Conduct disorder

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Conduct disorder is a psychiatric category to describe a pattern of repetitive behavior where the rights of others or the current social norms are violated. Symptoms include verbal and physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.^[1] Conduct disorder is a major public health problem because youth with conduct disorder not only inflict serious physical and psychological harm on others, but they are at greatly increased risk for incarceration, injury, depression, substance abuse, and death by homicide and suicide. After the age of 18, a conduct disorder may develop into antisocial personality disorder.^[2]

[edit] 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) (except for activities such as archery and hunting)
      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.

[edit] Causation

At one time or another most children and adolescents act out or do things that are destructive or troublesome for themselves or others. Only if this persists or continues to occur often is diagnosed by psychiatrists as conduct disorder. This disorder is found to be much more common in boys than in girls. As many as 50 percent of parents of 4- to 6-year-old children report that their children has expressed some form of this behavior, but most of these children show a decrease in antisocial behavior in the next couple years. Those that do not, in whom this behavior still persists, may be referred for psychological help. It is estimated that 5 percent of children show serious conduct problems, being described as impulsive, overactive, and aggressive and engaging in delinquent actions. Some possible explanations as to this behavior are genetic inheritance of a difficult temperament, ineffective parenting, and living in a neighborhood where violence is the norm. There is a lack of consensus on what actually works, despite the considerable efforts made to help children with conduct disorders.^[3]

A closely linked behavior is juvenile delinquency. This term refers to actions taken by an adolescent in breaking the law or engaging in illegal behavior. This is a very broad concept that ranges from legal infractions to littering to murder. According to U.S. government statistics, eight of ten cases of juvenile delinquency involve males. However, in the last two decades there has been a greater increase in female delinquency than in male delinquency. This behavior has been proven to vary in different cultures. Delinquency rates among minority groups and lower-socioeconomic-status-youth are especially high in proportion to the overall population of these groups. However, such groups have less influence over the judicial decision-making process in the United States and, therefore, may be judged delinquent more readily than their white, middle-socioeconomic-status counterparts. Many proposed causes of delinquency include heredity, identity problems, community influences, and family experiences. Although delinquency is less exclusively a phenomenon of lower socioeconomic status than it was in the past, some characteristics of lower-class culture might promote delinquency. It is a complex task but psychologists have found a way to predict whether a youth will turn violent or not. Researchers have pieced together some clues and found that violent youth are overwhelmingly male, and many are driven by feelings of powerlessness. A sense of power seems to enthuse youth the most in terms of violence.^[3]

[edit] Lack of empathy

Some scholars have proposed that lack of empathy and empathic concern (callous disregard for the welfare of others) is an important risk factor for conduct disorder.^{[4] [5]}

When youth with aggressive conduct disorder watch an individual intentionally hurting another (like closing a piano lid), regions of the brain that process painful information are activated, as are the amygdala and ventral striatum (part of the neural circuit involved in reward processing (Decety, Michalska, Akitsuki & Lahey, 2009).

Developmental psychologists and social neuroscientists have hypothesized that empathy and sympathetic concern for others are essential factors inhibiting aggression toward others.^{[6] [7]} The propensity for aggressive behavior has been hypothesized to reflect a blunted empathic response to the suffering of others.^[8] Such a lack of empathy in aggressive individuals may be a consequence of a failure to be aroused by the distress of others.^[9] Similarly, it has been suggested that aggressive behavior arises from abnormal processing of affective information, resulting in a deficiency in experiencing fear, empathy, and guilt, which in normally developing individuals inhibits the acting out of violent impulses.^[10]

Recently, a functional magnetic resonance imaging (fMRI) study conducted by neuroscientist Jean Decety and colleagues at the University of Chicago reported that youth with aggressive conduct disorder (who have psychopathic tendencies) have a different hemodynamic brain response when confronted with empathy-eliciting stimuli.^[11] In the study, researchers compared 16- to 18-year-old boys with aggressive conduct disorder to a control group of adolescent boys with no unusual signs of aggression. The youth with the conduct disorder had exhibited disruptive behavior such as starting a fight, using a weapon and stealing after confronting a victim. The youth were tested with fMRI while looking at video clips in which people endured pain accidentally, such as when a heavy bowl was dropped on their hands, and intentionally, such as when a person stepped on another's foot. Results show that the aggressive youth activated the neural circuits underpinning pain processing to the same extent, and in some cases, even more so than the control participants without conduct disorder.^[12] However, aggressive adolescents showed a specific and very strong activation of the amygdala and ventral striatum (an area that responds to feeling rewarded) when watching pain inflicted on others, which suggested that they enjoyed watching pain. Unlike the control group, the youth with conduct disorder did not activate the areas of the brain involved in understanding social interaction and moral reasoning (i.e., the paracingulate cortex and temporoparietal junction).

[edit] See also

• Antisocial personality disorder
• Bullying
• Challenging behavior
• Child pyromaniac
• Empathy
• Empathic concern
• Oppositional defiant disorder
• Psychopathy

[edit] References

[edit] Further reading

• Decety, J., & Moriguchi, Y. (2007). The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. BioPsychoSocial Medicine, 1, 22-65.
• Lahey, B.B., Moffitt, T.E.,& Caspi, A. (Eds.). Causes of conduct disorder and juvenile delinquency. New York: Guilford Press.
• Raine, A. (2002). Biosocial Studies of Antisocial and Violent Behavior in Children and Adults: A Review. Journal of Abnormal Child Psychology, 30, 311-326.
• Van Goozen, S.H.M., & Fairchild, G. (2008). How can the study of biological processes help design new interventions for children with severe antisocial behavior? Development and Psychopathology, 20, 941-973.

[edit] External links

• Bullying tendency wired in brain from the BBC News.
• Bullies may enjoy seeing others in pain National Science Foundation