Conduct Disorders F91 - ICD10 Description, World Health Organization
Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred.
Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire-setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.
Conduct Disorder - Diagnostic Criteria, American Psychiatric Association
The majority of children with oppositional defiant disorder grow out of it, but some progress into delinquency - i.e., conduct disorder. Children or adolescents with conduct disorder have the same behaviors as those with oppositional defiant disorder (i.e., defiance, disobedience, and disruptiveness). In addition, they add delinquent behaviors (e.g., physical violence, property destruction, law-breaking, reckless thrill-seeking) and antisocial behaviors (e.g., disrespect of others, irresponsibility, and dishonesty). At school, children or adolescents with conduct disorder are the bullies, thieves and vandals. Conduct disorder, to be diagnosed, must last 6 months or longer. Most children or adolescents with conduct disorder grow out of this disorder, but if this behavior persists past age 18, the diagnosis is changed to antisocial personality disorder. Thus oppositional defiant disorder, conduct disorder, and antisocial personality disorder are all part of the same dissocial spectrum. It appears that, by reason of nature/nurture, these individuals haven't learned compassion and cooperation; hence they disregard rules and the rights of others.
An individual diagnosed with conduct disorder needs to meet all of the following criteria:
- 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 of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
Aggression to People and Animals
- Often bullies, threatens, or intimidates others.
- Often initiates physical fights.
- Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
- Has been physically cruel to people.
- Has been physically cruel to animals.
- Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
- Has forced someone into sexual activity.
Destruction of Property
- Has deliberately engaged in fire setting with the intention of causing serious damage.
- Has deliberately destroyed others' property (other than by fire setting).
Deceitfulness or Theft
- Has broken into someone else's house, building, or car.
- Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).
- Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious Violations of Rules
- Often stays out at night despite parental prohibitions, beginning before age 13 years.
- 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.
- Is often truant from school, beginning before age 13 years.
- The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
- If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.
Fortunately, parent training is quite effective as a treatment for this disorder. At 5-6 year followup after parent training, two-thirds of the children no longer received the diagnosis of conduct disorder. It is essential that these individuals be given healthy, compassionate role models (e.g., Big Brothers, Scouts) and learn how to play by the rules and cooperate (e.g. structured sports programs). "Scared Straight" programs (showing delinquents what life in prison is like) may be effective.
Ineffective Therapies: physical punishment and incarceration is seldom effective. Likewise medication is seldom effective against the core features of this disorder.