Criteria for dissocial disorder

He Dissocial disorder (according to the DSM-IV) with the publication of the DSM-5 has become called Disorder of behavior. It refers to the recurring presence of distorted, destructive and negative behaviors, in addition to transgressive social norms, in the individual's behavior.

1. Criteria for dissocial disorder
2. Associated symptoms and disorders
3. Symptoms dependent on culture, age and sex

Criteria for dissocial disorder

A repetitive and persistent pattern of behavior in which the basic rights of other people or social norms of age are violated, manifesting itself by the presence of three (or more) of the following criteria during the last 12 months and at least of a criterion during the last 6 months:

Aggression to people and animals

• What a fanfarea, threatens or intimidates others
• Often begins physical fights
• has used a weapon that can cause serious physical damage to other people (P. eg., bat, brick, broken bottle, knife, gun)
• has expressed physical cruelty with people
• He has expressed physical cruelty with animals
• He has stolen facing the victim (P. eg., Attack with violence, snatching bags, extortion, armed robbery)
• He has forced someone to a sexual activity

Property destruction

• has deliberately caused fires with the intention of causing serious damage
• has deliberately destroyed other people's properties (different from provoking fires)

Fraudulence or robbery

• has violated the home, house or car of another person
• He often lies to obtain goods or favors or to avoid obligations (that is, "Tima" to others)
• He has stolen objects of a certain value without confrontation with the victim (P. eg., robberies in stores, but without raids or damage; falsifications)

Serious standards

• He often remains out of night despite paternal prohibitions, starting this behavior before the age of 13
• He has escaped from home at least twice, living in his parents' house or in a substitute home (or only once without returning for a long period of time)
• He usually makes steers at school, starting this practice before the age of 13

B. Dissocial disorder causes clinically significant deterioration of social, academic or work activity.

C. If the individual has 18 years or more, does not meet personality antisocial disorder criteria.

Specify the type based on the start age:

Children's starting type: at least one of the characteristics criteria of dissocial disorder is initiated before 10 years of age

Adolescent Start Type: Absence of any characteristic Dissocial Disorder Criteria before 10 years of age

Specify gravity:

Mild: Few or no behavior problem exceeds those required to establish diagnosis and behavioral problems only cause minimal damage to other

Moderate: The number of behavioral problems and their effect on other people are intermediate between "mild" and "serious"

Serious: various behavioral problems exceed those required to establish diagnosis or behavioral problems cause considerable damage to other.

The essential characteristic of the Social Di Disorder is a pattern of persistent and repetitive behavior in which the basic rights of the other or important social norms appropriate to the age of the subject are violated (Criteria a). These behaviors are divided into four groups: aggressive behavior that causes physical damage or threats to other people or animals (criteria A1-A 7), non-aggressive behavior that causes losses or damage to property (criteria A8 A9), fraud or fraud or robberies (criteria A1O-A12) and serious violations of the norms (criteria A13-A15). Three (or more) characteristic behaviors must have appeared during the last 12 months and at least one behavior will have occurred during the last 6 months. Behavioral disorder causes clinically significant deterioration of social, academic or work activity (criteria B). Dissocial disorder can be diagnosed in individuals over 18, but only if the personality antisocial disorder criteria (Criteria C) are met (Criteria C). The behavior pattern usually occurs in different contexts such as home, school or community. Since subjects with dissocial disorder tend to minimize their behavioral problems, the clinician must often see other informants. However, the knowledge that the informant has of the child's behavioral problems can be limited by inappropriate supervision or because the child has not revealed them.

Children or adolescents with this disorder usually begin aggressive behaviors and react aggressively to others. They can display fanfare behavior, threatening or intimidating (criteria al); start frequent physical fights (criteria A2); Use a weapon that can cause severe physical damage (P. eg., bat, brick, broken bottle, razor, or gun) (criteria A3); be cruel physically with people (A4 criteria) or animals (criteria A5); steal facing a victim (P.eg., Attack with violence, snatching bags, extortion or armed robbery) (criteria A6); or force another to a sexual activity (criteria A7). Physical violence can adopt the form of rape, assault or, in rare cases, homicide.

Deliberate destruction of other people's property is a characteristic fact of this disorder and may include deliberately setting fire with the intention of causing serious damage (A8 criteria) or deliberately destroying the property of other people of different ways (P. eg., Break car glass, vandalism in school) (Criteria A9).

Fraud or robberies are frequent and may include violating the floor, the house, or the car of another person (criteria A1o); Often subjects lie or break promises in order to obtain goods or favors, or avoid debts or obligations (p. eg., I will try to others) (criteria A11); or steal objects there are value without confrontation with the victim (P. eg., robberies in stores, falsifications) (criterion A12).

Characteristicly, the subjects who present this disorder also incur serious violations of the norms (P. eg., School, relatives). Children with this disorder and before the age of 13, remain away from home at night despite their parents' prohibitions (criteria A13).

