Table 17, DSM-IV to DSM-5 Conduct Disorder Comparison - DSM-5 Changes

DSM-IV: Conduct Disorder	DSM-5: Conduct Disorder
Disorder Class: Attention deficit and disruptive behavior disorders	Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

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 three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:	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 three (or more) 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	Aggression to people and animals
1. often bullies, threatens, or intimidates others	1. SAME
2. often initiates physical fights	2. SAME
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)	3. SAME
4. has been physically cruel to people	4. SAME
5. has been physically cruel to animals	5. SAME
6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)	6. SAME
7. has forced someone into sexual activity	7. SAME
Destruction of property	Destruction of property
8 has deliberately engaged in fire setting with the intention of causing serious damage	8. SAME
9. has deliberately destroyed others’ property (other than by fire setting)	9. SAME
Deceitfulness or theft	Deceitfulness or theft
10. has broken into someone else’s house, building, or car	10. SAME
11. often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)	11. SAME
12. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)	12. SAME
Serious violations of rules	Serious violations of rules
13. often stays out at night despite parental prohibitions, beginning before age 13 years	13. SAME
14. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)	14. SAME
15. is often truant from school, beginning before age 13 years	15. SAME

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

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.	C. SAME

Code based on age at onset: 312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years 312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years 312.89 Conduct Disorder, Unspecified Onset: age at onset is not known	Specify whether: 312.81 (F91.1) Conduct Disorder, Childhood-Onset Type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years 312.82 (F91.2) Conduct Disorder, Adolescent-Onset Type: Individuals show now symptom characteristic of conduct disorder prior to age 10 years 312.89 (F91.9) Conduct Disorder, Unspecified Onset: Criteria for a diagnosis or conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

N/A	Specify if: With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and setting. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, coworkers, extended family members, peers). Lack of remorse or guilt: Does not feel bad or guilty when he/she does something wrong (excluding 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, 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).

Specify severity: Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others Moderate: number of conduct problems and effect on others intermediate between “mild” and “severe” Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others	Specify current severity: Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking). Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism). Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

DSM-IV: Conduct Disorder

DSM-5: Conduct Disorder

Disorder Class: Attention deficit and disruptive behavior disorders

Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

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 three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

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 three (or more) 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

1. often bullies, threatens, or intimidates others

1. SAME

2. often initiates physical fights

2. SAME

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

3. SAME

4. has been physically cruel to people

4. SAME

5. has been physically cruel to animals

5. SAME

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

6. SAME

7. has forced someone into sexual activity

7. SAME

Destruction of property

8 has deliberately engaged in fire setting with the intention of causing serious damage

8. SAME

9. has deliberately destroyed others’ property (other than by fire setting)

9. SAME

Deceitfulness or theft

10. has broken into someone else’s house, building, or car

10. SAME

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

11. SAME

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

12. SAME

Serious violations of rules

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

13. SAME

14. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)

14. SAME

15. is often truant from school, beginning before age 13 years

15. SAME

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

B. SAME

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

C. SAME

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years
312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years
312.89 Conduct Disorder, Unspecified Onset: age at onset is not known

Specify whether:

312.81 (F91.1) Conduct Disorder, Childhood-Onset Type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years
312.82 (F91.2) Conduct Disorder, Adolescent-Onset Type: Individuals show now symptom characteristic of conduct disorder prior to age 10 years
312.89 (F91.9) Conduct Disorder, Unspecified Onset: Criteria for a diagnosis or conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

N/A

Specify if:

With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and setting. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, coworkers, extended family members, peers).
Lack of remorse or guilt: Does not feel bad or guilty when he/she does something wrong (excluding 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, 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).

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others
Moderate: number of conduct problems and effect on others intermediate between “mild” and “severe”
Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Specify current severity:

Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking).
Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

From: 3, DSM-5 Child Mental Disorder Classification

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DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].

Table 17DSM-IV to DSM-5 Conduct Disorder Comparison

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