's research on monkeys shows that infant monkeys formulate attachment bonds even with abusive mothers (In the experimental setup, the abusive 'mother' was a monkey made out of fabric who delivered mild shocks to the infant monkey or flung the infant monkey across the arena).

These findings also apply to human attachment bonds. Even in situations where immediate caregivers are abusive, human infants still tend to attach to them – rejection from a caregiver only enhances the efforts to increase proximity to them and establish an attachment bond with them.

Furthermore, in situations of danger, humans seek increased attachment. When ordinary pathways of attachment are unavailable, people tend to turn to their abusers. This leads to strong bonds and deep emotional connections with abusers. This attachment – both to abusive caregivers and to other abusers in the absence of a main caregiver – may be adaptive in the short run as it may aid survival. But in the long run, this attachment is maladaptive and can lay the foundation for, increase vulnerability to, and even directly lead to trauma bonding.

Stockholm syndrome

The concept of trauma bonding is often conflated with Stockholm syndrome. Although there are overarching similarities between the two, especially in the context of developing an emotional bond with one's victimizer, trauma bonding and Stockholm syndrome are distinct from one another. The main difference is the directionality of the relationship. While a trauma bond is unidirectional in that only the victim becomes emotionally attached to the victimizer, Stockholm syndrome is bi-directional.

In other words, in the case of Stockholm syndrome, the emotional connection is reciprocal such that the abuser also seems to develop an emotional connection towards the abused and harbor positive feelings for the abused, in addition to the abused developing an emotional bond with the abuser.

Realms of existence

In abusive relationships

Although the victim may disclose the abuse, the trauma bond means that the victim may wish to receive comfort from the very person who abused them.

PACE UK

Unhealthy, or traumatic, bonding occurs between people in an abusive relationship. The bond is stronger for people who have grown up in abusive households because it seems to them to be a normal part of relationships. On the psychometric scale for Stockholm syndrome the three main parts are justifying an abuser through cognitive distortions; Damage, ongoing psychological effects of abuse; and love.

Initially, the abuser is inconsistent in approach, developing it into an intensity perhaps not matched in other relationships of the victim. It is claimed the longer a relationship continues, the more difficult it is for people to leave the abusers with whom they have bonded.

There are multiple reasons why a victim would try to preserve their abusive relationship. A few of these many reasons could be fear, children, and financial constraints. These, among others, could lead a victim to accuse innocent people falsely. This could be detrimental to both individuals involved.

Battered women

Initial research about battered women held the view that a victim's return to an abusive relationship was an indicator of a flawed personality and more specifically, masochism. However, this view was perpetuated by the 'just-world hypothesis', which supports the idea that people “get what is coming for them”. In other words, the tendency to victim-blame arises from the belief that the world is a just and fair place where the victim is seen as deserving of any negative consequences. However, research on battered women and research on traumatic bonding has shown that that is not the case. In terms of battered women's decision to stay in or return to an abusive relationship, many factors are at play, ranging from family history and role expectations, to access to resources, to the dynamics of the relationship itself. A crucial part of the relationship's dynamic is the existence of a trauma bond. Maltreatment interspersed with periods of kindness aid the formation of a trauma bond that makes the victim harbor positive feelings towards the abuser.

Among battered women, a three-phase process can explain the intermittent reward-punishment cycle. During phase one, there is a gradual increase in tension, followed by an "explosive battering incident" in phase two, which is then followed by a peaceful expression of love and affection from the abuser during phase three. These phases' recurring and cyclical nature gives rise to a trauma bond.

Sex trafficking

Trauma bonds are extremely common in situations of sex trafficking, child grooming, commercial sexual exploitation of children (CSEC), and pimp-prostitute relationships.

Grooming

Child grooming involves establishing and maintaining trauma bonds between the child and the abuser. Along with the factors of power imbalance and intermittent reinforcement that contribute to trauma bonding, child grooming also necessitates gaining the trust of those around the child. Grooming also involves gaining the child's trust while simultaneously violating their boundaries. Treats and trips are used as bribes to both gain access to the child as well as ensure that they comply. Intense attachments coupled with cognitive distortions deepen the bond.

