The essential feature of conduct disorder is a repetitive and persistent pattern of behavior by a child or teenager in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules time and time again.
Specific Symptoms of Conduct Disorder
Conduct disorder is characterized by 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 (or more) of the following criteria in the past 12 months, 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.
Two subtypes of conduct disorder are provided based on the age at onset of the disorder (i.e., childhood-onset type and adolescent-onset type). The subtypes differ in regard to the characteristic nature of the presenting conduct problems, developmental course and prognosis, and gender ratio. Both subtypes can occur in a mild, moderate, or severe form. In assessing the age at onset, information should preferably be obtained from the youth and from caregiver(s). Because many of the behaviors may be concealed, caregivers may underreport symptoms and overestimate the age at onset.
This subtype is defined by the onset of at least one criterion characteristic of conduct disorder prior to age 10 years.
Individuals with childhood-onset type are usually male, frequently display physical aggression toward others, have disturbed peer relationships, may have had oppositional defiant disorder during early childhood, and usually have symptoms that meet full criteria for conduct disorder prior to puberty. These individuals are more likely to have persistent conduct disorder and develop adult antisocial personality disorder than are those with adolescent-onset type.
This subtype is defined by the absence of any criteria characteristic of conduct disorder prior to age 10 years.
Compared with those with the childhood-onset type, these individuals are less likely to display aggressive behaviors and tend to have more normative peer relationships (although they often display conduct problems in the company of others). These individuals are less likely to have persistent conduct disorder or develop adult antisocial personality disorder. The ratio of males to females with conduct disorder is lower for the adolescent-onset type than for the childhood-onset type.