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What is Conduct Disorder?



The DSM V Defines Conduct Disorder As:





A. 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 at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:


• Aggression to People and Animals


• Often bullies, threatens, or intimidates others.

• Often initiates physical fights.

• Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).

• Has been physically cruel to people.

• Has been physically cruel to animals.

• Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).

• Has forced someone into sexual activity.


• Destruction of Property


• Has deliberately engaged in fire setting with the intention of causing serious damage.

• Has deliberately destroyed others’ property (other than by fire setting).


• Deceitfulness or Theft


• Has broken into someone else’s house, building, or car.

• Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).

• Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).


• Serious Violations of Rules


• Often stays out at night despite parental prohibitions, beginning before age 13 years.

• Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.

• Is often truant from school, beginning before age 13 years.


B. • The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.


• Lack of remorse or guilt:


• Does not feel bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules.


• Callous—lack of empathy:


• Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others.


• Unconcerned about performance:


• Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance.


• Shallow or deficient affect:


• Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off” quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others).

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Copyright © 2013). American Psychiatric Association. All Rights Reserved. DSM-5™ Diagnostic Criteria Conduct Disorder 312.8x (F91.x)



HOW PREVALENT IS CONDUCT DISORDER?



In their December 2019 paper "Conduct Disorder" Dr Fairchild, et al, state that 3% of school age children have CD. This percentage is a worldwide statistic.

There are an estimated 1 in 10 children in the United States has Conduct Disorder.


There are approximately 67,683,000 children world wide with Conduct Disorder.


Conduct Disorder is six times more prevalent than Autism.





HOW CONDUCT DISORDER AFFECTS FAMILIES



Conduct Disorder rips families apart. Families living with CD often experience PTSD and C-PTSD, also known as Complex PTSD. PTSD in families occur from the constant physical, psychological, and sexual abuse perpetrated by the child with Conduct Disorder.


Children with CD lie, steal, and manipulate their families and others to gain control and obtain whatever they are wanting in the moment. These children are often vengeful and plot outrageous schemes of revenge for the smallest of perceived slights. Many times, these revenge scenarios include false allegations of abuse or neglect.


One of the issues with Conduct Disorder is the inability to learn from mistakes. Typical children can receive a stern lecture for misbehavior and will often learn from the experience. Not so with children displaying CD type behaviors. In addition, there is a deficit of critical thinking skills which cause them to repeat behaviors based upon desire not outcomes.


Callous and unemotional is a term used to describe the demeanor of a child with Conduct Disorder. Research has shown that the pleasure centers in the child’s brain become engaged during events that cause the typical person distress. The child feels pleasure when creating chaos, causing physical or emotional pain to another, or doing things that are considered socially unacceptable. Behaviors associated with CD are often “anti-social”, meaning those behaviors that go against society norms.





HOW CONDUCT DISORDER AFFECTS COMMUNITIES





Children who have CD can act out at school as well as in the home. Confrontations with educators and other children are not unusual. These confrontations can be physical and/or verbal. The child may refuse to adhere to school rules of decorum, attendance, classwork, etc. The child may bully or manipulate classmates perceived as weaker or malleable. Disruption in the educational environment creates learning challenges for everyone.


Other times children with Conduct Disorder use school and church as another means to isolate family members. The child will confide (i.e. lie) to educators, ministers, etc. regarding their home life. The alleged activities begin as small, unnerving items but grow progressively larger as the child learns the boundaries of what their new confidant will believe. If the parents or sibling approaches a minister, school staff member, etc. seeking help, the family member is already viewed as the problem based upon the information the child has been providing.

The most pervasive of issues surrounding Conduct Disorder is child to parent/ child to sibling violence and aggression. It is the dirty little secret of CD that no one wants to talk about. There are several issues with ignoring the problem, blaming the parents, disbelief that the situation is as dire as reported, is that the child continues the abusive behaviors as an adult with families of their own. This begins yet another cycle of domestic violence. One that could have been prevented if society would only listen.


Children diagnosed with Conduct Disorder have a 60% chance of receiving an adult personality disorder diagnosis, wreaking further havoc in communities.


Children with CD present more high risk behaviors than typical children of the same age. These include drug and alcohol abuse, prostitution, theft of property, and other forms of delinquent behaviors. As adults, the behaviors can continue and become more extreme, leading to incarceration or death.



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