A 2019 case study explores the life of one individual who was groomed. The victim's perception of the abuser as a benefactor, a substitute parent, and a mind controller, all contributed to the development of a traumatic bond between the victim and the abuser. In terms of being a benefactor, the abuser in this case study went above and beyond to give the victim what they needed: from getting the victim a job to gifting them a plot of land for their first house, the abuser was always present as a benefactor. The abuser also acted as a substitute parent, advising and offering emotional support in times of crisis. The roles of the abuser as a benefactor and substitute parent constituted the good treatment necessary to establish a trauma bond. In contrast, the abuser's role as a mind controller involved controlling and dominating tendencies that emulated being brainwashed. This combination of perceptions established a traumatic bond that the victim found incredibly difficult to break, because rejecting the emotional connection as a whole would also involve rejecting the perks and benefits – the trips, the gifts, the treats, the confidante and the caretaker.

Child grooming can be understood from a developmental perspective as well and the relationship between the victim and the abuser evolves across the lifespan. Grooming starts when the child is extremely young – the trust of the child and the family is acquired. The child is given immense attention and is showered with gifts. As the individual matures and enters adolescence, the abuser becomes a confidante and a benefactor. In the aforementioned case study, the abuser gave the victim career advice and even picked him up and dropped him off at school. Then, at the onset of adulthood, the abuser provided the victim with land to build their home and became the person the victim brought their partner home to. As the victim's developmental needs evolved, so did the abuser's response, such that the only thing constant was the victim's need for affection. In other words, the abuser was "able to capitalize on [the victim's] relational needs" until the victim was able to meet those needs in other ways.

Commercial Sexual Exploitation of Children (CSEC)

The commercial sexual exploitation of children (CSEC) can cause debilitating physical and psychological trauma. Along with causing functional impairments, it can amplify risk-taking behaviors and increase impulse dysregulation, further compromising the child's ability to conceptualize, comprehend, establish, and maintain boundaries. This can lead to confusion regarding what safety, affection, intimacy, and kindness entail, resulting in the formation of a trauma bond with the abuser/trafficker that is based on skewed perceptions of safety and kindness. The trauma bond deepens and strengthens when isolation and threats to survival increase, forcing the victim to depend almost entirely on the abuser for survival and protection. This increased emotional dependence on the abuser normalizes the emotional violence experienced by the victim at the hands of the abuser and gradually, the victim develops a sense of trust and safety – albeit skewed – towards the abuser.

Trauma coercive bond

Trauma bonding thrives in the presence of a power imbalance and intermittent reward/punishment behavior. Trauma-coercive bonding, on the other hand, has two additional elements: social isolation and the perceived inability to escape the situation. Since these two elements are crucial to the experiences of victims of CSEC, their bonds with their abusers are better described as trauma-coercive bonds rather than simply as trauma bonds. The element of coercion concreted by social isolation and the perceived inability to escape makes the trauma bond more complex and far more deep-rooted. The use of coercive trauma bonding encapsulates the psycho-social dynamics of a relationship between a victim and a perpetrator of CSEC.

Intimate partner violence (IPV)

IPV has been defined as physical, sexual, psychological, economic, or stalking abuse, both concrete and menaced, perpetuated by current or ex-partners. Trauma bonding is used to solidify this type of relationship by, rationalizing and/or minimizing a violent partner's behavior, self-blame, and reporting love in the context of fear.

Parent-child relationships

Trauma bonds in parent-child or caregiver-child dynamics can be borne from abuse and neglect or incestuous relationships.

Abuse and/or neglect

The children of dismissive caregivers or cruel/harsh caregivers can develop insecure attachments, which can be very dysfunctional. Inconsistencies in reward and punishment (i.e. intermittent reinforcement of good and bad treatment) can highlight the affection the child receives from the parent, forcing a split between the abuse and the kindness such that the child seeks to form an overall positive view of the caregiver and thus, focuses only on the affection and kindness they receive. Overall, a trauma bond develops such that the child's sense of self is derived from their emotional dependence on the authority figure who, in this case, is the parent and/or caregiver.

