Oppositional Defiant Insights

Oppositional Defiant Becomes More Treatable

Most persons diagnosed with oppositional-defiant disorder were undermethylated.
William Walsh, PhD

Stuck Is Frozen | Unstuck: A More Complicated Process

Oppositional Defiant And Stuck

For years we identified oppositional defiant behaviors by using inadequate, superficial, appearance criteria. Because no biological markers existed these lost, certainly misunderstood, oppositional defiant individuals often became segregated, even by the mental health community, as quite untreatable.

The internal admonition: “Refer him out.” “Get him off the streets.” The psychiatric recipe: mood stabilizers, stimulant medications, guesswork and cross your fingers.

“Behavior, character, narcissistic personality disorders” – they often appear stuck somewhere in the woods, beyond care, with no explanations or insights except perhaps in years of psychoanalysis.  Their extant DSM [Diagnostic Statistical Manual] label until recently was too often overheard as a disdainful slur: “Oh him, he's Axis II.”  Read: “untreatable.”

Into this pervasive confusion enters Dr William Walsh. More on Walsh and biology in a moment.

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Notes On Psych Medication Treatment Objectives

First a brief historical perspective:

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Brain Activity Measured: Mood, Cognition, Behavior

Consider brain activity itself, not just the appearances of brain activity. Feeling, thinking and behaving reveal underlying brain function, beyond simple appearances.

Mood – Serotonin

At the turn of the 20th century we began to identify and understand moods – feelings. Depression, anxiety, phobias, and feelings, through Freud's insights, connected with childhood experience, trauma, and imagination – instead of suspected dark humors flowing through the body. From those days though today oppositional defiant behaviors remain presumptively based on internal, affect-driven conflicts. Oppositional defiant behaviors, Freudian theorists would say, derive [only] from internal conflict. But consider this: that Freudian assessment of causality requires deep pockets – long-term residential care, jail, or psychoanalysis.

Through Freud's observations we did began to understand that unconscious conflicts drive imbalances of feelings and moods. Yes, they do. However, those ‘feelings' observations prove, as de Bono observes, “Excellent, but not enough.”

Treatment Objectives Limited: address the feelings. Treatment options: psychotherapy, psychoanalysis, anti-anxiety and antidepressant medications, identify and manage feelings.  That “feelings perspective” persists as the limited, inaccurate current standard of care for oppositional defiant challenges. Try an SSRI. Don't think about dopamine or methylation.

Cognition – Dopamine

Quite reluctantly and only recently, in the last 20 years, psychiatry now adds cognition – thinking. SPECT brain imaging, functional appreciation of real brain activities, especially in the prefrontal cortex, now opens new maps for improved treatment options. Interestingly, however, thinking and cognition did not make it solidly into the recent DSM 5 revision, except for macro thinking deficiencies: Traumatic Brain Injury and Dementia. Brain function and elemental neuroscience imbalances remain outside of the current standard of care. Even today appearance diagnoses and consequential treatment imprecision prevails. Measuring cognitive activity and reactions to changing reality as a clinical standard of care in 2014? Not yet.

ADHD, the most obvious, most pandemic of thinking disorders, remains almost totally misunderstood even by those experts in the field who discuss and treat behavioral attributes of “ADHD.” Brain function and neuroscience take second place over platitudes about mercurial behaviors, confusion about appearance parameters, and teacher reports. Neuroscience advocates find themselves in an ADHD Galileo moment. Denial of neuroscience evidence and modern measurement technology prevails.

We don't yet think sufficiently about thinking. Man's relationship with Changing Reality, his cognitive adjustments to the changing scene of his life: remarkably overlooked and not measured. Since thinking is not on everyday assessment radar many cognitive-thinking disorders look like, become misidentified as untreatable personality, character disorders.

If a cognitive-thinking diagnosis such as “ADHD” remains the appearance diagnostic standard over more neuroscientifically  based “Executive Function Challenges” – then it's no wonder that the public, down to freshmen in high school, consider themselves board certified in psychiatry. With superficial-labels-criteria everyone becomes a “ADHD expert.” With superficial diagnostic criteria medical treatment becomes an ever more speculative and superficial roll of the dice. Witness the remarkably inaccurate musings of the New York Times on these matters and you will even more appreciate the damage of posturing, gossip, non-science, and medical imprecision.

Treatment Objectives Limited: address the thinking/cognitive challenges. Treatment options: Stimulants for dopamine, non stimulants for glutamate and norepinephrine, neurofeedback, enhanced metacognition. Don't think of serotonin even though it might be a related problem.

Behavior – Multiple Biomedical Contributions

Behavioral challenges arise in associations with both serotonin and dopamine, affective and cognitive imbalances. Most treatment protocols do now include a variety of interventions to manage both affect and cognition, and yet many in that mysterious Behavior Disorder group remain too frequently overlooked. Most importantly, those who suffer with Behavior Disorder appear to remain free from either affective or cognitive conflict, beyond serotonin and beyond dopamine.

Neuroscience findings do exist, but remain under-appreciated as important markers. Categorical answers often fail to fully address the underlying complexity of biomedical contributions.