There may be house leaks during the night (Criteria A14). To be considered as a dissocial relative symptom, the leak must have occurred at least twice (or only once if the subject did not return for a prolonged period of time). Episodes of escape that occur as a direct consequence of physical or sexual abuse are not typically qualified in this criterion. Children with this disorder can make steers at school frequently, starting them before the age of 13 (Criteria A15). In major subjects this behavior is often manifested with absences of work without reasons that justify it.

Subtypes

Depending on the age of the beginning of the disorder, two subtypes of dissocial disorder (type of child start and teenage start type) have been established. Subtypes differ regarding the characteristic nature of the behavioral problems they present, evolutionary course and prognosis, and proportion by sex. Both subtypes can occur mild, moderate or severe way. When evaluating the age of onset, the information must be obtained preferably from the interested party and their caregivers. Since many of the behaviors are sometimes hidden, caregivers can expose less symptoms of the royal and overestimate the age of onset.

Children's Start Type. This subtype is defined by the beginning of at least one characteristic of dissocial disorder before 10 years of age. The subjects with the type of child start are usually male, frequently display physical violence over others, have problematic relationships with their classmates, may have manifested a challenging negative disorder during their early childhood and usually have symptoms that satisfy all disorder criteria social di before puberty. These subjects tend to experience a persistent dissocial disorder and develop an antisocial personality disorder in adult more often than subjects with a teenage starting type.

Teenage start type. This subtype is defined by the absence of dissocial disorder characteristics before 10 years of age. Compared to the subjects with the type of child start, they tend less to deploy aggressive behaviors and have more normative relationships with colleagues (although they frequently pose behavioral problems in the company of others). These subjects are less likely to suffer a persistent dissocial disorder or to develop in adult life an antisocial personality disorder. The proportion of men to women with dissocial disorder is lower in the type of teenage start than in the type of child start.

Gravity specifications

Mild. There are very few or none of the behavioral problems that exceed those required to establish the diagnosis, and these problems cause other relatively small damages (P. eg., Lying, making steers, being out of the house at night without permission). Moderate. The number of behavioral problems and their effect on other people are intermediate between him and me (p. eg., robberies without confrontation with the victim, vandalism). Serious. There are many behavioral problems that exceed those required to establish the diagnosis, or behavioral problems cause considerable damage to other people (P. eg., violation, physical cruelty, use ofarms, robberies with confrontation with the victim, destruction and raids).

Associated symptoms and disorders

Descriptive characteristics and associated mental disorders. Subjects with dissocial disorder may have little empathy and little concern for the feelings, desires and welfare of others.

Especially in ambiguous situations, the aggressive subjects affected by this disorder frequently perceive the intentions of others poorly, interpreting them as more hostile and threatening of what they really are, responding with aggressions that in that case consider reasonable and justified.

They can be insensitive, lacking appropriate feelings of guilt or remorse. Sometimes it is difficult to evaluate whether the experience experienced is genuine, since these subjects learn that the manifestation of guilt can reduce or avoid punishment. Subjects with dissocial disorder may be willing to give information about their peers and try to accuse others of their own misdeeds. Self -esteem is usually low, although the subject can project a hardness image. Little tolerance to frustration, irritability, emotional outbursts and reckless are frequently associated characteristics. Accident rates seem to be superior in subjects with dissocial disorder compared to others that do not suffer from this disorder. Dissocial disorder is usually associated with an early start of sexual activity, drinking, smoking, consuming illegal substances and incurring reckless and dangerous acts. The consumption of illegal substances can increase the risk of persistence of dissocial disorder. Disocial disorder's own behaviors can lead to suspensions or school expulsions, problems in labor adaptation, legal conflicts, sexually transmitted diseases, unwanted pregnancies and physical injuries produced in accidents or fights.

These problems can prevent assistance to ordinary schools or live with parents or in an adoptive home. Suicidal ideation, suicide attempts and consummated suicides occur with a frequency higher than expected. Dissocial disorder can be associated with an intellectual level lower than the average. Academic performance, especially in reading and other verbal skills, is usually below the expected level based on the age and intelligence of the subject, being able to justify the additional diagnosis of learning or communication disorder. Hyperactivity attention deficit disorder is frequent in children with dissocial disorder. Dissocial disorder can also be associated with one or more of the following mental disorders: learning disorders, anxiety disorders, mood disorders and substances related disorders. The following factors predispose to the development of a dissocial disorder: rejection and abandonment by parents, difficult child temperament, incoherent educational practices with hard discipline, physical or sexual abuse, lack of supervision, first years of life in institutions, frequent changes of caregivers, large family, association of a group of fellow criminals and certain types of family psychopathology.

Laboratory findings. In some studies, a lower heart rate and driver have been observed in subjects with dissocial disorder than in others without this disorder. However, physiological activation levels are not diagnosis of this disorder.

Symptoms dependent on culture, age and sex

With some frequency, the possibility that the diagnosis of dissocial disorder is not correctly applied to subjects from environments where undesirable behavior patterns are sometimes considered as protectors (P. eg., Threats, poverty, crime). According to the DSM-IV definition of mental disorder, the diagnosis of dissocial disorder should only be applied when the behavior in question is symptomatic of an underlying dysfunction of the individual and does not simply constitute a reaction to the immediate social context.