Incest

Incestuous relationships between parents and children cultivate trauma bonds similar to those prevalent in victims of sex trafficking. All participants of a 1994 study on trauma in adult incest survivors demonstrated some trauma bond with their abusers. There was a positive correlation between the pervasiveness of the trauma bond and the amount of contact the victim or the victim's close family members had with the abuser: those who self-reported less pervasive trauma also reported sustained contact with their abuser, while those who self-reported more pervasive trauma demonstrated an active avoidance of maintaining a relationship with their abuser. In incestuous parent-child dynamics, the study found that maintaining an unhealthy relationship with the abuser contributes to trauma and sustains the trauma bond.

This aligns with the idea that trauma bonds are toxic and difficult to leave due to the inherent power imbalance, which, in parent-child relationships, is even more pervasive than in other situations. Incestuous relationships also have an added layer of betrayal trauma, which arises from the exploitation of the victim's trust, resulting in a feeling of betrayal.

Military (tours of duty)

Trauma bonds can develop in military settings. The literature demonstrates this specifically in the context of tours of duty, wherein military personnel are deployed in hostile environments or areas of combat. A 2019 study exploring this specific phenomenon sought to understand the traumatic bond developed between Japanese soldiers and Korean 'comfort women' in the midst of World War II. The trauma, in this case, was two-fold: not only did the trauma bond develop in an abused-abuser dynamic, but the trauma itself was also a result of and was perpetuated by the war. While the relationships provided the Japanese soldiers with emotional relief and an escape from the violence of the war and the tyranny of the higher-ranking officers, they provided the Korean 'comfort women' with much-desired protection and kindness from the soldiers.

Soldiers would behave aggressively and violently towards the 'comfort women' and often sexually exploit them. They would use intimidation tactics to assert dominance and foster coercion. However, this abuse would be interspersed with kindness and empathy from the soldiers, whose moods – and subsequent behavior and interactions – were highly contingent on the time and context in terms of the ongoing war. Nonetheless, the intermittent kindness allowed the formation and maintenance of a trauma bond. Intermittent rewards were sometimes also more tangible, in the form of food, outings, and physical protection. However, protection and emotional support were pivotal in maintaining the trauma bonds, and far more important than food and outings. The Korean 'comfort women' eventually came to be emotionally dependent on the Japanese soldiers and began to relate this dependence with their own sense of power, thereby establishing a trauma bond that, for some, persisted even after the war was over.

Outcomes

Trauma bonding has several short-term and long-term impacts on the abused. It can force people to stay in abusive relationships, negatively affect self-image and self-esteem, perpetuate transgenerational cycles of abuse, and result in adverse mental health outcomes like the increased likelihood of developing depression and/or bipolar disorder.

Staying in abusive relationships

Owing to the debilitating psychological manipulation involved in the development of a trauma bond, abused people tend to stay in abusive relationships mainly because the perceived consequences of leaving the relationship seem far more negative than the consequences of staying in the abusive relationship.

In such relationships, maltreatment is often interspersed with fragments of solace and peace that involve the expression of love, kindness, affection, and/or general friendliness from the abuser towards the abused. This intermittent reinforcement of a reward (here, the abuser's love and kindness) amidst all the abuse becomes what the victim begins to hold on to. Thus, victims tend to become emotionally dependent on the abuser and construct the belief that their survival is contingent upon receiving the abuser's love. Victims thereby begin to formulate their sense of identity, (a form of and their sense of self around receiving the abuser's affection, points to what could be gaslighting. Kindness and affection from the abuser amidst the abuse becomes a focal point for the victim's emotional dependence. This dependency is characterized by the belief that their survival is contingent on the abuser's love and affection, leading victims to construct their sense of identity and self-worth around this dynamic Additionally, the provision of intermittent love and affection makes the victim cling to the hope that things can change. Furthermore, self-blame, the fear of social stigma and embarrassment, the fear of loneliness in the absence of a partner, and the lack of or poor social support from other family and friends also contribute to individuals remaining in abusive relationships.

Perpetuation of transgenerational cycles of abuse

People who have experienced trauma and traumatic bonds can – knowingly or unknowingly – repeat the cycle of abuse. In other words, victims who were traumatically bonded with abusers may grow to become abusers themselves. The abuse that victims inflict may or may not involve trauma bonding.

