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

Abstract

Background Prior research indicates that conduct disorder (CD) is associated with a range of comorbid mental disorders. However, the actual prevalence, subtypes, and patterns of comorbidity of DSM-IV defined CD in the general U.S. 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 = 3,199) in the National Comorbidity Survey Replication. Results The estimated lifetime prevalence of CD in the U.S. is 9.5% (males = 12.0%, females = 7.1%), with a median age-of-onset of 11.6 (0.2) years. Latent class analysis 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 U.S. population, and more severe subtypes and the presence of active CD are associated with higher risk of comorbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.