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


METHODS
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.
Wakefield
Jerome C
JC
School of Social Work and Institute of Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA. jcw2@columbia.edu
Pottick
Kathleen J
KJ
Kirk
Stuart A
SA
D000293:Adolescent; D002648:Child; D002983:Clinical Competence; D019955:Conduct Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011586:Psychology, Clinical; D011594:Psychometrics; D015203:Reproducibility of Results; D012931:Social Environment; D012949:Social Work, Psychiatric; D011795:Surveys and Questionnaires; D009626:Terminology as Topic