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Mark Twain Meets DSM-III-R: Conduct Disorder, Development, and the Concept of Harmful Dysfunction

By John Richters and Dante Cicchetti


The Diagnostic and Statistical Manual (3rd ed., rev.) (DSM-III-R) diagnosis of conduct disorder assumes that all children who engage in three or more criterion antisocial behaviors for 6 months or more suffer from a mental disorder. It resists all contextual information about a child's developmental history, capacities, strengths and circumstances, and assumes that the antisocial behavior necessarily stems from an underlying disorder. In this review, we use Mark Twain's narrative of the lives of Tom Sawyer and Huckleberry Finn as a point of departure for questioning the reasonableness of this assumption, and for examining normal as well as pathological pathways to antisocial behavior. We begin by reviewing the status of earlier controversies about the mental disorder concept in the service of documenting the impressive progress of the field in conceptualizing disorder. Next, we examine Wakefield's (1992a, 1992b) recently introduced 'harmful dysfunction' concept of mental disorder and employ its criteria to evaluate the hypothesis that chronic antisocial behavior in childhood as defined by DSM-III-R is caused by an underlying mental disorder. We also examine some of the difficulties in discriminating between disorder- and nondisorder-based antisocial behavior, and consider issues that warrant attention in future theoretical and empirical work. Finally, we explore the pragmatic rather than scientific basis for DSM-III-R's mental disorder claim and argue that regardless of its status as a mental dsorder, this most troubling and harmful behavior syndrome of childhood deserves the intensive interest, concern, and resources of the scientific and public health communities

Topics: Clinical Psychology, Developmental Psychology
Publisher: Cambridge University Press
Year: 1993
OAI identifier:

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  1. (1970). 10). Dr. Hutschnecker’s modest proposal. Washington Post,
  2. (1980). American Psychiatric Association.
  3. (1991). An early starter model for predicting delinquency. In
  4. (1986). An organizational approach to childhood depression. In
  5. (1991). Anxiety, inhibition, and conduct disorder in children: Relations to social impairment.
  6. (1991). Attachment and socialization: The positive side of social influence.
  7. (1985). Attachment theory: Retrospect and prospect. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research.
  8. (1990). Autonomic orienting responses i 15-year-old male subjects and criminal behavior at age 24.
  9. (1978). But is it good for science?
  10. (1986). Child psychiatry: The interface between clinical and developmental research.
  11. (1979). Cicchetti humans correlates with cerebrospinal fluid amine metabolites.
  12. (1992). Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: A review.
  13. (1993). Community violence and children’s development: Toward a research agenda for the 1990’s.
  14. (1955). Construct validity in psychological tests.
  15. (1993). Developmental considerations in the investigation of conduct disorder.
  16. (1988). Developmental psychopathology and incompetence in childhood: Suggestions for intervention.
  17. (1966). Deviant children grown up.
  18. (1987). Diagnostic and statistical manual of mental disorders (3rd d., rev.).
  19. (1992). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s d finition of mental disorder.
  20. (1993). DSM-III and the Transformation of American Psychiatry.
  21. (1989). Early school dropout: Configurations and determinants.
  22. (1993). Editorial. Toward a developmental perspective on conduct disorder. Development and Psychopathology,
  23. (1986). Effects of chronic fenfluramine on blood serotonin, cerebrospinal fluid metabolites, and behavior in monkeys.
  24. (1984). Electrodermal non-responding, antisocial behavior and schizoid tendencies in adolescents.
  25. (1984). Evolutionary biology and personality psychology: Toward a conception of human nature and individual differences.
  26. (1992). Goombata: The improbable rise and fall of John Gotti and his gang.
  27. (1977). Guiding principles. In
  28. (1980). Individual differences in infant-mother attachment. Mark Twain meets DSM III- R 29 Antecedents in neonatal behavior in an urban economically disadvantaged sample. doi
  29. (1990). Internal representational models of attachment relationships.
  30. (1991). Longitudinal studies of active and aggressive preschoolers: Individual differences in early behavior and in outcome.
  31. (1993). Main effects or transactions in the neuropsychology of conduct disorder?
  32. (1988). On moral judgments and personality disorders: The myth of psychopathic personality revisited.
  33. (1967). On the futility of the proposition that some people be labeled ‘mentally ill.’
  34. (1971). Personality disorder is disease.
  35. (1993). Prevention of conduct disorder before and after school entry: Relating interventions to developmental findings.
  36. (1991). Psychiatricdisorders in America: The Epidemiological Cat hment Area Study.
  37. (1993). Psychological, contextual, and psychobiological interactions: A developmental perspective on conduct disorder.
  38. (1978). Psychopathy and differential insensitivity. In
  39. (1990). Research on children of affectively ill parents: Some considerations for theory and research on normal development.
  40. (1991). Response perseveration and delayed responding in childhood behavior disorders.
  41. (1988). Response perseveration and delayed responding in undersocialized aggressive conduct disorder.
  42. (1989). Serotonergic studies in patients with affective and personality disorders: Correlates with suicidal and impulsive aggressive behavior.
  43. (1985). Statistical analysis of large neuropsychological data bases: Methodological and clinical considerations.
  44. (1993). Taxonomy and comorbidity of conduct problems: Evidence from empirically based approaches.
  45. (1947). The adventures of Huckleberry Finn.
  46. (1876). The adventures of Tom Sawyer.
  47. (1992). The concept of mental disorder: On the boundary between biological facts and social values.
  48. (1984). The domain of developmental psychopathology.
  49. (1981). The evolution of the concept of disease. In
  50. (1991). The making of a developmental psychopathologist. In
  51. (1960). The myth of mental illness: Foundations of a theory of personal conduct.
  52. (1993). The NIMH Community Violence Project: Children as victims and witnesses to violence.
  53. (1992). The outcome of childhood conduct disorder: Implications for defining adult personality disorder. doi
  54. (1993). The psychobiology of undersocialized aggressive conduct disorder: A theoretical perspective.
  55. (1971). The sane slave.
  56. (1989). The vote on DSM-IV.
  57. (1977). Vulnerability-A new view of schizophrenia. doi
  58. (1985). Wiseguy: Life in a mafia family.

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