This video describes oppositional defiant disorder (ODD), conduct disorder (CD), and antisocial personality disorder (APD). With ODD we see there eight symptom criteria. An individual would need to have four of these symptom criteria to be considered for a diagnosis of ODD and there are a couple of other criteria as well. In terms of symptom criteria, four out of eight are required and these are in three categories: anger irritable mood, argumentative defiant behavior, and vindictiveness. When we look at conduct disorder we see there are fifteen symptom criteria and an individual would have to have at least three of these symptoms. There are four categories: aggression to people and animals, destruction of property, lying or stealing, and what the DSM refers to as “serious violations of rules.” A couple of examples here would be truancy or repeatedly staying out overnight without parental permission. Conduct disorder also requires clinically significant impairment, but not clinically significant distress. If an individual is 18 years or older, they can't meet the full criteria for antisocial personality disorder. Conduct disorder and antisocial personality disorder are mutually exclusive. ODD and conduct disorder are not mutually exclusive. An individual can be diagnosed with both ODD and conduct disorder at the same time. When we look at antisocial personality disorder, we see there are seven symptom criteria an individual would have to have at least three. Here we see repeatedly engaging behavior that is grounds for arrest, lying, impulsivity, irritability or aggressiveness, a disregard for the safety of others, irresponsible behavior, and a lack of remorse. For an individual to have APD they have to be at least 18 years or older and evidence of conduct disorder would have to have been present before the age of 15. This is an interesting symptom criterion, because this isn't saying that individual has to have a diagnosis of conduct disorder in order to be diagnosed with antisocial personality order later on, rather this is saying that evidence of symptoms of conduct disorder had to have been present before the age of 15. The last criterion for APD is that the symptoms aren't exclusively observed during the course of schizophrenia or bipolar disorder.
When we look at the relationship between these three disorders, we usually conceptualize O D as the least severe, with conduct disorder being the next most severe, and antisocial personality disorder being the most severe. We know that ODD is a significant risk factor for developing CD, and we also know that CD is a significant predictor of developing APD. There are a few different features of conduct disorder that make it much more likely that we would see an eventual development into antisocial personality disorder. For example, if the subtype of conduct disorder is the childhood onset subtype, which is where one symptom is present before the age of 10, that would increase the risk of developing antisocial personality disorder later on. Also, there is a specifier “with limited prosocial emotions,” that would also increase the risk of developing APD. In terms of the potential progression from ODD to CD to APD, there are a lot of different percentages out there in terms of what percent of individuals with ODD would move on to have CD and what percent of people with CD would move on to have APD. Even though there's some variability in the research in terms of the percentages, in general, the progression of ODD to CD occurs about one third of the time. We can say the same thing when looking at conduct disorder and antisocial personality disorder. About one of every three individuals with conduct disorder will eventually develop antisocial personality disorder. We can calculate that one out of nine presentations of oppositional defiant disorder will eventually go on to develop antisocial personality disorder. That is one-third times one-third. There is speculation in the mental health treatment community and the research community that really these three disorders are simply manifestations of the same underlying disorder that are dependent on someone's age. We don't know this for sure, however, this is just one of the theories that's out there. Understand the relationship between ODD, CD, and APD informs clinical treatment and further research on these disorders is warranted.

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