Depressive and bipolar disorders. Irritability, aggression, and conduct problems can occur in children or adolescents with a major depressive disorder, a bipolar disorder, or disruptive mood dysregulation disorder. The behaviorial problems associated with these mood disorders can usually be distinguished from the pattern of conduct problems seen in conduct disorder based on their course. Specifically, persons with conduct disorder will display substantial levels of aggressive or non-aggressive conduct problems during peri- ods in which there is no mood disturbance, either historically (i.e., a history of conduct problems predating the onset of the mood disturbance) or concurrently (i.e., display of some conduct problems that are premeditated and do not occur during periods of intense emotional arousal). In those cases in which criteria for conduct disorder and a mood dis- order are met, both diagnoses can be given.
Intermittent explosive disorder. Both conduct disorder and intermittent explosive dis- order involve high rates of aggression. However, the aggression in individuals with inter- mittent explosive disorder is limited to impulsive aggression and is not premeditated, and it is not committed in order to achieve some tangible objective (e.g., money, power, intim- idation). Also, the definition of intermittent explosive disorder does not include the non- aggressive symptoms of conduct disorder. If criteria for both disorders are met, the diag- nosis of intermittent explosive disorder should be given only when the recurrent impul- sive aggressive outbursts warrant independent clinical attention.
Adjustment disorders. The diagnosis of an adjustment disorder (with disturbance of con- duct or with mixed disturbance of emotions and conduct) should be considered if clinically significant conduct problems that do not meet the criteria for another specific disorder de- velop in clear association with the onset of a psychosocial stressor and do not resolve within 6 months of the termination of the stressor (or its consequences). Conduct disorder is diag- nosed only when the conduct problems represent a repetitive and persistent pattern that is associated with impairment in social, academic, or occupational functioning.
ADHD and oppositional defiant disorder are both common in individuals with conduct disorder, and this comorbid presentation predicts worse outcomes. Individuals who show the personality features associated with antisocial personality disorder often violate the basic rights of others or violate major age-appropriate societal norms, and as a result their pattern of behavior often meets criteria for conduct disorder. Conduct disorder may also co-occur with one or more of the following mental disorders: specific learning disorder, anxiety disorders, depressive or bipolar disorders, and substance-related disorders. Aca- demic achievement, particularly in reading and other verbal skills, is often below the level expected on the basis of age and intelligence and may justify the additional diagnosis of specific learning disorder or a communication disorder.
476 Disruptive, Impulse—Control, and Conduct Disorders
Criteria and text for antisocial personality disorder can be found in the chapter ”Person- ality Disorders.” Because this disorder is closely connected to the spectrum of ”external- izing” conduct disorders in this chapter, as well as to the disorders in the adjoining chapter ”Substance—Related and Addictive Disorders,” it is dual coded here as well as in the chap- ter ”Personality Disorders.”
Diagnostic Criteria 312.33 (F63.1)
A. Deliberate and purposeful fire setting on more than one occasion.
B. Tension or affective arousal before the act.
C. Fascination with, interest in, curiosity about. or attraction to fire and its situational con- texts (e.g., paraphernalia, uses, consequences).
D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.