Conduct disorder and adult psychiatric diagnoses: Associations and gender differences in the U.S. adult population

Abstract

The authors’ objective was to examine the presence of Axis I and II psychiatric disorders among adult males and females with a history in childhood and/or adolescence of conduct disorder (CD).

Data were derived from a large national sample of the U.S. population. Face-to-face interviews of more than 34,000 adults ages 18 years and older were conducted during 2004–2005 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule –DSM-IV Version.

After adjusting for sociodemographic characteristics and psychiatric comorbidity, CD was associated with all Axis I and II disorders, particularly substance use disorders (SUD), bipolar disorder, and histrionic personality disorders. After adjusting for gender differences in the general population, men had significantly greater odds of social anxiety disorder and paranoid personality disorder, whereas women were more likely to have SUD. Furthermore, there was dose–response relationship between number of CD symptoms and risk for most psychiatric disorders.

From a clinical standpoint, knowledge of the gender differences in associations of CD with other psychiatric disorders in adulthood may be informative of developmental pathways of the disorder, and of possible gender-specific risk factors. Early recognition and treatment of CD may help prevent the development of adult-onset disorders.

Introduction

Conduct disorder (CD) is highly prevalent in childhood and early adolescence, constituting one of the most common chief complaints in child mental health consultations. It is accompanied by significant impairment in most spheres of life (Kim-Cohen et al., 2005, Lambert et al., 2001, Maughan et al., 2004, Nock et al., 2006), high public health costs (Foster and Jones, 2005), and family burden (Sourander et al., 2007). The prevalence of CD has been estimated to range from 4 to 16% in males and from 2 to 9% in females (Cohen et al., 1993, Loeber et al., 2000, Nock et al., 2006). There are some indications that its prevalence may be increasing in Western societies (Angold and Costello, 2001).

In previous studies, a history of CD has been associated with the later development of mood, anxiety, and substance use disorders (SUD), and some studies have also documented that 45–70% of individuals with CD develop antisocial personality disorder (ASPD) in early adulthood (Gelhorn et al., 2007, Kim-Cohen et al., 2003, Lahey et al., 2002, Nock et al., 2006, Zoccolillo et al., 1992). However, the relationship between CD with Axis I psychopathology and the broader spectrum of personality disorders has not been previously examined. Understanding these associations is crucial to help clinicians develop a greater awareness of the risk of future psychopathology and to design appropriate treatment and preventive interventions.

Prior research has also suggested that the association of CD with other disorders varies by gender, leading to different psychopathology in men and women in adulthood. For instance, internalizing disorders are more commonly associated with CD in adolescent girls than boys, whereas boys are more likely to develop externalizing disorders (Loeber and Keenan, 1994). However, whether gender differences in the association of CD with adult psychopathology are moderated by the presence of CD or merely reflect gender differences in the distribution of psychiatric disorders in the general population is unclear.

Finally, an important question from a developmental psychopathology perspective is whether the severity of CD influences the risk of associated psychopathology, i.e., whether there is a dose–response relationship between severity of CD and risk of psychiatric and personality disorders in adulthood. Prior studies have found dose–response relationships among different subtypes of CD and Axis I psychopathology (Nock et al., 2006). However, whether these relationships may apply to Axis II psychopathology and vary by gender is unclear.

The goal of this study was to address these gaps in the literature. To our knowledge, this is the first large epidemiological study to examine the association between CD and the broad range of Axis I and II disorders, looking at differences in men and women. We draw on data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large nationally representative sample of the US population (N = 34,635) collected in 2004–2005 (Grant et al., 2007). Our findings contribute to a better understanding of the gender differences in the association between CD and a broad range of psychiatric disorders in adults.