(calm piano music)
- Hey everybody, today we're gonna talk about
Conduct Disorder: what is it and how can we
best manage it, but before we jump into that,
are you new to my channel?
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turned on so that you don't miss out,
but let's jump into today's topic.
Now, Conduct Disorder is part of the disruptive
impulse control and conduct disorder section within the DSM,
and as always, I know the DSM isn't the end-all, be-all,
but I think it's really helpful to note
what category a mental disorder is within it
because it can give us an idea of other diagnoses
that may be similar and possibly help us to be better
informed so that we are properly diagnosed.
Other diagnoses that are within this same category
are Oppositional Defiant Disorder, which I have
a video on it if you wanna watch more or learn more
I'll link it in the description; Intermittent
Explosive Disorder; Antisocial Personality Disorder,
I have a video on that I'll link down there as well;
Pyromania; and Kleptomania.
And these conditions involve problems in the self-control
of emotions and behaviors, that's how they describe it
in the DSM, and I know based on that short description,
many of you are already thinking that that sounds
a lot like other diagnoses such as BPD or ADHD.
But these are different, because the behaviors
that we're talking about aren't just getting upset
or mad at someone in our lives or even being
emotionally volatile in relationships.
That's not what we're talking about.
These behaviors violate the rights of others.
For instance, like being really physically aggressive
to someone, hurting someone, or destroying their property,
so it's violating their rights.
Do you see how that's different?
And when diagnosing something like Conduct Disorder,
it's important that the mental health professional
consider the person's age, gender, and culture
because we all know that we can act differently
depending on those very important factors.
Okay, enough about all of that.
Let's get into Conduct Disorder itself
and how it is diagnosed.
Now someone with Conduct Disorder must have:
a repetitive and persistent pattern of behaviors
in which the basic rights of others or major
age-appropriate societal norms or rules are violated.
I know that's a mouthful, but just stay with me.
As manifested by the presence of at least three
of the following 15 criteria, and it has to have happened
in the past 12 months, so they have to meet
at least three of these things in the past 12 months,
and with at least one criterion present
in the past six months.
So let's get through these 15 criteria, okay?
Number one is they will often bully or threaten
and intimidate others.
Number two, often initiating physical fights.
Number three, has used a weapon that can cause
serious physical harm to others, for example
like a bat, a brick, broken bottle, a knife,
a gun, even a car.
Number four, has been physically cruel to people.
Number five, has been physically cruel to animals.
Number six, has stolen while confronting a victim,
and that really means just like mugging someone
or snatching someone's purse, or maybe armed robbery.
Number seven, has forced someone into sexual activity.
Number eight, has deliberately engaged in fire setting
with the intention of causing serious damage.
Number nine, has deliberately destroyed others' property,
other than fire setting.
Number 10, has broken into someone else's house,
building, or car.
Number 11, often lies to obtain goods or favors
or to avoid obligations, so in other words
they're conning people so that they can get something
they want or get out of something they don't wanna do.
Number 12, has stolen items of value without confronting
a victim, like shoplifting, like they're stuffing things
in their bag and they're walking out
so they don't actually have to engage with anybody,
but they're still stealing items of value.
Number 13, often stays out at night despite their parents
not allowing it.
Number 14, has run away from home overnight at least twice
while living in their parents' house,
or once without returning for a lengthy period of time.
And finally number 15, often skips school,
beginning before 13 years of age.
Now I know that's a lot, it's a lot for me to even say,
but remember that we must meet at least three
of these criteria in the last year, and at least one
within the last six months.
And we also within the diagnostic criteria,
so we've gone through all of that, we also
when diagnosing this have to specify whether these symptoms
were present before or after the age of 10.
And if we have limited prosocial emotions or not,
and what that really means is that our typical way
of engaging with those around us needs to be assessed
over time with many sources of information
like they have to assess us and what we say
is going on, they have to talk to our parents
and see what they have to say and our teachers
and our friends and so on.
And in order to be specified as having
limited prosocial emotions, we must meet at least
two of the next four criteria, and the first is
lack of remorse or guilt, so we can do terrible things,
we really just don't even feel bad about it.
Number two, we can be really callous,
having a lack of empathy, meaning we're completely
unconcerned or disregard the feelings of others.
Number three, we're unconcerned about performance,
so don't really care how we're doing in school
or at work and we'll often even blame others
for our poor performance.
And number four, shallow or deficient affect,
which really means that we just don't express feelings
or show our emotions to others in any way
other than what can be perceived as shallow or insincere.
Now it's important to know that most people
with Conduct Disorder do not meet the criteria
for the limited prosocial emotion specifier.
But those of us who develop this mental illness
prior to the age of 10 are much more likely
to have that specifier.
Just like everything in mental health,
if we are diagnosed at a younger age and exhibit
those symptoms, it means that we have a longer period
in our life where we have to manage it and so
if we don't get help, it can get worse
and be kind of like the most severe form
of that disorder.
And so as always, everyone is different,
and it's also important to note that aggressive individuals
with Conduct Disorder frequently misperceive
the intentions of others as more hostile
and threatening than is the case, and therefore
they'll respond with aggression that they then feel
is reasonable and justified when it really isn't.
And finally, conduct disorder can be a precursor
to Antisocial Personality Disorder.
A lot of times when we're diagnosing
Antisocial Personality Disorder they will ask
if they previously, if this patient previously
was diagnosed with CD or not, and they'll take that
into consideration when making the diagnosis.
But you may be wondering, so how common is Conduct Disorder?
