Lecture 5: Conduct Disorder Flashcards
DSM-5 Criteria: Conduct Disorder
“A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated”
Four Symptom Domains:
- Aggressive Behaviors
- Behaviors that result in property loss or damage
- Deceitfulness or theft
- Other serious rule violations (e.g. running away from home, truancy)
CD Dimensions: Aggressive Behaviors
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
Has been physically cruel to people
Has been physically cruel to animals
Has stolen while confronting the victim
Has forced someone into sexual activity
CD Dimensions: Destruction of Property
Has deliberately engaged in fire setting with the intention of causing serious damage
*This is characteristic of younger years, ~6
(no opportunity to steal or for sexual aggression)
Has deliberately destroyed others’ property other than fire setting
CD Dimensions: Deceitfulness or theft
Has broken into someone else’s house, building, or car
Often lies to obtain goods or favors to avoid obligations
Has stolen items of nontrivial value without confronting a victim
CD Dimensions: Serious Rule Violations
Often stays out at night despite parental prohibition, beginning before age 13
Has run away from home overnight
Is often truant from school
**These symptoms cause clinically important job, school or social impairment
If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder
*APD is not diagnosed prior to age 18
Conduct Disorder Subtypes
*Childhood-Onset Type
1+ problem with conduct before age 10
*Adolescent-Onset Type
No problems before age 10
Hormonal Changes, Peer Relationships–Especially Females
*There are different pathways to CD – some kind of trauma e.g. death of parent, rape
*Severity:
Mild – 3-4 endorsements, behavior causes minor harm
Moderate
Severe – 10+ endorsements and/or behavior causes considerable harm
Emotional Deficits in CD
Children may potentially:
Lack empathy and feelings of guilt (callous-unemotional)
Little concern for feelings and well-being of others
Misperceives the intentions of others in ambiguous situations as more hostile and threatening
Failure to inhibit antisocial behavior regardless of knowledge of potential punishment
**Kenneth Dodge-study of ambiguous situation, child labels disruption intentional or accidental. correlates to aggressive versus nonaggressive behavior
Important change DSM-5 for CD
“With a callous-unemotional presentation” specifier
To receive this specifier, criteria for CD must be met and child should also show 2 or more characteristics showing limited prosocial emotions: lack of remorse or guilt lack of empathy unconcern over performance shallow affect
These characteristics should be present persistently for at least 12 months across multiple settings and relationships
Individual Risk Factors for CD
*Neurological:
some evidence for decreased activity in right temporal lobe
frontal lobe abnormalities
*Physiological:
Under-aroused – it’s possible that the child needs a high level of intensity for arousal, and child then needs to become even more aggressive to decrease arousal
e.g. similar to cutting (“it has to bleed!”)
Decreased resting heart rate
Decreased heart rate reactivity
Decrease skin conductance reactivity
Decreased startle response to victimization pictures
Family Risk Factors for CD
Inconsistent parenting
Authoritarian or harsh parenting
Parental conflict – divorce
Use of physical aggression
Little involvement in child’s activities
Family dynamics: interaction of cause and effect
Poor monitoring
Perspectives on the Etiology of ODD & CD
No one factor has been determined to be a single cause
Multiple interacting etiologies development of disorders of disruptive, impulsive, and conduct disordered behaviors – numerous possible combinations of contributing variables
CD – Development & Course
Typically, mild delinquent behaviors emerge first, followed by more severe behaviors gradually surfacing later
Average ages of emergence of CD symptoms:
8 – lies fights
9 – police, fire setting, weapon use
10 – vandalism
11 – physical cruelty
12 – steals, runs away from home, truant, breaks and enters
13 – forced sexual activity
CD – Course, Outcomes & Future Risks
Early onset of drinking, smoking, sexual behavior, illegal drug use
Increased risk for future criminal behavior, incarceration, alcohol abuse, marital discord, occupation impairment, social impairment
CD as predictor of APD
Up to 40%-50% of children with CD will meet criteria for APD in adulthood
Cortical development may play a substantial role, which is even more of a reason not to diagnose APD prior to age 18
Antisocial Personality Disorder: Criteria
Three or more of the following:
- Failure to conform to social norms (behaviors warranting arrest)
- Deceitfulness
- Impulsivity
- Irritability and aggressiveness
- Reckless disregard for safety of others or self
- Consistent irresponsibility
- Lack of remorse (indifference or rationalization)
