|The ICD-10 Classification of Mental and Behavioural
World Health Organization, Geneva, 1992
Conduct disorders are characterized by a repetitive and
persistent pattern of dissocial, aggressive, or defiant conduct.
Such behaviour, when at its most extreme for the individual,
should amount to major violations of age-appropriate social
expectations, and is therefore more severe than ordinary childish
mischief or adolescent rebelliousness. Isolated dissocial or
criminal acts are not in themselves grounds for the diagnosis,
which implies an enduring pattern of behaviour.
Features of conduct disorder can also be symptomatic of other
psychiatric conditions, in which case the underlying diagnosis
should be coded.
Disorders of conduct may in some cases proceed to dissocial
personality disorder (F60.2). Conduct disorder is frequently
associated with adverse psychosocial environments, including
unsatisfactory family relationships and failure at school, and is
more commonly noted in boys. Its distinction from emotional
disorder is well validated; its separation from hyperactivity is
less clear and there is often overlap.
Judgements concerning the presence of conduct disorder should
take into account the child's developmental level. Temper
tantrums, for example, are a normal part of a 3-year-old's
development and their mere presence would not be grounds for
diagnosis. Equally, the violation of other people's civic rights
(as by violent crime) is not within the capacity of most
7-year-olds and so is not a necessary diagnostic criterion for
that age group.
Examples of the behaviours on which the diagnosis is based
include the following: excessive levels of fighting or bullying;
cruelty to animals or other people; severe destructiveness to
property; firesetting; stealing; repeated lying; truancy from
school and running away from home; unusually frequent and severe
temper tantrums; defiant provocative behaviour; and persistent
severe disobedience. Any one of these categories, if marked, is
sufficient for the diagnosis, but isolated dissocial acts are not.
Exclusion criteria include uncommon but serious underlying
conditions such as schizophrenia, mania, pervasive developmental
disorder, hyperkinetic disorder, and depression.
This diagnosis is not recommended unless the duration of the
behaviour described above has been 6 months or longer.
Differential diagnosis. Conduct disorder overlaps with
other conditions. The coexistence of emotional disorders of
childhood (F93.-) should lead to a diagnosis of mixed disorder of
conduct and emotions (F92.-). If a case also meets the criteria
for hyperkinetic disorder (F90.-), that condition should be
diagnosed instead. However, milder or more situation-specific
levels of overactivity and inattentiveness are common in children
with conduct disorder, as are low self-esteem and minor emotional
upsets; neither excludes the diagnosis.
* conduct disorders associated with emotional disorders (F92.-) or
hyperkinetic disorders (F90.-)
* mood [affective] disorders (F30-F39)
* pervasive developmental disorders (F84.-)
* schizophrenia (F20.-)
This category comprises conduct disorders involving dissocial
or aggressive behaviour (and not merely oppositional, defiant,
disruptive behaviour) in which the abnormal behaviour is entirely,
or almost entirely, confined to the home and/or to interactions
with members of the nuclear family or immediate household. The
disorder requires that the overall criteria for F91 be met; even
severely disturbed parent - child relationships are not of
themselves sufficient for diagnosis. There may be stealing from
the home, often specifically focused on the money or possessions
of one or two particular individuals. This may be accompanied by
deliberately destructive behaviour, again often focused on
specific family members—such as breaking of toys or ornaments,
tearing of clothes, carving on furniture, or destruction of prized
possessions. Violence against family members (but not others) and
deliberate fire-setting confined to the home are also grounds for
Diagnosis requires that there be no significant conduct
disturbance outside the family setting and that the child's social
relationships outside the family be within the normal range.
In most cases these family-specific conduct disorders will have
arisen in the context of some form of marked disturbance in the
child's relationship with one or more members of the nuclear
family. In some cases, for example, the disorder may have arisen
in relation to conflict with a newly arrived step-parent. The
nosological validity of this category remains uncertain, but it is
possible that these highly situation-specific conduct disorders do
not carry the generally poor prognosis associated with pervasive
This type of conduct disorder is characterized by the
combination of persistent dissocial or aggressive behaviour
(meeting the overall criteria for F91 and not merely comprising
oppositional, defiant, disruptive behaviour), with a significant
pervasive abnormality in the individual's relationships with other
The lack of effective integration into a peer group constitutes
the key distinction from "socialized" conduct disorders
and this has precedence over all other differentiations. Disturbed
peer relationships are evidenced chiefly by isolation from and/or
rejection by or unpopularity with other children, and by a lack of
close friends or of lasting empathic, reciprocal relationships
with others in the same age group. Relationships with adults tend
to be marked by discord, hostility, and resentment. Good
relationships with adults can occur (although usually they lack a
close, confiding quality) and, if present, do not rule out the
diagnosis. Frequently, but not always, there is some associated
emotional disturbance (but, if this is of a degree sufficient to
meet the criteria of a mixed disorder, the code F92.- should be
Offending is characteristically (but not necessarily) solitary.
Typical behaviours comprise: bullying, excessive fighting, and (in
older children) extortion or violent assault; excessive levels of
disobedience, rudeness, uncooperativeness, and resistance to
authority; severe temper tantrums and uncontrolled rages;
destructiveness to property, fire-setting, and cruelty to animals
and other children. Some isolated children, however, become
involved in group offending. The nature of the offence is
therefore less important in making the diagnosis than the quality
of personal relationships.
The disorder is usually pervasive across situations but it may
be most evident at school; specificity to situations other than
the home is compatible with the diagnosis.
* conduct disorder, solitary aggressive type
* unsocialized aggressive disorder
This category applies to conduct disorders involving persistent
dissocial or aggressive behaviour (meeting the overall criteria
for F91 and not merely comprising oppositional, defiant,
disruptive behaviour) occurring in individuals who are generally
well integrated into their peer group.
The key differentiating feature is the presence of adequate,
lasting friendships with others of roughly the same age. Often,
but not always, the peer group will consist of other youngsters
involved in delinquent or dissocial activities (in which case the
child's socially unacceptable conduct may well be approved by the
peer group and regulated by the subculture to which it belongs).
However, this is not a necessary requirement for the diagnosis:
the child may form part of a nondelinquent peer group with his or
her dissocial behaviour taking place outside this context. If the
dissocial behaviour involves bullying in particular, there may be
disturbed relationships with victims or some other children.
Again, this does not invalidate the diagnosis provided that the
child has some peer group to which he or she is loyal and which
involves lasting friendships.
Relationships with adults in authority tend to be poor but
there may be good relationships with others. Emotional
disturbances are usually minimal. The conduct disturbance may or
may not include the family setting but if it is confined to the
home the diagnosis is excluded. Often the disorder is most evident
outside the family context and specificity to the school (or other
extrafamilial setting) is compatible with the diagnosis.
* conduct disorder, group type
* group delinquency
* offences in the context of gang membership
* stealing in company with others
* truancy from school
* gang activity without manifest psychiatric disorder (Z03.2)
ICD-10 copyright © 1992 by World
AZ Psychiatry copyright
by Dr. Manaan Kar Ray