For instance, in a 2018 study on convicted child murderers, researchers found that caregivers who committed child homicide (murdered their child/care-receiver) had experienced traumatic experiences and had trauma bonds with abusers in their early lives. Individuals with cruel and/or dismissive caregivers are likely to develop insecure attachments that result in a host of problems, including emotion dysregulation and an attitude of confusion towards the caregiver, who becomes a source of comfort as well as fear. These adverse attachments can manifest in the individual's relationship with their own children as well. Attachment issues and painful memories of trauma bonds with their own caregivers can be triggered and individuals may demonstrate heightened and disproportionate aggression toward their child, some culminating in homicide. In this study, participants had experienced physical abuse, sexual abuse, lack of protection from external dangers, abandonment, emotional rejection, and more from their caregivers. Nonetheless, participants expressed unconditional love towards their caregivers, justified by wanting to maintain an overall positive view of them. In their continued efforts to form an emotional connection, a trauma bond was fostered. These experiences had a severe negative impact on their relationship and bonding with their own children, contributing to "affectionless, unempathetic interpersonal behavior" that inflated aggressive and violent tendencies triggered by vulnerabilities.

Neurophysiological outcomes

The experience of being in a trauma bond can have adverse neurobiological and neurophysiological outcomes. The body of the victim of a trauma bond is in a perpetual 'fight-or-flight' response state, which can increase cortisol levels that can have a cascading effect and trigger other hormones.

Persistent, chronic stress can also hamper the cellular response in the body, thereby negatively impacting immunity, organ health, mood, energy levels, and more. In the long run, this can cause epigenetic changes as well. Furthermore, a study conducted in 2015 found that establishing a trauma bond in infancy is also linked with amygdala dysfunction, neurobehavioral deficits, and increased vulnerability to psychiatric disorders later on in life.``Psychological abuse is correlated to sleep-related impairments. Disruption in sleep patterns leads to adverse neurophysiological problems, such as an increase in anxiety, and irritability. For victims of psychological abuse, the increase in cortisol affects the brain in such a manner that it allows the trauma bonding to be strengthened.

Adverse mental health outcomes

Trauma bonding is linked to several adverse mental health and well-being outcomes. As a result of the abuse itself and of their emotional dependence on their abusers, victims tend to develop an incredibly negative self-image. "controlling, restricting, degrading, isolating, or dominating" abuse has a crippling effect on the self-image and self-esteem of the abused, and this psychological abuse is far more dangerous than physical abuse. In a 2010 study on battered women labeling themselves as "stupid", researchers found that victims who felt like they allowed themselves to be mistreated and victims who stayed in abusive relationships labeled themselves as "stupid" for doing so. This further contributes to a negative self-image and maintenance of low self-esteem, both of which foster a poor self-concept, which, in turn, adversely impacts mental well-being. The same was observed in the aforementioned case study on grooming.

Trauma bonding can also lead to dissociative symptoms that could be a self-preservation and/or coping mechanism. Neurobiological changes can also affect brain development and hamper learning. The internalization of the psychological manipulation and trauma can give rise to anxiety and increase the likelihood of engagement in risk-taking behaviors. Furthermore, the isolation involved in trauma bonding can foster a generally skewed sense of trust, making victims vulnerable to situations that may retraumatize or revictimize them. Victims may also tend to either completely dismiss or minimize dangerous, damaging behaviors and violence around them.

Trauma bonds in parent-child relationships (wherein the child is the victim, and the parent is the abuser) can also lead to depressive symptoms later on in life. In a 2017 study exploring this, it was found that an "affectionless control" parenting style, characterized by high protection and low care from parents, was a major predictor of depressive symptomology for the victim. In other words, the presence of poor parental bonding coupled with childhood trauma bonds increased the likelihood of the child developing depressive symptoms in the future. A negative self-image is formed when feelings of inadequacy and hopelessness persist and are reinforced by caregivers. Perpetual efforts to seek secure emotional attachments reap no rewards and a trauma bond facilitates a negative core schema that influences perceptions and interactions throughout one's life. This can give rise to mental health issues such as depression, bipolar disorder, mania, suicidality, and substance abuse that can be pervasive and lifelong.

