Research studies indicate that the number of African Americans diagnosed with oppositional defiant disorder (ODD) is disproportionately higher than other demographic groups. A consensual qualitative research (CQR) design was used to understand the contextual factors, diagnostic processes and implications associated with ODD in African American males. Six mental health professionals were interviewed and four domains identified: insurance influence, ODD diagnostic criteria, ODD stigmatization, and assessment, diagnosis, and treatment. Findings indicated that factors beyond the health needs of the client, including counselor bias, might play a critical role in diagnostic assessment. Implications are provided for counselors and counselor educators. Recommendations for further research are suggested on the diagnosis–billing model and the long-term implications of ODD diagnoses for African American males.