CONDUCT DISORDER

Definition Conduct disorder is a clinical term referring to the clustering of

persistent
antisocial acts of children and adolescents. The condition is thought to be
due to
underlying psychopathology leading to significant impairment in one or
more
domains of functioning. The symptoms are clustered in four areas:
aggression to
people and animals, destruction of property, deceitfulness and theft, and
serious
violations of rules. Subtyping is allowed based on the age of onset of
symptoms.
Severity can be specified as mild, moderate, or severe. The category is
currently
conceived of as a polythetic diagnosis in that no one specific criterion is
necessary
for and any combination of criteria will suffice to establish the diagnosis.
There is no
formal provision for evaluating the context in which these antisocial
clusters occur.
Both these features contribute to the fact that the category is inherently
heterogenous. The current criteria require that at least three of a list of
fifteen
antisocial behaviors be present over a period of 12 months; one of them
has to be
present in the past 6 months. Exclusion criteria for antisocial personality
disorder are
added. In epidemiological studies, this category has been robust,
especially in its
most recent more stringent versions. Its inherent heterogeneity has made
conduct
disorder less useful for causal and treatment studies. National practice
guidelines
have been developed for this disorder by this author.
History Clinical interest in antisocial behavior began with the specialty of
forensic
pathology. Early investigations focused on the detection of criminal
stigmata in
physiognomy and anatomy. Subsequently, Richard von Krafft-Ebing's
detailed
descriptions of deviant sexual behavior began to move the field into the
realm of
behavior observations. Following the writings of Sigmund Freud, whose
speculations
regarding aggression as an instinct were of direct relevance, psychiatric
clinicians
began the exploration of antisocial acts as psychopathology. Soon
afterwards,
ethologists began their naturalistic observations of animal aggression and
explored
its relationship to human behavior, providing ontogenetic and phylogenetic
anchors.
Konrad Lorenz was especially interested in aggression as an instinct.
Following the
results from several longitudinal studies that demonstrated the stability of
antisocial
acts within the same individuals over time and in diverse environments,
their poor
response to criminological management and supportive counseling,
interest
intensified in the clinical definition of antisocial behavior. Psychometric
work in the
middle of the twentieth century established the coherence of antisocial and
aggressive patterns of behavior. At the same time, John Bowlby was
studying
subtypes of delinquents. The description of “affectionless characters,” with
their
histories of prolonged disruptions of early relationships, became one of the
sources
of inspiration for the study of attachment and also provided a bridge from
analytic
concepts and ethology to the clinical study of antisocial acts. Most
recently, interest
in biological substrates has reemerged. Stella Chess and Alexander
Thomas
introduced the notion of the “difficult temperament” which served as an
early
childhood antecedent of behavior problems in some boys; Robert
Cloninger further
specified the risks. High novelty seeking with low harm avoidance, both
heritable
traits, were instrumental in generating risk of conduct disorder. Recent
studies of
genetic transmission indicate certain heritability for antisocial behavior.