Should the DSM-IV Diagnostic Criteria for Conduct Disorder Consider Social Context?

• Published in: The American journal of psychiatry Vol. 159; no. 3; pp. 380 - 386
• Main Authors: Wakefield, Jerome C., Pottick, Kathleen J., Kirk, Stuart A.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01-03-2002; American Psychiatric Association
• Subjects: Adolescent; Behavior disorders; Biological and medical sciences; Child; Children & youth; Clinical Competence; Conduct disorder; Conduct Disorder - classification; Conduct Disorder - diagnosis; Conduct Disorder - psychology; Conduct disorders; Diagnostic and Statistical Manual IV; False Positive Reactions; Female; Humans; Judgment; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - psychology; Nosology. Terminology. Diagnostic criteria; Psychiatric Status Rating Scales - statistics & numerical data; Psychology; Psychology, Clinical; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Reproducibility of Results; Social context; Social Environment; Social work; Social Work, Psychiatric; Surveys and Questionnaires; Techniques and methods; Terminology as Topic; Social environment; Human; Psychology; Conduct disorder; Nosology; Experimental study; Student; Recommendation; Symptomatology; Validity; Need; Treatment; Criterion; Social work; Classification; Diagnosis; Diagnostic and Statistical Manual IV; Social behavior disorder; Comparative study; Judgment
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.159.3.380

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.