In addition, young immigrants from countries razed by war, who have lived a history of aggressive behaviors perhaps necessary for their survival in that context, do not necessarily justify a diagnosis of dissocial disorder. The consideration of the social and economic context in which undesirable behaviors have occurred can be useful to the clinician.

The symptoms of the disorder vary with age as the individual develops more physical strength, cognitive skills and sexual maturity. Less serious behaviors (p. eg., Lying, stealing in stores, physical fights) tend to appear first, while others (p. eg., robbery with scalo) do so later.

Typically, the most serious behavior problems (P. eg., violation, theft with confrontation with the victim) tend to manifest ultimately. However, there are notable differences between individuals, some of which incur the most harmful behaviors at a very early age.

Dissocial disorder, especially the child type, is much more frequent in men.

The differences between sexes are also observed in specific types of behavioral problems.

Men with a diagnosis of social disorder frequently incur robberies, fights, vandalism and school discipline problems. Women with a diagnosis of dissocial disorder tend to incur lies, school absenteeism, leaks, toxic consumption and prostitution. While the aggression that implies a passionate confrontation is usually more deployed by men, women tend to practice more behaviors that do not entail confrontation.

Prevalence

The prevalence of social disorder seems to have increased during the last decades, being able to be higher in urban nuclei than in rural areas.

The rates vary widely depending on the nature of the population studied and the analysis methods: in men of age less than 18 years, rates range between 6 and 16 %; In women, rates move between 2 and 9 %. Dissocial disorder is one of the most frequently diagnosed in the mental health centers for children both on an outpatient regime and hospitalization.

Course

The beginning of the dissocial disorder can occur around 5 or 6 years of age, but is usually observed at the end of childhood or at the beginning of adolescence. It is very rare to begin after 16 years of age. The course of dissocial disorder is variable. In a majority of subjects the disorder refers to adult life. However, a substantial proportion continues to manifest in the adult stage behaviors that meet personality antisocial disorder criteria. Many subjects with dissocial disorder, particularly those of the teenage start and who have minor and scarce symptoms, reach adequate social and labor adaptation in adult life. A early start predicts a worse forecast and a growing risk in adult life of suffering an antisocial personality disorder and substance consumption disorders. Individuals with dissocial disorder run the risk of subsequently experiencing mood disorders, anxiety disorders, somatomorphic disorders and substance consumption disorders.

Family pattern

Studies on twins and adoptions show that dissocial disorder has both genetic and environmental components. The risk of dissocial disorder increases in children with a biological or adoptive father with antisocial personality disorder or with a brother affection of dissocial disorder. The disorder also seems to be more frequent in children of biological parents with dependence on alcohol, mood or schizophrenia disorders, or biological parents with history of attention deficit disorder with hyperactivity or dissocial disorder.

Differential diagnosis

Although the challenging negative disorder includes some of the characteristics observed in dissocial disorder (P. eg., disobedience and opposition to authority figures), does not include the persistent pattern of the most serious behavior forms, which imply the violation of the basic rights of other people or the social norms of the subject of the subject of the subject. When the subject's behavioral pattern satisfies the criteria of both dissocial disorder and defiant negative disorder, the diagnosis of dissocial disorder must occupy the preferential place and the challenging negative disorder should not be diagnosed.

Although children with attention deficit disorder with hyperactivity usually exhibit hyperactive and impulsive behavior that can be disturbing, this behavior does not violate itself the social norms of age and, therefore, do not usually comply. When the criteria for attention deficit disorder with hyperactivity and dissocial disorder are fully met simultaneously, both diagnoses must be established.

Irritability and behavioral problems usually occur in children or adolescents with a manic episode. They are normally distinguished from the pattern of behavioral problems of the dissocial disorder by the episodic course and the symptomatic characteristics accompanying a manic episode. If the criteria of both disorders are met, both the diagnosis of dissocial disorder and bipolar disorder I. The diagnosis of adaptive disorder (with behavior alteration or with mixed alteration of emotions and behavior) must be taken into account if clinically significant behavioral problems that do not satisfy the criteria of another specific disorder are developed in clear association with the beginning of A psychosocial stress. Some isolated behavior problems that do not meet criteria of dissocial disorder or adaptive disorder can be encoded as antisocial behavior in childhood or adolescence (v. Other problems that can be subject to clinical attention, page 699). Dissocial disorder is only diagnosed if behavioral problems represent a repetitive and persistent pattern that is associated with alterations in social, academic or work activity.

In the subjects with more than 18 years of age, only one diagnosis of dissocial disorder will be applied if the disorder does not also meet personality antisocial disorder criteria. The diagnosis of antisocial personality disorder cannot be attributed to subjects of less than 18 years.

Relationship with the diagnostic criteria of research of CIE-lo

Although of different format, the diagnostic criteria of the DSM-IV and the CIE-L for the dissocial disorder are almost identical.

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