Conduct disorder

Conduct disorder
Classification and external resources
ICD-10	F91
ICD-9	312
MeSH	D019955

Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors."^[1]

DSM IV-TR Criteria

According to the current DSM classification system^[2], a diagnosis of conduct disorder is based on the following criteria:

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code type based on age at onset

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

312.89 Conduct Disorder, Unspecified Onset: age at onset is not known

Specify severity

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others (e.g., lying, truancy, staying out after dark without permission)

Moderate: number of conduct problems and effect on others intermediate between “mild” and “severe” (e.g., stealing without confronting a victim, vandalism)

Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others (e.g., rape, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering)

Proposed Changes for the DSM-V

Currently, there are no proposed revisions for the main criteria of conduct disorder in the DSM-V. However, there is a recommendation by the work group to add an additional specifier for Callous and Unemotional Traits^[3]. For this specifier, the individual must:

A. Meet full DSM-IV criteria for conduct disorder

B. Show 2 or more of the following characteristics persistently over at least 12 months and in more than one relationship or setting. The clinician should consider multiple sources of information to determine the presence of these traits, such as whether the person self-reports them as being characteristic of him or herself and if they are reported by others (e.g., parents, other family members, teachers, peers) who have known the person for significant periods of time.

1. Lack of Remorse or Guilt: Does not feel bad or guilty when he/she does something wrong (except if expressing remorse when caught and/or facing punishment).
2. Callous-Lack of Empathy: Disregards and is unconcerned about the feelings of others.
3. Unconcerned about Performance: Does not show concern about poor/problematic performance at school, work, or in other important activities.
4. Shallow or Deficient Affect: Does not express feelings or show emotions to others, except in ways that seem shallow or superficial (e.g., emotions are not consistent with actions; can turn emotions “on” or “off” quickly) or when they are used for gain (e.g., to manipulate or intimidate others).

Etiology

Epidemiology

Prevalence & Incidence

Gender Differences

Racial/Ethnic Differences

Risk & Protective Factors

Developmental Course

Currently, there are thought to be two possible developmental courses to conduct disorder. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors. In this way, it is often linked to worse outcomes and these individuals are more likely to develop antisocial personality disorder. The second developmental course is known as the "adolescent-onset type" and occurs when conduct disorder symptoms are present after the age of 10 years. At times, these individuals will remit before adulthood.

See also

• Drift Hypothesis
• Bullying
• Challenging behavior
• Child pyromaniac
• Oppositional defiant disorder

References

1. ^ Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (pp. 144-198). New York: Guilford Press.
2. ^ American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: Author.
3. ^ American Psychiatric Association. (2010). DSM 5 Development: Conduct Disorder. Retrieved from: http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=370Baker.

"The Good Son"

Further reading

• Decety, J., & Moriguchi, Y. (2007). The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. BioPsychoSocial Medicine, 1, 22-65.
• Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for child and adolescent with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37, 215-237
• Lahey, B.B., Moffitt, T.E.,& Caspi, A. (Eds.). Causes of conduct disorder and juvenile delinquency. New York: Guilford Press.
• Raine, A. (2002). Biosocial Studies of Antisocial and Violent Behavior in Children and Adults: A Review. Journal of Abnormal Child Psychology, 30, 311-326.
• Van Goozen, S.H.M., & Fairchild, G. (2008). How can the study of biological processes help design new interventions for children with severe antisocial behavior? Development and Psychopathology, 20, 941-973.

External links

• Conduct Disorder Symptoms and Treatment Society of Clinical Child and Adolescent Psychology
• Bullying tendency wired in brain from the BBC News.
• Bullies may enjoy seeing others in pain National Science Foundation