| Disorders usually first diagnosed in infancy, childhood, or adolescence. |
Conduct Disorder--
In psychiatry, conduct disorder is a pattern of repetitive behavior where the rights of others or
the social norms are violated. Possible symptoms are over-aggressive behavior, bullying, physical
aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism,
and stealing.
Diagnosis
The diagnostic criteria for Conduct Disorder (codes 312.xx, with xx representing digits which vary
depending upon the severity, onset, etc. of the disorder) as listed in the DSM-IV-TR are as follows:
1. 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:
1. Aggression to people and animals
1. often bullies people, threatens, or intimidates others
2. often initiates physical fights
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick,
broken bottle, knife, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed
robbery)
7. has forced someone into sexual activity
2. Destruction of property
1. has deliberately engaged in fire setting with the intention of causing serious damage.
2. has deliberately destroyed others' property (other than by fire).
3. Deceitfulness or theft
1. has broken into someone else's house, building, or car
2. often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
3. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but
without breaking and entering; forgery)
4. Serious violations of rules
1. often stays out at night despite parental prohibitions, beginning before age 13 years
2. 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)
3. is often truant from school, beginning before age 13 years
2. The disturbance in behavior causes clinically significant impairment in social, academic,
or occupational functioning.
3. If the individual is age 18 years or older, criteria are not met for Antisocial personality
disorder.
After the age of 18, a conduct disorder may develop into antisocial personality disorder.
Antisocial personality disorder (APD) is a psychiatric condition characterized by an individual's
common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and
indifference to the rights and feelings of others. Antisocial personality disorder is terminology used
by the American Psychiatric Association's Diagnostic and Statistical Manual, while the World Health
Organization's ICD-10 refers to Dissocial personality disorder. People diagnosed with this disorder
are typically called Sociopaths.
Diagnosis of Antisocial personality disorder is documented to be significantly more common among
men than among women.[1]
Central to identifying individuals exhibiting characteristics of the disorder is that they appear to
experience a limited range of human emotions. This can explain their lack of empathy for the
suffering of others, since they cannot experience the emotion associated with either empathy or
suffering. Risk-seeking behavior and substance abuse may be attempts to escape feeling empty or
emotionally void.
The rage exhibited by sociopaths, as well as the anxiety associated with certain presentations of
antisocial personality disorder, may represent the limit of emotion(s) experienced, or might also
suggest physiological responses, without analogy to emotion, experienced by others.
According to the older theory of Freudian psychoanalysis, a person with antisocial personality
disorder has a strong id and ego that overpowers the superego. The theory proposes that
internalized morals of our unconscious mind are restricted from surfacing to the ego and
consciousness. However, this explanation provides no insight into the cause or treatment of the
problem.
Research has shown that individuals with antisocial personality disorder are indifferent to the
possibility of physical pain or many punishments and show no indications that they experience fear
when so threatened.
One approach to explaining antisocial personality disorder behaviors is put forth by sociobiology, a
science that attempts to understand and explain a wide variety of human behavior based on
evolutionary biology. Sociobiological explanations for antisocial behavior types explore evolutionarily
stable strategies, attempting to discern whether the antisocial phenotype has evolved because it
gains fitness specifically within, or alongside, the survival strategies of other humans exhibiting
different, perhaps complementary behaviors (e.g., in a symbiotic or parasitic manner).[2]
Establishing the diagnosis
Antisocial personality disorder and the closely related construct of psychopathy can be assessed
and diagnosed through clinical interview, self-rating personality surveys, and ratings from coworkers
and family. The Psychopathy Checklist-Revised (PCL-R) is one source for diagnosing psychopathy in
forensic male populations.
Diagnostic criteria (DSM-IV-TR)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, currently DSM-IV-TR), a widely
used manual for diagnosing mental and behavioral disorders, defines antisocial personality disorder
as a pervasive pattern of disregard for and violation of the rights of others occurring since age
15vc, as indicated by three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly
performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit
or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor
financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or
stolen from another
The manual lists the following additional necessary criteria:
* The individual is at least 18 years of age.
