On the National Counselor Examination (NCE), the Counselor Preparation Comprehensive Examination (CPCE), or another counseling exam, you may come across questions related to diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). This video will help you understand Conduct Disorder.
What is Conduct Disorder? What are the symptoms and criteria for the diagnosis? Are there risk factors for Conduct Disorder? All these questions, and more, will be answered in the video!
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text-revision (DSM-5-TR), Conduct Disorder is “a repetitive and persistent pattern of behavior in which the basic rights of other or major age-appropriate societal norms or rules are violated”.
With conduct disorder, the DSM-5-TR lays out a list of ways that conduct disorder may manifest—or the symptoms of conduct disorder. In total, there are 15 symptoms in four different categories. A diagnosis of conduct disorder would require at least three of these symptoms to be present within the last 12 months, with at least one of the symptoms being present in the last six months.
As mentioned, there are 15 symptoms of conduct disorder, and these are split into four categories.
Category 1: Aggression Towards People and Animals
Category 2: Destruction of Property
Category 3: Acts of Deceitfulness or Theft
Category 4: Serious Violations of Rules
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For those with contact disorder. They’re at risk for a variety of different difficulties in life. From legal concerns to increased risk of sexually transmitted infections, to higher rate of vehicle accidents or school expulsion, we see that the difficulties with conduct disorder are wide and varied.
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Let’s dive into the symptoms and criteria of conduct disorder, as well as features and difficulties that can come with the diagnosis.
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But first my name is Keegan. I have a master’s degree in counseling and I’m a Licensed Professional Counselor. I make videos like this to help you better understand psychology, mental health, and the world of counseling.
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According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, conduct disorder is ”
a repetitive and persistent pattern of behavior in which the basic rates of others are major age appropriate societal norms or rules are violated.”
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With conduct disorder, the DSM-5-TR lays out a list of ways that conduct disorder can manifest. They split these criteria or symptoms into four different categories, which we’ll review in this video. As we go through the categories and the criteria themselves, keep in mind that for a diagnosis of conduct disorder, a person must have at least three of these symptoms within the last 12 months, and at least one of those symptoms being within the last six months. With that let’s look at the criteria for conduct disorder.
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As I said, these criteria are broken up into different categories. And the first category of criteria that we’re going to look at is aggression toward people or animals.
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The first criterion is that the person often bullies, threatens, or intimidates others. When we look at the criteria for a diagnosis, it’s important to pay attention to the specific words that are used. In this case, one of the words that stands out to me is the word “often”. Meaning that if somebody has bullied someone once within the last 12 months, they’re probably not checking the box on this criterion because once in a 12 month period isn’t in my mind often. Instead, if they’re doing these things consistently, maybe like once a week, every two weeks, once a month, even—that is more consistent or maybe more often, we would say.
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The second criterion is that they often initiate physical fights. Again, we’re going to want to note the word often here, but we’re also going to want to pay attention to the word initiate. Initiate is an important word here because if they’re often in a physical fight or participating in physical fights, that’s probably not hitting the mark of this criterion.
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Instead, they need to be the one that starts the fight. They need to initiate it. They need to be the one that maybe is instigating the physical fight and getting it started.
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Third is if the client is using a weapon that could cause or causes serious physical harm to another. The weapon could be something like a bat, a brick, a broken bottle, a gun, things like that. Paying attention to how this criterion is written, you’ll notice that this one does not specify that it has to happen often or regularly, like the previous two do.
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Instead, this one seems to be if they’ve done this at any point, even just once within the last 12 months. It also doesn’t necessarily need to be that they use the weapon and did cause serious harm. It may just be that they had a weapon or were using a weapon that could have cause, had the potential to cause serious harm to somebody else.
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The fourth and fifth criteria are that they were physically cruel to people or animals, respectively. These criteria get a little bit tricky because we have to use more of our professional judgment here as the DSM doesn’t necessarily lay out what is considered cruel.
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In a 2002 article, Gleyzer and colleagues defined cruelty toward animals as “a pattern of deliberately, repeatedly, and unnecessarily hurting vertebrate animals in a manner likely to cause serious injury.”
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In my mind, then for these criteria, we’re going to be looking at things that go beyond what might be considered typical bullying, for example, and maybe more aggressive, more dangerous, more severe. Using our professional judgment, we’re going to have to figure out if something fits better into the category of bullying, if it’s something that might be better fitting into the more physical fight sort of a category, or if it’s something that we would consider to be more cruel.
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It’s also important to note that people might have behaviors that fit into all of these categories, that they may have behaviors that are more of the bullying behaviors, and they may also have behaviors that would fit better into this cruelty toward animals or people category.
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The sixth criterion is if the person has stolen from somebody while confronting the victim. The last part there is important because for this criterion, they need to be confronting or in contact with the person that they’re stealing from.
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For example, if they knew that they were breaking into a house and nobody was home and they were stealing, then that would likely not fit into this criterion. Specifically, it would fit better into some of the other ones that we’re going to talk about because if they know that nobody’s home, they know that they’re not going to be confronting the victim.
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However, if they’re doing something like armed robbery, they’re then going to be in contact with the victim, and that would fit into this criterion. Likewise, things like purse snatching or extortion would fit into this category as well.
