Links between ODD and CD may be clarified by the identification of distinct dimensions within the symptoms of ODD. Burke (in press) separated symptoms indexing negative affect (touchy, angry and spiteful) from other oppositional behaviors (loses temper, agues with adults and actively defies) using factor analysis. Negative affect predicted later symptoms of depression whereas oppositional symptoms predicted later CD. In a similar vein, Stringaris and Goodman (2009b) have proposed irritable, headstrong and hurtful dimensions of oppositionality on theoretical grounds. Despite strong inter-correlations, these dimensions show separable cross-sectional correlates. In a large national sample irritability was particularly associated with symptoms of emotional disorders, the headstrong dimension with symptoms of ADHD, and the hurtful dimension with callousness. All three dimensions were associated with CD symptoms cross-sectionally (Stringaris & Goodman, 2009b). In longitudinal analyses only the headstrong dimension predicted CD three years later, after control for baseline CD. Irritability predicted emotional psychopathology (Stringaris & Goodman, 2009a). With respect to formulating DSM-V ODD diagnostic criteria, it is possible that the identification of ODD dimensions may allow the diagnosis to be subtyped. This may in turn help to clarify the relationship of ODD and CD.