Oppositional defiant disorder

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Oppositional_defiant_disorder 

 

Oppositional defiant disorder
Specialty	Pediatrics, Psychology
Symptoms	Recurrent patterns of negative, hostile, or defiant behavior towards authority figures
Complications	Enforcement action
Usual onset	Childhood or adolescence (can become evident before 8 years of age)
Duration	Is diagnosed until 18 years of age
Causes	Insufficient care for the affected child during early development
Risk factors	ADHD
Differential diagnosis	Conduct disorder, disruptive mood dysregulation disorder, attention-deficit hyperactivity disorder, bipolar disorder, autism spectrum disorder, a psychotic disorder, borderline personality disorder, major depressive disorder, antisocial personality disorder
Treatment	Medication, Cognitive behavioral therapy, family therapy, intervention (counseling)
Medication	CNS stimulants (methylphenidate, amphetamine) non-stimulants (atomoxetine, viloxazine) alpha-2a agonists (guanfacine XR, clonidine XR)
Prognosis	Poor unless professionally treated
Frequency	~3%

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures, including law enforcement officials. Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

History

Oppositional defiant disorder was first defined in the DSM-III (1980). Since the introduction of ODD as an independent disorder, the field trials to inform its definition have included predominantly male subjects. Some clinicians have debated whether the diagnostic criteria would be clinically relevant for use with women, and furthermore, some have questioned whether gender-specific criteria and thresholds should be included. Additionally, some clinicians have questioned the preclusion of ODD when conduct disorder is present. According to Dickstein, the DSM-5 attempts to:

"redefine ODD by emphasizing a 'persistent pattern of angry and irritable mood along with vindictive behavior,' rather than DSM-IV's focus exclusively on negativistic, hostile, and defiant behavior.' Although DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is 'angry/irritable mood'—defined as 'loses temper, is touchy/easily annoyed by others, and is angry/resentful.' This suggests that the process of clinically relevant research driving nosology, and vice versa, has ensured that the future will bring greater understanding of ODD."

Epidemiology

ODD is a pattern of negative, defiant, disobedient, and hostile behavior, and it is one of the most prevalent disorders from preschool age to adulthood. This can include frequent temper tantrums, excessive arguing with adults, refusing to follow rules, purposefully upsetting others, getting easily irked, having an angry attitude, and vindictive acts. Children with ODD usually begin showing symptoms around age 6 to 8, although the disorder can emerge in younger children too. Symptoms can last throughout teenage years. The pooled prevalence is 3.6% up to age 18.

Oppositional defiant disorder has a prevalence of 1–11%. The average prevalence is approximately 3%. Gender and age play an important role in the rate of the disorder. ODD gradually develops and becomes apparent in preschool years, often before the age of eight years old. However, it is very unlikely to emerge following early adolescence.

There is a difference in prevalence between boys and girls, with a ratio of 1.4 to 1 before adolescence. Other research suggests a 2:1 ratio. Prevalence in girls tends to increase after puberty. Researchers have found that the general prevalence of ODD throughout cultures remains constant. However, the gendered disparities in diagnoses is only seen in Western cultures. It is unknown whether this reflects underlying differences in incidence or under-diagnosis of girls. Physical abuse at home is a significant predictor of diagnosis for girls only, and emotional responsiveness of parents is a significant predictor of diagnosis for boys only, which may have implications for how gendered socialization and received gender roles affect ODD symptoms and outcomes.

Children from lower-income backgrounds are more likely to be diagnosed with ODD. The correlative link between low income and ODD diagnosis is direct in boys, but in girls, the link is more complex; the diagnosis is associated with specific parental techniques such as corporal punishment which are in turn linked to lower income households. This disparity may be linked to a more general tendency of boys and men to display more externalized psychiatric symptoms, and girls to display more internalized ones (such as self-harm or anorexia nervosa).

African Americans and Latinos are more likely to receive diagnoses of ODD or other conduct disorders compared to non-Hispanic White youth with the same symptoms, who are more likely to be diagnosed with ADHD. This has wide-ranging implications about the role of racial bias in how certain behaviors are perceived and categorized as either defiant or inattentive/hyperactive.

Prevalence of ODD and conduct disorder are significantly higher among children in foster care. One survey in Norway found that 14 percent met the criteria, and other studies have found a prevalence of up to 17 or even 29 percent. Low parental attachment and parenting style are strong predictors of ODD symptoms.

