Conduct Disorder - A Precursor to Borderline or Antisocial Personality Disorder?

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What is Conduct Disorder?


CD (Conduct Disorder) and ODD (Oppositional Defiant Disorder) are quite closely associated in classification and developmental terms. Oppositional Defiant Disorder behaviours are assumed to be precursors to a more serious Conduct Disorder; although this is not a proven hypothesis. In some studies however, a figure of an 80% chance of a conduct disorder developing in young adulthood has been quoted.

Some young people with CD may have a slightly lower IQ than the norm. There may also be differences in the structure and function of the brain and a reduction of certain chemicals such as serotonin and cortisol. An excellent book - Adolescent Forensic Psychiatry by Susan Bailey (FRCPsych.) which covers the subject and would be useful to parents and also professionals working in looked after children settings.

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Signs and Symptoms of Conduct Disorder in the young adult


Aggression

  • Fighting
  • Bullying
  • Instances of aggravated assault (stealing from a person whilst confronting them)
  • Usage of weapons
  • Physical cruelty
  • Rape
  • Cruelty to animals


Deceitfulness

  • Lying
  • Stealing or Shoplifting
  • Breaking and entering

Destruction of Property

  • Smashing up other people’s property
  • Deliberate setting of fires

Rule Breaking

  • Truanting
  • Running away from home
  • Staying out late or all night
  • Disappearing for days at a time
  • Smoking
  • Drug and alcohol abuse
  • Risky or unprotected sex

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How is diagnosis made?


The child must have exhibited at least 3 of the above behaviours in the last 12 months; at least one of them being in the last 6 months.The transgressions of truancy and staying out all night have generally taken place before the age of 13 years. There are three levels of severity of Conduct Disorder, mild, moderate and severe.

Problems Conduct Disorder can cause


A young person who suffers with a conduct disorder rarely trusts anyone in a position of authority; this can make persuading them to have treatment very difficult and even impossible in some cases. They will be inherently suspicious of doctors, psychiatrists, psychologists, behavioural experts, etc., etc.

There are usually legal implications for the adolescent or young adult who steals, destroys or damages the property of others or threatens and harms animals and other people. Many sufferers of ODD will land up at the very least in court; some of these will go to goal.

Because of the regular outbursts of temper and aggression, making and keeping friends will be difficult. This can also cause problems in adulthood if the disorder has not been treated, which will manifest as a string of broken relationships.

School work is likely to suffer as most young people suffering from CD do not regularly attend school or college. Failure to attend can be costly for parents as many LEA’s (Local Education Authorities) fine parents for the truancy of their offspring. Lack of qualifications obtained at school or college will prevent the young person reaching their full potential and may mean that they do not get work. In the event that they do manage to secure employment, this is likely to be short-lived due to their angry and aggressive outbursts.

There are differences in the behaviours of boys and girls with the disorder. Girls will be more likely to be promiscuous and engage in activities such as prostitution; they will often run away to do this. Boys are more likely to steal, damage property, set fires and be violent and aggressive than girls. Both sexes are equally likely to engage in drug and alcohol abuse.

Youngsters with Conduct Disorder frequently threaten suicide; do not ignore these threats, they must be taken seriously.

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Treatments for CD


Treatments depend on the severity of the disorder. Mild cases with not many symptoms my respond to just one treatment. Severe cases with many symptoms may need a combination of therapies along with medication. Some treatments offered are:

  • Educational mentoring and support
  • Cognitive Behavioural Therapy
  • Role Play
  • Family Therapy including parental counselling
  • Psychotherapy
  • Anger Management
  • Medication

Conduct disorder is not preventable but if diagnosed early can be managed with early diagnosis and intervention. If left unmanaged and untreated the young adult can go on to develop a more serious personality disorder such as Antisocial Personality Disorder or Borderline Personality Disorder

It should be noted as well that there are also some similarities to Bipolar Disorder and it is believed by some that Conduct Disorder may be a component of Bipolar in children.

©Susan Bailey 2013 All Rights Reserved

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