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Seventh, if the person has forced somebody into sexual activity, that is the next criterion. This criterion may include things like drugging somebody so that they’re unconscious while the sexual assault occurs, or having the victim of the sexual assault be fully conscious during it. Either of those may fit into this category. And so, broadly, we’re looking at if they’re forcing someone else into sexual activity in any way, that is likely going to be checking the box here.
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Those are the seven criteria for the category of aggressive acts toward people and animals. Now we’re going to move on to the second category, which is destruction of property, and in this category we’re only going to be looking at two criteria.
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The first is if the person has intentionally started fires to cause serious damage. Again, looking at the wording here, there’s some important things that we’re going to want to pay attention to. Intentionally would be the first, meaning that they’re starting this fire on purpose and that they know what is likely to come from the fire itself.
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If they start the fire by accident, that’s probably not going to be fitting here for this criterion. We also need to have a good understanding of what they believe. The intent of the fire was—or what was likely to come from the fire—and in that we need to make sure that their intent was to cause serious damage.
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Hopefully looking at some of these different examples and piecing this wording apart has helped you understand what we’re looking for in criterion, like this.
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The second criterion is if the person has intentionally destroyed property in a way other than by fire setting. This might include things like breaking the windows of homes or vehicles, vandalism in general, or other things that may cause the destruction or damage of property.
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With this, I’ll note that in this criterion and all of the others, we want to keep in mind that for people with conduct disorder, or when we’re looking into conduct disorder as a possible diagnosis, we need to be mindful that the person might not readily admit to starting something on fire intentionally, or intentionally destroying property. In those cases, we may need to use our best professional and clinical judgment, and it can be very helpful to get information from other sources as well, and not to rely solely on that person’s view alone.
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But sometimes we have to rely only on that person’s view, and we don’t have other sources of information as well. And so it can be tricky. And it’s something that we need to be aware of as we’re assessing for a diagnosis like conduct disorder.
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The third category includes acts of deceitfulness or theft. The first criterion here is if the person has broken into the home, car, or building of another person. Of course, their intent here needs to be considered. If they broke into the building because they had reason to believe that somebody was in danger inside the building, that’s probably not going to fit here.
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But if they’re doing something like breaking into a building for the thrill of it, that’s probably going to be checking the box for this criterion.
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The second criterion here is if they often lie to obtain goods or favors, or if they lie to avoid obligations. If they are intentionally breaking promises, or are intentionally conning somebody to get out of something or to gain something, those are things that are probably going to be fitting into this criterion.
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Third here is stealing items of non-trivial value without confronting the victim. Earlier we discussed stealing while confronting the victim. In this case, it’s without confronting the victim, and so here they’re going to be doing things that the victim is not involved with. Examples that might be fitting here are shoplifting or forgery.
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Those are the criteria in the category of deceitfulness or theft. The final category that we’re going to look at is serious violations of rules.
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The final category that we’re going to look at is serious violations of rules. The first criterion here is that before the age of 13, the person starts to stay out at night. It’s important to note that this has to be in the context that they have been prohibited from doing this by their parent or guardian. Meaning, that if their parent or guardian has told them that they can stay out at night, that’s probably not going to be fitting into this criterion.
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But, because this is in the category of rule violations, if their parent or guardian has told them specifically that they need to be back home at a certain time and can’t stay out all night, but the person is doing it anyway, that would then be that violation of a rule that is probably going to be fitting into this criterion.
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The second criterion here is if the person has run away from home and has stayed away overnight at least twice, or if they have run away from home and stayed away for a lengthier period of time, at least once, that would also be fitting for this criterion.
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This is another one of those times where the DSM doesn’t really give us a great definition of what lengthy time is, and so we’re going to have to use some professional judgment here. Tthe way that I think about this is if the DSM says that if the person has stayed away at least overnight, at least twice, meaning that they’ve been away from home overnight for at least two days. And so when I think about them staying away for a lengthier amount of time, in my mind, it’s reasonable then to consider a lengthy amount of time to be three or more days because that’s going to be then in excess of the total amount of time that they’ve been away for the first part of this criterion.
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It’s important to note, though, that that’s not necessarily the right way to think about it. And I don’t think it’s necessarily wrong either. It’s just one way that we might think about this. And again, we’re going to have to use our best clinical judgment, nd we may need to consult at times to see what is going to be that lengthy amount of time. Because it’s possible that it’s going to vary to some degree based on the case, the situation, and the circumstances that are surrounding it.
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The final criterion here is if the person is truant from school, beginning before the age of 13. It’s important here to talk about what truancy is. Generally, truancy is when somebody is missing school or skipping school without reason, and that this is happening often, that there is multiple absences that have been occurred in that way. If this is that we have to look at the legal definition of truancy for where we are, because there could be some variability in that, and so that’s important to consider to.
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Just because somebody has a lot of absences, even if those absences are unexcused or that they’re just skipping, that doesn’t necessarily constitute truancy per se. There may need to be that legal part too.
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Okay, so those are the criteria for conduct disorder. In total, we covered four categories and 15 criteria. Remember that of those a person needs to have at least three of the criteria met within a 12 month period, with at least one of those criteria being within the last six months.
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Next we’re going to discuss some of the specifiers that can go along with a conduct disorder diagnosis as well as risk factors for conduct disorder.
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I hope that you found this video helpful. Make sure that while you’re here, you check out some of the other videos on my channel. Thanks for watching and I’ll see you in the next video.