* There is evidence of conduct disorder with onset before age 15 years.
* The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a
manic episode.
Sex differences: APD is diagnosed much more frequently in men than in women.[citation needed]
The DSM-IV diagnostic criteria does not take into account relational aggression, in which women are
more likely to engage than physical aggression.
Diagnostic criteria (ICD-10)
Chapter V of the tenth revision of the International Classification of Diseases offers a set of criteria
for diagnosing the related construct of dissocial personality disorder.
Dissocial Personality Disorder (F60.2), usually coming to attention because of a gross disparity
between behavior and the prevailing social norms, and characterized by:
* callous unconcern for the feelings of others;
* gross and persistent attitude of irresponsibility and disregard for social norms, rules, and
obligations;
* incapacity to maintain enduring relationships, though having no difficulty in establishing them;
* very low tolerance to frustration and a low threshold for discharge of aggression, including
violence;
* incapacity to experience guilt or to profit from experience, particularly punishment;
* marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has
brought the patient into conflict with society.
There may also be persistent irritability as an associated feature. Conduct disorder during childhood
and adolescence, though not invariably present, may further support the diagnosis.
Causes
The cause of this disorder is unknown, but biological or genetic factors may play a role. Child abuse
or exposure to violence at a young age may also be a factor.
A family history of the disorder — such as having an antisocial parent — increases the chances of
developing the condition. A number of environmental factors within the childhood home, school and
community, such as an overly punitive home or school environment may also contribute.[4]
Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the
fathers of individuals with antisocial personality disorder. He found that, within such a family, males
had an increased incidence of APD, whereas females tended to show an increased incidence of
somatization disorder instead.[5]
Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in
the first five years of life. Glueck and Glueck (1968) saw indications that the mothers of children
who developed this personality disorder tended to display a lack of consistent discipline and
affection, and an abnormal tendency to alcoholism and impulsiveness. These factors all contributing
to failure to create a stable and functional home with consistent structure and behavioral boundaries.
[5]
Adoption studies support the role of both genetic and environmental contributions to the
development of the disorder. Twin studies also indicate an element of hereditability of antisocial
behaviour in adults and have shown that genetic factors are more important in adults than in
antisocial children or adolescents where shared environmental factors are more important. (Lyons
et al., 1995)[5]
Symptoms
Common characteristics of people with antisocial personality disorder include:
* Persistent lying or stealing
* Recurring difficulties with the law
* Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
* Aggressive, often violent behavior; prone to getting involved in fights
* Inability to keep a job
* A persistent agitated or depressed feeling (dysphoria)
* Inability to tolerate boredom
* Disregard for the safety of self or others
* A childhood diagnosis of conduct disorders
* Lack of remorse for hurting others
* Superficial charm
* Impulsiveness
* A sense of extreme entitlement
* Inability to make or keep friends
* Lack of guilt
* Recklessness, impulsivity[6][4]
People who have antisocial personality disorder often experience difficulties with authority figures.[7]
Prevalence
The National Comorbidity Survey, which used DSM-III-R criteria, found that 5.8% of males and
1.2% of females showed evidence of a lifetime risk for the disorder.[8] In penitentiaries , the
percentage is estimated to be as high as 75%. Prevalence estimates within clinical settings have
varied from 3% to 30%, depending on the predominant characteristics of the populations being
sampled. {Diagnostic and Statistical Manual of Mental Disorders} Perhaps not surprisingly, the
prevalence of the disorder is even higher in selected populations, such as people in prisons (who
include many violent offenders) (Hare 1983). Similarly, the prevalence of ASPD is higher among
patients in alcohol or other drug (AOD) abuse treatment programs than in the general population
(Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.[9]
Relationship with other mental disorders
Antisocial personality disorder is negatively correlated with all DSM-IV Axis I disorders except
substance-abuse disorders. Antisocial personality disorder is most strongly correlated with
Psychopathy as measured on the Psychopathy Checklist-Revised (PCL-R).
