DSM-IV conduct disorder criteria as predictors of antisocial personality disorder

Conduct disorder (CD) is a disorder of childhood and adolescence defined by rule-breaking, aggressive, and destructive behaviors. For some individuals, CD signals the beginning of a lifelong persistent pattern of antisocial behavior (antisocial personality disorder [ASPD]), whereas for other people, these behaviors either desist or persist at a subclinical level. It has generally been accepted that about 40% of individuals with CD persist. This study examined the rate of persistence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) CD into ASPD and the utility of individual DSM-IV CD symptom criteria for predicting this progression. We used the nationally representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Approximately 75% of those with CD also met criteria for ASPD. Individual CD criteria differentially predicted severity and persistence of antisocial behavior with victim-oriented, aggressive behaviors generally being more predictive of persistence. Contrary to previous estimates, progression from CD to ASPD was the norm and not the exception in this sample. Relationships between individual DSM-IV CD symptom criteria and persistent antisocial outcomes are discussed. These findings may be relevant to the development of DSM-V.