Earlier conceptions of ODD had higher rates of diagnosis. When the disorder was first included in the DSM-III, the prevalence was 25% higher than when the DSM-IV revised the criteria of diagnosis. The DSM-V made more changes to the criteria, grouping certain characteristics together in order to demonstrate that people with ODD display both emotional and behavioral symptoms. In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviors or other symptoms are directly related to the disorder or simply a phase in a child's life. Consequently, future studies may find that there was also a decline in prevalence between the DSM-IV and the DSM-V.

Signs and symptoms

The fourth revision of the Diagnostic and Statistical Manual (DSM-IV-TR) (now replaced by DSM-5) states that a person must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for ODD. These symptoms include:

• Often loses temper
• Is often touchy or easily annoyed
• Is often angry and resentful
• Often argues with authority figures or, for children and adolescents, with adults
• Often actively defies or refuses to comply with requests from authority figures or with rules
• Often deliberately annoys others
• Often blames others for their mistakes or misbehavior
• Has been spiteful or vindictive at least twice within the past six months

These behaviors are mostly directed towards an authority figure such as a teacher or a parent. Although these behaviors can be typical among siblings, they must be observed with individuals other than siblings for an ODD diagnosis. Children with ODD can be verbally aggressive. However, they do not display physical aggressiveness, a behavior observed in conduct disorder. Furthermore, they must be perpetuated for longer than six months and must be considered beyond a normal child's age, gender and culture to fit the diagnosis. For children under five years of age, they must occur on most days over a period of six months. For children over five years of age, they must occur at least once a week for at least six months. If symptoms are confined to only one setting, most commonly home, it is considered mild in severity. If it is observed in two settings, it is characterized as moderate, and if the symptoms are observed in three or more settings, it is considered severe.

These patterns of behavior result in impairment at school or other social venues.

Etiology

There is no specific element that has yet been identified as directly causing ODD. Research looking precisely at the etiological factors linked with ODD is limited. The literature often examines common risk factors linked with all disruptive behaviors, rather than ODD specifically. Symptoms of ODD are also often believed to be the same as CD, even though the disorders have their own respective set of symptoms. When looking at disruptive behaviors such as ODD, research has shown that the causes of behaviors are multi-factorial. However, disruptive behaviors have been identified as being mostly due either to biological or environmental factors.

Genetic influences

Research indicates that parents pass on a tendency for externalizing disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems. Research has also shown that there is a genetic overlap between ODD and other externalizing disorders. Heritability can vary by age, age of onset, and other factors. Adoption and twin studies indicate that 50% or more of the variance causing antisocial behavior is attributable to heredity for both males and females. ODD also tends to occur in families with a history of ADHD, substance use disorders, or mood disorders, suggesting that a vulnerability to develop ODD may be inherited. A difficult temperament, impulsivity, and a tendency to seek rewards can also increase the risk of developing ODD. New studies into gene variants have also identified possible gene-environment (G x E) interactions, specifically in the development of conduct problems. A variant of the gene that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behavior following threatening events. Brain imaging studies show patterns of arousal in areas of the brain that are associated with aggression in response to emotion-provoking stimuli.

Prenatal factors and birth complications

Many pregnancy and birth problems are related to the development of conduct problems. Malnutrition, specifically protein deficiency, lead poisoning or exposure to lead, and mother's use of alcohol or other substances during pregnancy may increase the risk of developing ODD. In numerous research, substance use prior to birth has also been associated with developing disruptive behaviors such as ODD. Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.

Neurobiological factors

Deficits and injuries to certain areas of the brain can lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have hypofunction in the part of the brain responsible for reasoning, judgment, and impulse control. Children with ODD are thought to have an overactive behavioral activation system (BAS), and an underactive behavioral inhibition system (BIS). The BAS stimulates behavior in response to signals of reward or non-punishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of non-reward or punishment. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions.

