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Conduct disorder

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Conduct disorder
SpecialtyPsychiatry, psychology, child and adolescent psychiatry Edit this on Wikidata

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 themselves. After the age of 18, a conduct disorder may develop into antisocial personality disorder.[2]

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 activites 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.

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.[3] [4]

When youth with aggressive conduct disorder watch an individual intentionally hurting another (like closing a piano lead), regions of the brain that process painful information are activated, as well as the amygdala and ventral striatum (part of the neural circuit involved in reward processing (Decety, Michalska, Akitsuki & Lahey, 2008).

Interestingly, developmental psychologists and social neuroscientists have hypothesized that empathy and sympathetic concern for others are essential factors inhibiting aggression toward others.[5] [6] The propensity for aggressive behavior has been hypothesized to reflect a blunted empathic response to the suffering of others.[7] Such a lack of empathy in aggressive individuals may be a consequence of a failure to be aroused by the distress of others.[8] 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.[9]

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.[10] 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.[11] 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).

Further Readings

  • 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.

References

  1. ^ Loeber, R., Farrington, D.P., Stouthamer-Loeber, M., & Van Kammen, W.B. (1998). Antisocial behavior and mental health problems: Explanatory factors in childhood and adolescence. Mahwah, NJ: Lawrence Erlbaum Associates.
  2. ^ Lahey, B.B., Loeber, R., Burke, J.D., & Applegate, B. (2005). Predicting future antisocial personality disorder in males from a clinical assessment in childhood. Journal of Consulting and Clinical Psychology, 73, 389-399.
  3. ^ Frick, P.J., Stickle, T.R., Dandreaux, D.M., Farrell, J.M., & Kimonis, E.R. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, 471-487.
  4. ^ Lahey, B.B., & Waldman, I.D. (2003). A developmental propensity model of the origins of conduct problems during childhood and adolescence. In B.B. Lahey, T.E. Moffitt, & A. Caspi (Eds.), Causes of conduct disorder and juvenile delinquency (pp. 76-117). New York: Guilford Press.
  5. ^ Eisenberg, N. (2005). Age changes in prosocial responding and moral reasoning in adolescence and early adulthood. Journal of Research on Adolescence, 15, 235-260.
  6. ^ Decety, J., & Meyer, M. (2008). From emotion resonance to empathic understanding: A social developmental neuroscience account. Development and Psychopathology, 20, 1053-1080.
  7. ^ Blair, R.J.R. (2005). Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations. Consciousness and Cognition, 14, 698-718.
  8. ^ Raine, A., Venables, P., & Mednick, S. (1997). Low resting heart rate at age three years predisposes to aggression at age 11 years: Evidence from the Mauritius Child Health Project. Journal of the Academy of Child and Adolescent Psychiatry, 36, 1457-1464.
  9. ^ Herpertz, S.C., & Sass, H. (2000). Emotional deficiency and psychopathy. Behavioral Science and Law, 18, 317-323.
  10. ^ Decety, J., Michalska, K.J., Akitsuki, Y., & Lahey, B. (2008). Atypical empathic responses in adolescents with aggressive conduct disorder: a functional MRI investigation. Biological Psychology, Epub ahead of print.
  11. ^ Decety, J., Michalska, K.J., & Akitsuki, Y. (2008). Who caused the pain? A functional MRI investigation of empathy and intentionality in children. Neuropsychologia, 46, 2607-2614.

See also



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