DSM 5 Criteria for Conduct Disorder

## **How do healthcare professionals diagnose conduct disorder?** To diagnose conduct disorder, healthcare professionals conduct a thorough evaluation that includes: - **Clinical interview**: A detailed interview with the child, parents, and teachers to gather information about the child's behavior, family history, and any environmental factors that may contribute to the disorder. - **Observation**: Observing the child's behavior in different settings, such as at home, school, or during the clinical interview, to identify patterns of conduct problems and to assess interpersonal and emotional functioning. - **Psychological testing**: Administering standardized tests to assess the child's emotional, behavioral, and cognitive functioning, as well as any co-occurring mental health conditions. - **Medical evaluation**: A physical examination to rule out any medical conditions contributing to the child's behavior. - **Review of records**: Examining school records, medical history, and any previous psychological evaluations to gather additional information about the child's behavior and development. By combining information from these assessments, healthcare professionals can determine whether the child meets the DSM-5 criteria for conduct disorder and develop an appropriate treatment plan while also considering the presence of co-occurring conditions such as bipolar disorder.

## **What is DSM 5?** The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a comprehensive classification system for mental disorders. It is published by the American Psychiatric Association (APA) and is widely used by mental health professionals in the United States and around the world. The DSM-5 serves as the standard for diagnosing mental disorders and provides standardized criteria to ensure consistency and accuracy in diagnosis. The manual covers a wide range of mental health conditions, including mood disorders, anxiety disorders, personality disorders, and more. The DSM-5 is regularly updated to reflect advances in our understanding of mental health and to incorporate the latest research findings.

## **DSM criteria for conduct disorder** DSM criteria for conduct disorder outline specific behaviors and patterns that characterize the disorder. To be diagnosed with conduct disorder, a person must display a persistent pattern of behavior that violates the rights of others or major age-appropriate societal norms or rules. Essentially, these are conduct disorder symptoms. According to the American Psychiatric Association (2013), the diagnostic criteria for conduct disorder include the following: A. 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 at least three of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: **1. 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. **2. 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). **3. 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). **4. 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 the parental or parental surrogate home (or once without returning for a lengthy period). Is often truant from school, beginning before age 13 years. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder. _Specify whether:_ - 312.81 (F91.1) Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years. - 312.82 (F91.2) Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years. - 312.89 (F91.9) Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years. _Specify if:_ - **With limited prosocial emotions**: To qualify for this specifier, an individual must have dis- played at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers). - **Lack of remorse or guilt**: Does not feel bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules. - **Callous—lack of empathy:** Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others. - **Unconcerned about performance**: Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance. - **Shallow or deficient affect**: Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off” quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others). _Specify current severity:_ - **Mild**: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking). - **Moderate**: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism). - **Severe**: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

## **Differences between the DSM 4 and DSM 5 conduct disorder criteria** Differences between the DSM-4 and DSM-5 conduct disorder criteria are relatively minor, but they do exist. The DSM-5, published in 2013, aimed to provide clearer, more precise criteria and reflect the latest field research. Here are some of the key differences between the DSM-4 and DSM-5 criteria for conduct disorder: - **Disorder classification**: DSM-4 classified Conduct Disorder under "Attention deficit and disruptive behavior disorders," but in the DSM-5, it has been reclassified under "Disruptive, Impulse-Control, and Conduct Disorders." - **Severity specifier**: DSM-5 added a severity specifier (mild, moderate, severe) based on the number of conduct problems, their impact on others, and the harm caused. These changes aimed to provide more detailed and accurate descriptions of individuals with conduct disorder, allowing for better diagnosis and treatment planning.

## **Conduct disorder treatment** To effectively address conduct disorder, a comprehensive treatment plan is essential. Here are some key components of treatment for conduct disorder: - **Cognitive-behavioral therapy (CBT)**: CBT helps children and adolescents identify and change negative thought patterns and behaviors. It can improve problem-solving skills, anger management, and impulse control. - **Parent training programs**: These programs educate parents on effective parenting techniques, such as setting clear boundaries, using consistent discipline, and reinforcing positive behaviors. - **Family therapy**: Family therapy can address communication issues and conflict resolution and improve overall family dynamics, which can be crucial in managing conduct disorder. - **Medication**: While there are no specific medications for CD, certain medications may be prescribed to treat co-occurring conditions such as ADHD, depression, or anxiety. - **Group therapy**: Group therapy can provide a supportive environment for children and adolescents to learn social skills, empathy, and how to interact positively with peers. It's important to note that early intervention and a tailored approach to treatment are crucial for effectively managing conduct disorder and preventing long-term consequences.

## **Reference** American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.