Social-cognitive factors

As many as 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act. Children with ODD have difficulty controlling their emotions or behaviors. In fact, students with ODD have limited social knowledge that is based only on individual experiences, which shapes how they process information and solve problems cognitively. This information can be linked with the social information processing model (SIP) that describes how children process information to respond appropriately or inappropriately in social settings. This model explains that children will go through five stages before displaying behaviors: encoding, mental representations, response accessing, evaluation, and enactment. However, children with ODD have cognitive distortions and impaired cognitive processes. This will therefore directly impact their interactions and relationship negatively. It has been shown that social and cognitive impairments result in negative peer relationships, loss of friendship, and an interruption in socially engaging in activities. Children learn through observational learning and social learning. Therefore, observations of models have a direct impact and greatly influence children's behaviors and decision-making processes. Children often learn through modeling behavior. Modeling can act as a powerful tool to modify children's cognition and behaviors.

Environmental factors

Negative parenting practices and parent–child conflict may lead to antisocial behavior, but they may also be a reaction to the oppositional and aggressive behaviors of children. Factors such as a family history of mental illnesses and/or substance use disorders as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behavior disorders. Parenting practices not providing adequate or appropriate adjustment to situations as well as a high ratio of conflicting events within a family are causal factors of risk for developing ODD.

Insecure parent–child attachments can also contribute to ODD. Often little internalization of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance use. Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated.

School is also a significant environmental context besides family that strongly influences a child's maladaptive behaviors. Studies indicate that child and adolescent externalizing disorders like ODD are strongly linked to peer network and teacher response. Children with ODD present hostile and defiant behavior toward authority including teachers which makes teachers less tolerant toward deviant children. The way in which a teacher handles disruptive behavior has a significant influence on the behavior of children with ODD. Negative relationships from the socializing influences and support network of teachers and peers increases the risk of deviant behavior. This is because the child consequently gets affiliated with deviant peers that reinforce antisocial behavior and delinquency. Due to the significant influence of teachers in managing disruptive behaviors, teacher training is a recommended intervention to change the disruptive behavior of ODD children.

In a number of studies, low socioeconomic status has also been associated with disruptive behaviors such as ODD.

Other social factors such as neglect, abuse, parents that are not involved, and lack of supervision can also contribute to ODD.

Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods. Studies have also found that the state of being exposed to violence was a contribution factor for externalizing behaviors to occur.

Diagnosis

For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD. Other common comorbid disorders include depression and substance use disorders. Adults who were diagnosed with ODD as children tend to have a higher chance of being diagnosed with other mental illness in their lifetime, as well as being at higher risk of developing social and emotional problems.

Management

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.

Children with oppositional defiant disorder tend to exhibit problematic behavior that can be very difficult to control. An occupational therapist can recommend family based education referred to as parent management training (PMT) in order to encourage positive parents and child relationships and reduce the child's tantrums and other disruptive behaviors. Since ODD is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy.

Psychopharmacological treatment

Psychopharmacological treatment is the use of prescribed medication in managing oppositional defiant disorder. Prescribed medications to control ODD include mood stabilizers, anti-psychotics, and stimulants. In two controlled randomized trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. However, a third study found the treatment of lithium over a period of two weeks invalid. Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity.

The effectiveness of drug and medication treatment is not well established. Effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. Psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention.

Individual interventions

Individual interventions are focused on child-specific individualized plans. These interventions include anger control/stress inoculation, assertiveness training, a child-focused problem-solving skills training program, and self-monitoring skills.

Anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. They include a process of steps the child may go through.

Assertiveness training educates individuals in keeping a balance between passivity and aggression. It aims to help the child respond in a controlled and fair manner.

A child-focused problem-solving skills training program aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions.

Parent and family treatment

According to randomized trials, evidence shows that parent management training is most effective. It has strong influences over a long period of time and in various environments.

Parent-child interaction training is intended to coach the parents while involving the child. This training has two phases; the first phase is child-directed interaction, where the focus is to teach the child non-directive play skills. The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. The parent-child interaction training is best suited for elementary-aged children.

Parent and family treatment has a low financial cost, which can yield an increase in beneficial results.

Multimodal intervention

Multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighborhood. It is an intervention that concentrates on multiple risk factors. The focus is on parent training, classroom social skills, and playground behavior programs. The intervention is intensive and addresses barriers to individuals' improvement such as parental substance use or parental marital conflict.

An impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or adhered to for adequate periods of time.

