Conduct Disorder 473
case and respond with aggression that they th en feel is reasonable and justified. Person-
ality features of trait negative emotionality and poor self-control, including poor frustra-
tion tolerance, irritability, temper outbursts,  suspiciousness, insens itivity to punishment,
thrill seeking, and recklessnes s, frequently co-occur with conduct disorder. Substance
misuse is often an associated fe ature, particularly in adolescent females. Suicidal ideation,
suicide attempts, and completed suicide occur at  a higher-than-expected rate in individu-
als with conduct disorder. 
Prevalence
One-year population prevalence estimates range from 2% to more than 10%, with a median
of 4%. The prevalence of conduct disorder a ppears to be fairly consistent across various
countries that differ in race and ethnicity. Pr evalence rates rise from  childhood to adoles-
cence and are higher among males than amon g females. Few children with impairing con-
duct disorder receive treatment.
Development and Course
The onset of conduct disorder may occur as ea rly as the preschool years, but the first sig-
nificant symptoms usually emerge during the period from middle childhood through
middle adolescence. Oppositi onal defiant disorder is a common precursor to the child-
hood-onset type of conduct disorder. Conduct disorder may be diagnosed in adults, how-
ever, symptoms of conduct di sorder usually emerge in ch ildhood or adol escence, and
onset is rare after age 16 years. The course of  conduct disorder after onset is variable. In a
majority of individuals, the disorder remits by adulthood. Many individuals with conduct
disorder—particularly those with adolescent-onset type and those with few and milder