Treatment objectives less limited, more comprehensive: Measure biomedical markers first, then treat the complexity associated with both laboratory data and behavioral presentations. Feelings and thinking, Serotonin and Dopamine, and all the enzyme systems matter.

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The New Biology and Oppositional Defiant: ODD

Dr Walsh

Enter Dr William Walsh and interesting findings from his recent book Nutrient Power: Heal Your Biochemistry, Heal Your Brain.

Through new understandings of biologically based behavioral biotypes that include affect-feelings, and cognition-thinking present fresh opportunities to understand this least understood of the brain functions – behavior. Interestingly, behavior disorders such as Oppositional Defiant and ADHD now provide fruitful soils for more serious biologic germination.

From ADHD to Bipolar to Borderline, just what is the problem for those who don't move forward with changing reality? They range in typical response from angry to stubborn, to imperious, to irritated to narcissistic – either in the context of family, job, or life in general they're oppositional, intractably opinionated and incessantly struggling for control.

CorePsych Posting Agenda: Walsh Behavioral Biotypes

From murderers to ADHD, from Oppositional Defiant to Conduct Disorders, biology – actual biologic markers – can turn the tide of challenging, apparently conflict-free, behaviors. From the early 1970s for more than 20 years Bill Walsh studied violent crimes¹ at Statesville Correctional Center in Joliet, IL.

Noteworthy is the fact that his conclusions remain applicable today. Why? Because they're data driven and evidence based – results from reviews of over 1.5 million laboratory results associated with Behavior Disorders and ADHD.

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Problems With Treatment For Chemical Imbalances Manifesting ODD Using Nutrient Protocols

1. ODD and Oppositional Disorder Non-compliance: Undermethylation findings are almost always associated with deep thinkers who remain non-compliant with specific interventions, and especially oppositional with supplements.
2. Monitor the actual taking of both medications and supplements – difficult but necessary until the recovery begins to take place, often several months later for undermethylators. Don't use the Honor System, adolescents and young adults especially remain non-compliant in association with undermethylation.
3. Regularly Reconfirm Treatment Expectations so the patient will know how long to expect it will take before they show improvements so they will endure. Knowing and stating expectations will provide some reassurance.
4. Undermethylation is measured most especially with Whole Blood Histamine and SAM/SAH ration available at Doctor's Data. See this previous CorePsych post for more details – this one on the comorbidity with ADHD and depression.
5. The Walsh Nutrient Protocol aims at increasing serotonin and dopamine levels in the brain.
6. Methylation suppresses SERT and DAT transporters on the presynaptic neuron, keeping both serotonin and dopamine in the synapse.
7. ODD Clinical Pearl From Dr Walsh: First get the adolescent or adult alone in the room to search for a common ground, an objective they can subscribe to beyond correcting their ODD behavior. Find out what they  want for themselves: with a boy who's short: Zinc will help him grow – with an adolescent girl ODD with acne: Zinc will help with their acne. Finding their objectives will help with their built-in need to be right and disagree.

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CorePsych Post Agenda: Behavior Disorders & ADHD Subsets

The Posting Plan: My mission at CorePsych remains the same as when I started writing in '06: Neuroscience evidence changes thinking. When we understand the value of evidence in these chemical imbalances and target specific objectives we can more effectively help those who suffer, often even with the following unusual personality disorders.

From Walsh's book¹ and his database of 1500 children I'll bring you regular outlines here at CorePsych for measuring and helping to correct each of these:

1. Oppositional Defiant Disorder [ODD] –  Undermethylated: Iron will with opposition to all authority, even dating back to age two.
2. Intermittent Explosive Disorder [IED] – Well behaved and cooperative but associated with occasions of unexplained uncontrollable rage.
3. Conduct Disorder [CD] – Elevated Urine Pyrroles: Act out aggressively and express anger inappropriately including violence, destruction of property, lying, bullying, stealing and truancy.
4. Antisocial Personality Disorder [ASPD] – Sociopaths, cruelty to animals, fascination with fire, ODD by 4 and CD by 10 yo.
5. Nonviolent Behavior Disorders – 3 subtypes: 1. Undermethylated, 2. Glucose dyscontrol, 3. Malabsorbers
6. ADHD – 2/3 Show Increased Zn/Cu Ratios: 3 subtypes: 1. Inattentive, 2. Impulsive, 3. Combined

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Zinc and Copper

End Note: Elevated Copper/Zinc Ratio In 2004 Study ²

Open label outcome study measuring effectiveness of nutrient therapy for 207 patients with behavioral disorders. Cu/Zn elevated in 75.4% of patients with elevated serum copper and depressed plasma zinc.  More than 3 of 4 suffer with this imbalance. These next posts will share Dr Walsh's experience regarding specific corrective actions.

Coming posts: Intermittent episodic rage, attention deficit without hyperactivity, and ADHD with hyperactivity.

Stay tuned for more character,

cp
Dr Charles Parker
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References

¹ Walsh, Dr. William J. (2014-05-06). Nutrient Power: Heal Your Biochemistry and Heal Your Brain (Kindle Locations 2426-2427). Skyhorse Publishing. Kindle Edition.
² Walsh WJ, Glab LB, Haakenson ML. (2004). Reduced violent behavior following biochemical therapy. Physiol Behav. 82: 835-839.

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