Potential markers
Although antisocial personality disorder cannot be formally diagnosed before age 18, three markers
for the disorder, known as the MacDonald Triad, can be found in some children. These are, a longer-
than-usual period of bedwetting, cruelty to animals, and pyromania[10].
It is not known how many children who exhibit these signs grow up to develop antisocial personality
disorder, but these signs are often found in the histories of diagnosed adults. Because it is
unknown how many children have these symptoms and who do not develop antisocial personality
disorder, the predictive value (ie, the usefulness of these symptoms for predicting future antisocial
personality disorder) is unclear.
These three traits are now included in the Diagnostic and Statistical Manual of Mental Disorders IV-
TR under conduct disorder.
A child who shows signs of antisocial personality disorder may be diagnosed as having either
conduct disorder or oppositional defiant disorder. Not all of these children, however, will grow up
to develop antisocial personality disorder.
References
1. ^ Public Health Agency of Canada, A Report on Mental Illnesses in Canada
2. ^ Mealey, Linda (1995). The Sociobiology of Sociopathy: An Integrated Evolutionary Model.. Vol. 18 (3) 523-
599. Behavioral and Brain Sciences.
3. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder
(pdf file)
4. ^ a b Antisocial Personality Disorder. Mayo Foundation for Medical Education and Research (2006). Retrieved
on 2007-02-20.
5. ^ a b c Antisocial Personality Disorder (APD). Armenian Medical Network (2006). Retrieved on 2007-02-20.
6. ^ Antisocial Personality Disorder. Psychology Today (2005). Retrieved on 2007-02-20.
7. ^ Antisocial Personality Disorder Treatment. Psych Central (2006). Retrieved on 2007-02-20.
8. ^ Antisocial Personality Disorder. Antisocial Personality Disorder for professionals. Armenian Medical Network
(2006). Retrieved on 2007-02-20.
9. ^ Antisocial Personality Disorder, Alcohol, and Aggression. Alcohol Research & Health. National Institute on
Alcohol Abuse and Alcoholism (2006). Retrieved on 2007-02-20.
10. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
In psychiatry, conduct disorder is a pattern of repetitive behavior where the rights of others or
the social norms are violated. Possible symptoms are over-aggressive behavior, bullying, physical
aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism,
and stealing.
Diagnosis
The diagnostic criteria for Conduct Disorder (codes 312.xx, with xx representing digits which vary
depending upon the severity, onset, etc. of the disorder) as listed in the DSM-IV-TR are as follows:
1. 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:
1. Aggression to people and animals
1. often bullies people, threatens, or intimidates others
2. often initiates physical fights
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick,
broken bottle, knife, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed
robbery)
7. has forced someone into sexual activity
2. Destruction of property
1. has deliberately engaged in fire setting with the intention of causing serious damage.
2. has deliberately destroyed others' property (other than by fire).
3. Deceitfulness or theft
1. has broken into someone else's house, building, or car
2. often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
3. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but
without breaking and entering; forgery)
4. Serious violations of rules
1. often stays out at night despite parental prohibitions, beginning before age 13 years
2. 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)
3. is often truant from school, beginning before age 13 years
2. The disturbance in behavior causes clinically significant impairment in social, academic,
or occupational functioning.
3. If the individual is age 18 years or older, criteria are not met for Antisocial personality
disorder.
After the age of 18, a conduct disorder may develop into antisocial personality disorder.
Antisocial personality disorder (APD) is a psychiatric condition characterized by an individual's
common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and
indifference to the rights and feelings of others. Antisocial personality disorder is terminology used
by the American Psychiatric Association's Diagnostic and Statistical Manual, while the World Health
Organization's ICD-10 refers to Dissocial personality disorder. People diagnosed with this disorder
are typically called Sociopaths.
Diagnosis of Antisocial personality disorder is documented to be significantly more common among
men than among women.[1]
Central to identifying individuals exhibiting characteristics of the disorder is that they appear to
experience a limited range of human emotions. This can explain their lack of empathy for the
suffering of others, since they cannot experience the emotion associated with either empathy or
suffering. Risk-seeking behavior and substance abuse may be attempts to escape feeling empty or
emotionally void.
