Conduct Disorder (according to the DSM-IV) with the publication of the DSM-5 has been renamed Conduct Disorder. It refers to the recurrent presence of distorted, destructive and negative behaviors, in addition to transgressors of social norms, in the behavior of the individual.
Criteria for conduct disorder
A repetitive and persistent pattern of behavior in which the basic rights of others or important age-appropriate social norms are violated, manifested by the presence of three (or more) of the following criteria during the last 12 months and at least of one criterion during the last 6 months:
Aggression to people and animals
- often brags, threatens, or intimidates others
- often starts physical fights
- used a weapon that could cause serious physical harm to others (e.g., bat, brick, broken bottle, knife, gun)
- has manifested physical cruelty towards people
- has manifested physical cruelty to animals
- has stolen while confronting the victim (e.g., assault, snatching purses, extortion, armed robbery)
- has forced someone into sexual activity
Destruction of property
- has deliberately set fires with the intention of causing serious harm
- has deliberately destroyed other people’s property (other than setting fires)
Fraudulence or theft
- has broken into another person’s home, house, or car
- often lies to obtain goods or favors or to avoid obligations (i.e., “swindle” others)
- has stolen objects of certain value without confrontation with the victim (e.g., shoplifting, but without break-ins or vandalism; forgeries)
Serious rule violations
- often stays out of the house at night despite parental prohibitions, beginning this behavior before the age of 13
- has run away from home during the night at least twice, living in his or her parents’ home or in a foster home (or only once without returning for a long period of time)
- He usually plays hooky from school, starting this practice before the age of 13
B. Conduct disorder causes clinically significant impairment in social, academic, or work activity.
C. If the individual is 18 years of age or older, he or she does not meet criteria for antisocial personality disorder.
Specify type based on age of onset:
Childhood onset type: at least one of the criterion characteristics of conduct disorder begins before 10 years of age
Adolescent onset type: absence of any criterion characteristic of conduct disorder before 10 years of age
Specify severity:
Mild: few if any behavioral problems exceed those required to establish the diagnosis and the behavioral problems cause only minimal harm to others
Moderate: the number of behavioral problems and their effect on other people are intermediate between “mild” and “severe”
Serious: Several behavioral problems exceed those required to establish the diagnosis or the behavioral problems cause considerable harm to others.
The essential characteristic of social disorder is a persistent and repetitive pattern of behavior in which the basic rights of others or important social norms appropriate to the subject’s age are violated (Criterion A). These behaviors are divided into four groups: aggressive behavior that causes or threatens physical harm to other people or animals (Criteria A1-A 7), non-aggressive behavior that causes loss or damage to property (Criteria A8 A9), fraud or theft (Criteria A1O-A12) and serious violations of regulations (Criteria A13-A15). Three (or more) characteristic behaviors must have occurred during the last 12 months and at least one behavior must have occurred during the last 6 months. The behavioral disorder causes clinically significant impairment in social, academic, or work functioning (Criterion B). Conduct disorder can be diagnosed in individuals over 18 years of age, but only if the criteria for antisocial personality disorder (Criterion C) are met. The behavior pattern usually occurs in different contexts such as home, school or the community. Since subjects with conduct disorder tend to minimize their behavioral problems, the clinician must often rely on other informants. However, the informant’s knowledge of the child’s behavioral problems may be limited by inadequate supervision or the child’s failure to disclose them.
Children or adolescents with this disorder often initiate aggressive behaviors and react aggressively to others. They may display boastful, threatening or intimidating behavior (Criterion Al); starting frequent physical fights (Criterion A2); use a weapon that can cause serious physical harm (e.g., bat, brick, broken bottle, knife, or gun) (Criterion A3); being physically cruel to people (Criterion A4) or animals (Criterion A5); stealing while confronting a victim (e.g., assault, bag snatching, extortion, or armed robbery) (Criterion A6); or forcing another into sexual activity (Criterion A7). Physical violence can take the form of rape, assault or, in rare cases, homicide.
