Conduct Disorder

Conduct disorder requires at least three problematic behaviors within the past 12 months, with at least one occurring in the past six months. Behaviors fall into four categories: aggression toward people and animals, property destruction, deceitfulness or theft, and serious rule violations. Diagnosis typically occurs in childhood or adolescence, and severity ranges from mild to severe based on symptom count and impact on others.

Childhood-onset conduct disorder, marked by symptoms before age 10, is associated with a poorer prognosis and more persistent course compared to adolescent-onset cases. Childhood-onset is strongly predictive of antisocial personality disorder and other psychosocial difficulties in adulthood. Adolescent-onset conduct disorder typically shows better outcomes, with most cases remitting by adulthood.

Limited prosocial emotions include lack of remorse, callousness, and shallow affect. Individuals with this specifier show little empathy, disregard consequences of their actions, and often misinterpret others' intentions as hostile. This presentation is associated with a more severe and persistent course of conduct disorder throughout development.

Risk factors include parental neglect, inconsistent discipline, exposure to violence, and association with delinquent peers. Genetic predispositions and temperamental factors like low frustration tolerance, negative emotionality, and low self-control also influence development. Neurobiological findings show reduced autonomic fear responses and structural differences in brain regions associated with emotional regulation.

Boys typically exhibit physical aggression, while girls more often display relational aggression or truancy. These gender-based behavioral differences reflect cultural and social norms influencing symptom expression. Careful diagnostic evaluation is necessary to avoid bias and recognize conduct disorder across diverse gender presentations and cultural contexts.

Aggression includes bullying, physical cruelty, and using weapons like bats or bricks to cause serious harm. Other symptoms involve deliberate property destruction, habitual shoplifting, deceitfulness, and serious rule violations such as truancy or running away. Affected individuals often show irritability, temper outbursts, and insensitivity to punishment.

Conduct disorder frequently co-occurs with attention deficit hyperactivity disorder, substance use disorders, and mood disorders, which can exacerbate symptoms. It often follows oppositional defiant disorder developmentally. These comorbid conditions complicate treatment and require comprehensive, individualized approaches tailored to the person's developmental and social context.