Psychological Medicine



Original Article

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication


MATTHEW K. NOCK a1c1, ALAN E. KAZDIN a2, EVA HIRIPI a3 and RONALD C. KESSLER a3
a1 Department of Psychology, Harvard University, Cambridge, MA, USA
a2 Yale University School of Medicine, New Haven, CT, USA
a3 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

Article author query
nock mk   [PubMed][Google Scholar] 
kazdin ae   [PubMed][Google Scholar] 
hiripi e   [PubMed][Google Scholar] 
kessler rc   [PubMed][Google Scholar] 

Abstract

Background. Prior research indicates that conduct disorder (CD) is associated with a range of co-morbid mental disorders. However, the actual prevalence, subtypes and patterns of co-morbidity of DSM-IV-defined CD in the general US population remains unknown.

Method. Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents (n=3199) in the National Comorbidity Survey Replication (NCS-R).

Results. The estimated lifetime prevalence of CD in the US is 9·5% (12·0% among males and 7·1% among females), with a median age-of-onset of 11·6 (0·2) years. Latent class analysis (LCA) identified five CD subtypes characterized by rule violations, deceit/theft, aggression, severe covert behaviors, and pervasive CD symptoms. A dose–response relationship was revealed between CD subtype severity and risk of subsequent disorders. Results also indicated that CD typically precedes mood and substance use disorders, but most often occurs after impulse control and anxiety disorders. Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders, remitted CD is associated with significantly lower risk of subsequent disorders.

Conclusions. CD is prevalent and heterogeneous in the US population, and more severe subtypes and the presence of active CD are associated with higher risk of co-morbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.

(Published Online January 26 2006)


Correspondence:
c1 Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA. (Email: nock@wjh.harvard.edu)


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