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Am J Psychiatry. 2002 Mar;159(3):380-6.

Should the DSM-IV diagnostic criteria for conduct disorder consider social context?

Author information

1
School of Social Work and Institute of Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA. jcw2@columbia.edu

Abstract

OBJECTIVE:

The text of the DSM-IV states that a diagnosis of conduct disorder should be made only if symptoms are caused by an internal psychological dysfunction and not if symptoms are a reaction to a negative environment. However, the DSM-IV diagnostic criteria are purely behavioral and ignore this exclusion. This study empirically evaluated which approach--the text's negative-environment exclusion or the purely behavioral criteria--is more consistent with clinicians' intuitive judgments about whether a disorder is present, whether professional help is needed, and whether the problem is likely to continue.

METHOD:

Clinically experienced psychology and social work graduate students were presented with three variations of vignettes describing youths whose behavior satisfied the DSM-IV criteria for conduct disorder. The three variations presented symptoms only, symptoms caused by internal dysfunction, and symptoms caused by reactions to a negative environment. The clinicians rated their level of agreement that the youth described in the vignette had a disorder, needed professional mental health help, and had a problem that was likely to continue into adulthood.

RESULTS:

Youths with symptoms caused by internal dysfunction were judged to have a disorder, and those with a reaction to a negative environment not to have a disorder. The difference was not explained by the clinicians' judgments of the youths' need for professional help or the expected duration of symptoms.

CONCLUSIONS:

The clinicians' judgments supported the validity of the DSM-IV's textual claim that a diagnosis of conduct disorder is valid only when symptoms are due to an internal dysfunction.

Comment in

PMID:
11870000
DOI:
10.1176/appi.ajp.159.3.380
[Indexed for MEDLINE]

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