Conduct Disorder

About Conduct Disorder

DSM-V criteria for Conduct Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines conduct disorder as a fulfilment of at least three of the symptoms below, from any of the four categories.

Aggression to people and animals:

  • Exhibiting bullying, threatening and intimidating behaviour
  • Initiating fights with others
  • Displaying aggressive behaviour using a weapon (eg. Baseball bat or knife)
  • Displaying physical cruelty to people and/or animals
  • Stealing from others through a confronting situation (eg. Robbery or mugging)

Destruction of property:

  • Engaging in arson intending to cause damage to property
  • Deliberately destructing property belonging to others

Deceitfulness or theft:

  • Breaking into others’ property (eg. House or car)
  • Lying for their own gain
  • Stealing from others through a non-confronting situation (eg. Shoplifting)

Serious violations of rules:

  • Staying out overnight before the age of 13 years, without parental consent
  • Running away from home at least twice (or once for a prolonged period of time)
  • Frequent truancies before the age of 13 years

Subtypes of conduct disorder

Conduct disorder can mainly be classified into three sub-types: childhood-onset conduct disorder, adolescent-onset conduct disorder, and conduct disorder with callous unemotional traits.

Childhood-onset conduct disorder is primarily characterised by symptoms of aggression, often with a preceding clinical history of oppositional defiant disorder. Adolescent-onset conduct disorder is usually less severe in nature, with a higher likelihood that the associated symptoms will resolve with age. Conduct disorder with callous unemotional traits, or those who fall under the ‘limited prosocial emotions’ specifier show little remorse in their behaviour, do not react emotionally to punishment, and have a much more severe symptom profile than the two other subtypes.

 

Prevalence of conduct disorder

The prevalence rate of conduct disorders is about 4%, and is higher in males.

Comorbidity with conduct disorder

Conduct disorder is associated with higher risks of Attention Deficit Hyperactivity Disorder (ADHD), oppositional defiant disorder, substance use disorders, antisocial personality disorders as well as suicidal ideation and attempts.

 

Cognitive issues associated with Conduct Disorder

Individuals with conduct disorder face challenges in social cognition, particularly with recognising and imitating negative facial expressions that others make. This result is attributed to the fact that individuals with conduct disorder do not pay as much attention to a person’s eyes when they are trying guess how they feel, further suggesting that they are impaired in showing empathy for others.

For both oppositional defiant disorder and conduct disorder, there has been some evidence to suggest that impaired executive functioning is another cognitive issue associated with the disorders. They have poorer working memory and attention than children without the disorder. Most notably, when placed under stressful conditions, children with oppositional defiant disorder or conduct disorder were unable to adapt to the environment and as a result, their performance on executive functioning tasks was affected negatively.