Comorbidity

Oppositional defiant disorder can be described as a term or disorder with a variety of pathways in regard to comorbidity. High importance must be given to the representation of ODD as a distinct psychiatric disorder independent of conduct disorder.

In the context of oppositional defiant disorder and comorbidity with other disorders, researchers often conclude that ODD co-occurs with an attention deficit hyperactivity disorder (ADHD), anxiety disorders, emotional disorders as well as mood disorders. Those mood disorders can be linked to major depression or bipolar disorder. Indirect consequences of ODD can also be related or associated with a later mental disorder. For instance, conduct disorder is often studied in connection with ODD. Strong comorbidity can be observed within those two disorders, but an even higher connection with ADHD in relation to ODD can be seen. For instance, children or adolescents who have ODD with coexisting ADHD will usually be more aggressive and have more of the negative behavioral symptoms of ODD, which can inhibit them from having a successful academic life. This will be reflected in their academic path as students.

Other conditions that can be predicted in children or people with ODD are learning disorders in which the person has significant impairments with academics and language disorders, in which problems can be observed related to language production and/or comprehension.

Criticism

Oppositional defiant disorder's validity as a diagnosis has been criticized since its inclusion in the DSM III in 1980. ODD was considered to produce minor impairment insufficient to qualify as a medical diagnosis, and was difficult to separate from conduct disorder, with some estimates that over 50% of those diagnosed with conduct disorder would also meet criteria for ODD. The diagnosis of ODD was also criticized for medicalizing normal developmental behavior. To address these problems, the DSM-III-R dropped the criterion of swearing and changed the cutoff from five of nine criteria, to four of eight. Most evidence indicated a dose–response relationship between the severity of symptoms and level of functional impairment, suggesting that the diagnostic threshold was arbitrary. Early field trials of ODD used subjects who were over 75% male.

Recent criticisms of ODD suggest that the use of ODD as a diagnosis exacerbates the stigma surrounding reactive behavior and frames normal reactions to trauma as personal issues of self-control. Anti-psychiatry scholars have extensively criticized this diagnosis through a Foucauldian framework, characterizing it as a tool of the psy apparatus which pathologizes resistance to injustice. Oppositional defiant disorder has been compared to drapetomania, a now-obsolete disorder proposed by Samuel A. Cartwright which characterized slaves in the Antebellum South who repeatedly tried to escape as being mentally ill.

Race and gender bias

See also: School-to-prison pipeline

Research has shown that African Americans and Latinos are disproportionately likely to be diagnosed with ODD compared to White counterparts displaying the same symptoms, who are more likely to be diagnosed with ADHD. Assessment, diagnosis and treatment of ODD may not account for contextual problems experienced by the patient, and can be influenced by cultural and personal racial bias on the part of counselors and therapists. Many children diagnosed with ODD were, upon reassessment, found to better fit diagnoses of obsessive–compulsive disorder, bipolar disorder, attention deficit hyperactivity disorder, or anxiety disorder. Diagnoses of ODD or conduct disorder are not eligible for disability accommodation at school under the Individuals with Disabilities Education Act. When parents request accommodation for a diagnosed disorder which is eligible, such as ADHD, the request can be denied on the basis that such conditions are co-morbid with ODD. This bias in perception and diagnosis leads to defiant behaviors being medicalized and rehabilitated in White children, but criminalized for Latino and African American ones. Counselors working with children diagnosed with ODD reported that it was common for them to face stigma around the diagnosis in educational and justice systems, and that the diagnosis affected patients' self image. In one study over a quarter of children placed in the foster care system in the United States were found to have been diagnosed with ODD. Over half of children in the juvenile justice system have been diagnosed with ODD.

Latina women may be disproportionately impacted by the diagnosis of ODD because of the difference between Latino and White conceptions of femininity and appropriate feminine behavior.

African American males are known to be more likely to be suspended or expelled from school, receive harsher sentences for the same offenses as defendants of different races, or be searched, assaulted or killed by police officers. The disproportionately high diagnosis of ODD in AA males may be used to rationalize these outcomes. In this manner, ODD diagnoses can serve as a mechanism of the school-to-prison pipeline. From this viewpoint, the ODD diagnosis frames expected reactions to injustice or trauma as defiant or criminal.