Deliberate destruction of other people’s property is a characteristic feature of this disorder and may include deliberately setting fire with the intention of causing serious harm (Criterion A8) or deliberately destroying other people’s property in various ways (e.g. , breaking car windows, vandalism at school) (Criterion A9).
Fraud or theft is frequent and can include breaking into another person’s apartment, house, or car (Criterion A1O); subjects often lie or break promises in order to obtain goods or favors, or avoid debts or obligations (e.g., “scam” others) (Criterion A11); or steal objects of certain value without confrontation with the victim (e.g., shoplifting, counterfeiting) (Criterion A12).
Characteristically, subjects who present this disorder also commit serious violations of norms (e.g., schoolchildren, family members). Children with this disorder and before the age of 13 remain out of home at night despite their parents’ prohibitions (Criterion A13).
There may be leaks from the house at night (Criterion A14). To be considered a symptom of conduct disorder, the escape must have occurred at least twice (or only once if the subject did not return for a prolonged period of time). Runaway episodes that occur as a direct consequence of physical or sexual abuse do not typically qualify under this criterion. Children with this disorder may frequently play hooky from school, starting before age 13 (Criterion A15). In older subjects, this behavior frequently manifests itself with absences from work without justified reasons.
Subtypes
Depending on the age of onset of the disorder, two subtypes of conduct disorder have been established (childhood onset type and adolescent onset type). The subtypes differ in the characteristic nature of the behavioral problems they present, evolutionary course and prognosis, and sex ratio. Both subtypes can present in a mild, moderate or severe form. When evaluating the age of onset, the information should preferably be obtained from the interested party and their caregivers. Because many behaviors sometimes remain hidden, caregivers may underreport symptoms and overestimate the age of onset.
Infant onset type. This subtype is defined by the onset of at least one feature of conduct disorder before the age of 10 years. Individuals with the infantile-onset type are usually male, frequently display physical violence toward others, have problematic relationships with peers, may have exhibited oppositional defiant disorder during early childhood, and usually present with symptoms that meet all criteria for the disorder. di social before puberty. These subjects tend to experience persistent conduct disorder and develop antisocial personality disorder in adulthood more often than subjects with an adolescent-onset type.
Adolescent onset type. This subtype is defined by the absence of features of conduct disorder before 10 years of age. Compared to subjects with the infantile onset type, they are less likely to display aggressive behavior and have more normative relationships with peers (although they frequently present behavioral problems in the company of others). These subjects are less likely to suffer from persistent conduct disorder or to develop antisocial personality disorder in adulthood. The proportion of males to females with conduct disorder is lower in the adolescent onset type than in the childhood onset type.
Gravity specifications
Mild. There are few, if any, behavioral problems beyond those required to establish the diagnosis, and these problems cause relatively little harm to others (eg, lying, playing hooky, being out at night without permission). Moderate. The number of behavioral problems and their effect on other people are intermediate between �mild� and �severe� (e.g., robberies without confrontation with the victim, vandalism). Serious. There are many behavioral problems in excess of those required to establish the diagnosis, or the behavioral problems cause considerable harm to others (e.g., rape, physical cruelty, use of weapons, robberies with confrontation with the victim, vandalizing and raids).
Associated symptoms and disorders
Descriptive characteristics and associated mental disorders. Individuals with conduct disorder may have little empathy and little concern for the feelings, desires, and well-being of others.
Especially in ambiguous situations, aggressive individuals affected by this disorder frequently misperceive the intentions of others, interpreting them as more hostile and threatening than they really are, responding with aggression that in such case they consider reasonable and justified.
They may be callous, lacking appropriate feelings of guilt or remorse. It is sometimes difficult to evaluate whether the remorse experienced is genuine, since these individuals learn that the expression of guilt can reduce or avoid punishment. Individuals with conduct disorder may be willing to give information about their peers and try to accuse others of their own misdeeds. Self-esteem is usually low, although the subject may project an image of toughness. Low tolerance for frustration, irritability, emotional outbursts and recklessness are frequently associated characteristics. Accident rates appear to be higher in subjects with conduct disorder compared to others who do not suffer from this disorder. He…