Well we know statistically speaking
that it is most common in boys, and we find it
affects two to 16% of children.
Yes, I know that's a huge range, but they estimate
it's probably around the four percent range,
but since most people with Conduct Disorder
don't get diagnosed and treated, it's really hard
for them to get a clear and research-supported number.
And now, let's answer the question like, so why
can this happen, why can someone struggle
with Conduct Disorder?
Well like most mental illnesses, we don't really know why.
But we do have some research that shows
that it can be due to an abusive upbringing,
whether it be neglect, sexual abuse, emotional,
or physical abuse.
Or it could be due to the temperament of the child,
meaning that the parents did what they could,
they were there for their child, supporting
and doing everything they knew to do, but the child
was just constantly upset and could never
be controlled or soothed.
This could even be related to lower IQ, they find,
and of course there is the genetic component as well.
If a biological parent has Conduct Disorder,
we are more likely to have it too, along with
all sorts of mental illnesses.
We find if we had that close, familial link,
we're more predisposed.
And they also find that children whose parents
were alcoholics, had schizophrenia, or bipolar disorder
are again, at a higher risk, but that's just
genetically speaking, it doesn't mean that we're 100%
going to get it, it usually means it increases our risk
from say four percent of the population
like I talked about to like 20%.
And finally, they also find that those
with Conduct Disorder have a difference
in their brain structure.
This could be due to development and genetics,
but also injury to the brain.
They find that there are functional differences
in the areas of the brain associated with affect regulation
and processing, which really just means like
how you process how you feel and express that to others.
There are also marked differences with how
their amygdala works.
You remember what the amygdala is?
We call it that little, it's like a kidney-shaped area,
little bean-type area in our brain
we call the fire alarm, and it's responsible
for the perception of emotions such as anger, fear,
and sadness, as well as the controlling of aggression,
and so you can see how marked differences in this area
could lead someone to acting in ways that we heard
through that 15 criteria, right?
Now obviously these brain differences are not
used to diagnose, just because we have differences
in our brain does not mean we have Conduct Disorder,
but it has found some differences between people's brains
who had Conduct Disorder versus people's brains
who didn't, and I just kinda thought
it was worth mentioning.
Now, most importantly, let's get into treatment options,
and overcoming Conduct Disorder is difficult,
but it's not hopeless, and with the support of family,
teachers, and friends, it can be managed.
And I also recognize that most of us with Conduct Disorder
aren't going to seek out help, 'cause it doesn't
tend to bother us as much as it does those around us,
and so it was really, really hard for me to find
a lot of research-based treatment options,
but here are the few that I found.
Number one, CBT or cognitive behavioral therapy.
Now because CBT has the behavioral component to it as well,
it can help us figure out where our beliefs
about a situation may have gone off track.
Remember earlier when I said that those
with Conduct Disorder will perceive someone's slight
to us as a much bigger, more aggressive thing
than it may have been, and then will act out accordingly?
CBT can help us understand that, track that,
and notice when our perception may be just really off-base.
So CBT can be really helpful and beneficial,
but just like any treatment, we have to want
to work on it and change, and not everyone
with conduct disorder is going to want to.
We all know treatment and getting better and recovery
is like really, really hard and so we have to be willing
to put in the effort.
Number two, parent training, where parents are taught
how to reward positive behaviors and how to manage
the negative ones.
Since a child with Conduct Disorder will spend
most of their time at home or school, I believe
this treatment to be vital to someone's recovery.
Some areas even offer what's called PMT
or parent management training specifically for parents
of children with these types of issues.
And number three, anger management classes.
These sorts of classes can help us learn
the early signs of our anger and work with us
to come up with other, more healthy ways
to express and vent that anger.
Maybe we need to go kick a soccer ball
into that cement wall, maybe we need to scream
into a pillow, maybe we need to take a kickboxing class,
whatever it can be, it's really great for us
to have other ways to vent all the upset we may feel.
Next, IEPs and 504s.
The school needs to be onboard and understand
what's going on and how to help.
Overall, we want every situation that we could be in
to be helpful and supportive so we can best manage
our symptoms and urges with just so much more ease.
And I keep mentioning child-like tools
because this is usually diagnosed around the age of 10,
and since it can be a precursor for Antisocial
Personality Disorder, many who have CD as children,
when they turn 18, they can meet the diagnostic criteria
for Antisocial Personality Disorder and move into that,
and so that's why a lot of the treatment around
Conduct Disorder is focused on children.
And also, medication.
While no medication is approved for the treatment
of Conduct Disorder, many doctors use some medications
off-label, meaning it's not intended for that use
but they'll use it to help you treat some of the symptoms
that can come along with it.
These medications are things like SSRIs or SNRIs,
otherwise known as antidepressants, as well as
antipsychotic medication, but as always,
please speak to a medical doctor before deciding
if a medication is right for you or your child.
I've talked about this in the past, but a therapist
should never recommend a medication for you,
we're not medical doctors.
Doctors go to school to learn how medications
can interact with our bodies and they have
such a wider breadth of knowledge, and I just have to say
that because some therapists will say,
go to your doctor and ask for X, Y, or Z.
That's not okay.
Only a medical doctor can do that, like a psychiatrist
or your general doctor you see when you're sick.
I hope you found the information helpful.
I know there are so many misconceptions
and just misinformation out there,
and I just wanted to ensure that we are all
properly informed, but as always, if you think
I left something out or you wanna add in
your own personal experience, please leave it
in the comments down below, I will see you next time, bye!