The rage exhibited by sociopaths, as well as the anxiety associated with certain presentations of
antisocial personality disorder, may represent the limit of emotion(s) experienced, or might also
suggest physiological responses, without analogy to emotion, experienced by others.
According to the older theory of Freudian psychoanalysis, a person with antisocial personality
disorder has a strong id and ego that overpowers the superego. The theory proposes that
internalized morals of our unconscious mind are restricted from surfacing to the ego and
consciousness. However, this explanation provides no insight into the cause or treatment of the
problem.
Research has shown that individuals with antisocial personality disorder are indifferent to the
possibility of physical pain or many punishments and show no indications that they experience fear
when so threatened.
One approach to explaining antisocial personality disorder behaviors is put forth by sociobiology, a
science that attempts to understand and explain a wide variety of human behavior based on
evolutionary biology. Sociobiological explanations for antisocial behavior types explore evolutionarily
stable strategies, attempting to discern whether the antisocial phenotype has evolved because it
gains fitness specifically within, or alongside, the survival strategies of other humans exhibiting
different, perhaps complementary behaviors (e.g., in a symbiotic or parasitic manner).[2]
Establishing the diagnosis
Antisocial personality disorder and the closely related construct of psychopathy can be assessed
and diagnosed through clinical interview, self-rating personality surveys, and ratings from coworkers
and family. The Psychopathy Checklist-Revised (PCL-R) is one source for diagnosing psychopathy in
forensic male populations.
Diagnostic criteria (DSM-IV-TR)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, currently DSM-IV-TR), a widely
used manual for diagnosing mental and behavioral disorders, defines antisocial personality disorder
as a pervasive pattern of disregard for and violation of the rights of others occurring since age
15vc, as indicated by three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly
performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit
or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor
financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or
stolen from another
The manual lists the following additional necessary criteria:
* The individual is at least 18 years of age.
* There is evidence of conduct disorder with onset before age 15 years.
* The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a
manic episode.
Sex differences: APD is diagnosed much more frequently in men than in women.[citation needed]
The DSM-IV diagnostic criteria does not take into account relational aggression, in which women are
more likely to engage than physical aggression.
Diagnostic criteria (ICD-10)
Chapter V of the tenth revision of the International Classification of Diseases offers a set of criteria
for diagnosing the related construct of dissocial personality disorder.
Dissocial Personality Disorder (F60.2), usually coming to attention because of a gross disparity
between behavior and the prevailing social norms, and characterized by:
* callous unconcern for the feelings of others;
* gross and persistent attitude of irresponsibility and disregard for social norms, rules, and
obligations;
* incapacity to maintain enduring relationships, though having no difficulty in establishing them;
* very low tolerance to frustration and a low threshold for discharge of aggression, including
violence;
* incapacity to experience guilt or to profit from experience, particularly punishment;
* marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has
brought the patient into conflict with society.
There may also be persistent irritability as an associated feature. Conduct disorder during childhood
and adolescence, though not invariably present, may further support the diagnosis.
Causes
The cause of this disorder is unknown, but biological or genetic factors may play a role. Child abuse
or exposure to violence at a young age may also be a factor.
A family history of the disorder — such as having an antisocial parent — increases the chances of
developing the condition. A number of environmental factors within the childhood home, school and
community, such as an overly punitive home or school environment may also contribute.[4]
Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the
fathers of individuals with antisocial personality disorder. He found that, within such a family, males
had an increased incidence of APD, whereas females tended to show an increased incidence of
somatization disorder instead.[5]
Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in
the first five years of life. Glueck and Glueck (1968) saw indications that the mothers of children
who developed this personality disorder tended to display a lack of consistent discipline and
affection, and an abnormal tendency to alcoholism and impulsiveness. These factors all contributing
to failure to create a stable and functional home with consistent structure and behavioral boundaries.
