Conduct Disorder

Definition of Conduct Disorder

Anger is often an emotion that individuals experience in response to a real or perceived loss of a possession, space, self-esteem, value or sense of entitlement. Whilst in the early stages of normal development, an individual may react by being physically aggressive. While most individuals outgrow this kind of behaviour as they emotionally mature and develop more sophisticated language and problem-solving skills, individuals with a diagnosis of conduct disorder (CD) do not.

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) (American Psychiatric Association), 2013), is a handbook that is used by professionals around the world to diagnose mental disorders. The DSM–V describes CD as a persistent and long term (chronic) pattern of very problematic behaviour in which there are serious violations of social norms and rules. The behaviour problems are associated with physical aggression directed towards people and/or animals, destruction of property, deceitfulness, or theft and/or serious violation of rules. In other words, the individuals frequently and persistently aggressive in situations where others of the same age would not respond aggressively. These behaviours cause clinically significant impairment in social, academic, or occupational functioning (American Psychiatric Association, 2013).

Types of Conduct Disorder

In the DSM-V (American Psychiatric Association, 2013), three presentation types of CD are identified:

1. Childhood onset: the child showed at least one symptom characteristic of CD before the age of 10 years.
2. Adolescent onset: the child showed no symptom characteristic of CD before the age of 10 years.
3. Unspecified onset: unable to determine at what age the onset of the first symptom was.

Causes of CD

There is no single cause, rather a number of risk factors that may contribute to the development of persistent aggression. These include:

1. Hereditary factors: certain personality traits inherited from family members can make the child vulnerable.
2. Temperamental factors – the child has a difficult temperament or is aggressive from an early age that is difficult to manage.
3. Environmental factors – the influence of the family is a strong risk factor for many individuals. Some of the family level risk factors include:

• Parental lack of supervision.
• Parental rejection and neglect.
• Parental discipline is too harsh or too relaxed or inconsistent.
• Parental inconsistent child rearing practices.
• Parental criminality.
• Parental disharmony.
• Lack of parental monitoring.
• Parents with a mental health problem.
• Parents with a substance abuse problems.
• Parents involved in criminal behaviour.
• Individual has been physically or sexually abused.
• Individual living in institutionalised care.
• Individual has frequent changes of caregivers.
• Individual is part of a large family.

Symptoms of Conduct Disorder

Aggression towards people and animals

• Often bullying, threatening, or intimidating others.
• Often initiating physical fights.
• Use weapons that can cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife and guns).
• Being physically cruel to people.
• Being physically cruel to animals.
• Stealing while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
• Forcing others into sexual activity.

Destruction of property

• Deliberately engaging in fire setting with the intention of causing serious damage.
• Deliberately destroying others’ property (other than by fire setting).

Deceitfulness or theft

• Breaking into someone else’s house, building, or car.
• Often lying to obtain goods or favours or to avoid obligations (i.e. “cons” others).
• Stealing items of non-trivial value without confronting a victim (e.g. shoplifting, but without breaking and entering; forgery).

Serious violations of rules

• Often staying out at night despite parental prohibitions
• Running away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).
• Truancy from school

For support managing symptoms of Conduct Disorder see:

• Teaching Emotional Regulation
• Managing Anger, a guide for Parents and Teachers

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).