Conduct Disorder

Conduct disorder involves complex neurobiological dysfunction across multiple brain circuits. Neuroimaging reveals reduced volume and activity in the ventromedial prefrontal cortex (impaired decision-making), orbitofrontal cortex (reduced consequence evaluation), and amygdala (blunted threat and empathy processing). Serotonergic hypofunction in the raphe nuclei lowers impulse control thresholds, while dysregulated dopaminergic reward pathways in the nucleus accumbens drive sensation-seeking behavior. Elevated testosterone and cortisol dysregulation via the HPA axis maintain chronic aggression. The clinician must differentiate conduct disorder from oppositional defiant disorder, ADHD, PTSD, bipolar disorder, and intermittent explosive disorder, then develop a comprehensive treatment plan including pharmacotherapy, evidence-based psychotherapy, and family-based interventions.