[5]
Adoption studies support the role of both genetic and environmental contributions to the
development of the disorder. Twin studies also indicate an element of hereditability of antisocial
behaviour in adults and have shown that genetic factors are more important in adults than in
antisocial children or adolescents where shared environmental factors are more important. (Lyons
et al., 1995)[5]
Symptoms
Common characteristics of people with antisocial personality disorder include:
* Persistent lying or stealing
* Recurring difficulties with the law
* Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
* Aggressive, often violent behavior; prone to getting involved in fights
* Inability to keep a job
* A persistent agitated or depressed feeling (dysphoria)
* Inability to tolerate boredom
* Disregard for the safety of self or others
* A childhood diagnosis of conduct disorders
* Lack of remorse for hurting others
* Superficial charm
* Impulsiveness
* A sense of extreme entitlement
* Inability to make or keep friends
* Lack of guilt
* Recklessness, impulsivity[6][4]
People who have antisocial personality disorder often experience difficulties with authority figures.[7]
Prevalence
The National Comorbidity Survey, which used DSM-III-R criteria, found that 5.8% of males and
1.2% of females showed evidence of a lifetime risk for the disorder.[8] In penitentiaries , the
percentage is estimated to be as high as 75%. Prevalence estimates within clinical settings have
varied from 3% to 30%, depending on the predominant characteristics of the populations being
sampled. {Diagnostic and Statistical Manual of Mental Disorders} Perhaps not surprisingly, the
prevalence of the disorder is even higher in selected populations, such as people in prisons (who
include many violent offenders) (Hare 1983). Similarly, the prevalence of ASPD is higher among
patients in alcohol or other drug (AOD) abuse treatment programs than in the general population
(Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.[9]
Relationship with other mental disorders
Antisocial personality disorder is negatively correlated with all DSM-IV Axis I disorders except
substance-abuse disorders. Antisocial personality disorder is most strongly correlated with
Psychopathy as measured on the Psychopathy Checklist-Revised (PCL-R).
Potential markers
Although antisocial personality disorder cannot be formally diagnosed before age 18, three markers
for the disorder, known as the MacDonald Triad, can be found in some children. These are, a longer-
than-usual period of bedwetting, cruelty to animals, and pyromania[10].
It is not known how many children who exhibit these signs grow up to develop antisocial personality
disorder, but these signs are often found in the histories of diagnosed adults. Because it is
unknown how many children have these symptoms and who do not develop antisocial personality
disorder, the predictive value (ie, the usefulness of these symptoms for predicting future antisocial
personality disorder) is unclear.
These three traits are now included in the Diagnostic and Statistical Manual of Mental Disorders IV-
TR under conduct disorder.
A child who shows signs of antisocial personality disorder may be diagnosed as having either
conduct disorder or oppositional defiant disorder. Not all of these children, however, will grow up
to develop antisocial personality disorder.
References
1. ^ Public Health Agency of Canada, A Report on Mental Illnesses in Canada
2. ^ Mealey, Linda (1995). The Sociobiology of Sociopathy: An Integrated Evolutionary Model.. Vol. 18 (3) 523-
599. Behavioral and Brain Sciences.
3. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder
(pdf file)
4. ^ a b Antisocial Personality Disorder. Mayo Foundation for Medical Education and Research (2006). Retrieved
on 2007-02-20.
5. ^ a b c Antisocial Personality Disorder (APD). Armenian Medical Network (2006). Retrieved on 2007-02-20.
6. ^ Antisocial Personality Disorder. Psychology Today (2005). Retrieved on 2007-02-20.
7. ^ Antisocial Personality Disorder Treatment. Psych Central (2006). Retrieved on 2007-02-20.
8. ^ Antisocial Personality Disorder. Antisocial Personality Disorder for professionals. Armenian Medical Network
(2006). Retrieved on 2007-02-20.
9. ^ Antisocial Personality Disorder, Alcohol, and Aggression. Alcohol Research & Health. National Institute on
Alcohol Abuse and Alcoholism (2006). Retrieved on 2007-02-20.
10. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
Conduct Disorder Charles Huffine, M.D.
 |  |  |  |