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 the specifiers and risk factors for Conduct Disorder.

Conduct Disorder Specifiers

As a reminder, many diagnoses have specifiers. Specifiers are a way to note aspects of a diagnosis that might be relevant. For Conduct Disorder, we can break the specifiers up into three categories—onset, limited prosocial emotions, and severity. Below we’ll look at the specifiers that the DSM-5-TR contains for Conduct Disorder.

Onset Specifiers
There are three specifiers for Conduct Disorder that are related to onset. First is childhood onset. For childhood onset, the client would show at least one criterion for conduct disorder before the age of 10.

Second is adolescent onset. In this case, the client would have displayed no symptoms of conduct disorder before the age of 10, and symptoms would have appeared after this age.

Finally, there is an unspecified onset specifier. This is for situations where it isn’t clear when symptoms began to appear. In other words, it can’t be easily or clearly determined if symptoms appeared during childhood or adolescence.

Limited Prosocial Emotions Specifier
In the case of the limited prosocial emotions specifier, we have to look for a variety of characteristics that are considered less prosocial. Specifically, we are looking for a lack of remorse or guilt, a lack of empathy, the client being unconcerned with their performance (such as in school), or a shallow/deficient affect. With a shallow/deficient affect, this means that they do not express or show emotions, or do so in an insincere or superficial manner.

For a limited prosocial emotions specifier, the client would need to have at least two of these characteristics in the 12-month period.

Severity Specifiers
The last area of specifiers is for severity. Here, the severity of the conduct disorder can be rated mild, moderate, or severe.

Mild severity is when the client has very few, if any, additional criteria they meet beyond the minimum for the diagnosis.
Moderate severity is when the number of criteria that are met are more than the few needed for the diagnosis, but not an amount that might be deemed severe. Being that the severity criteria are not well-defined, I have included the way that I often think about this. You can find that info below.
The severe specifier then is when the criteria that are met are in excess of what is needed for a diagnosis, or if the client is causing harm to others.

Determining Severity

As I mentioned, the DSM-5-TR does not clearly lay out the number of symptoms needed for the three levels of severity. Below is a way that I think about this as it helps me be more consistent.

Mild severity: 3–5 symptoms (less than three symptoms would not meet the criteria for Conduct Disorder)
Moderate severity: 6–10 symptoms
Severe severity: 11–15 symptoms, or the symptoms met include harm to others.

This isn’t necessarily the “right” way to do this, but just a way that I think about it.

Conduct Disorder Risk Factors

For Conduct Disorder, there are multiple things that can increase risk. However, nothing for sure seems to cause Conduct Disorder. It is important to know that even if someone has experienced one or more risk factors, that does not mean they will form a conduct disorder.

Temperament as an infant that that is not well controlled
Temperament as infant was not well-controlled
Lower-than-average intelligence
Rejection from parents
Neglect
Inconsistent parenting or child-rearing
Harsh discipline methods
Physical or sexual abuse
Lack of supervision
Being institutionalized earlier in life
Large families
Criminal behavior by parents
Having parents with substance use disorders
Having a biological parent with a conduct disorder—meaning genetic factors
A biological parent having an alcohol use disorder, depressive disorder, bipolar disorder, or schizophrenia, or ADHD

Keep in mind that this is not a complete list, but hopefully it does help demonstrate that there is a wide variety of factors that can increase risk for Conduct Disorder. Again, someone having experienced one or more of these risk factors certainly does not mean they will develop a Conduct Disorder. Instead, it simply means that there is a greater likelihood that they could.

On the other hand, it is important to note that someone could develop a Conduct Disorder without having experienced any of these risk factors.