CONDUCT PROBLEMS Pınar Özeren

Description Conduct disorder is a psychiatric category to describe a pattern of repetitive behavior where the rights of others or the current social norms are violated. Symptoms include verbal and physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.

The Case: Ali, 32 years old Graduated from primary school Scrap dealer Divorced for 1.5 years Have 3 children staying with their mother Heavy drinker and smoker since 10 years

Application Reason He tried to throw himself from the Yenibosna Bridge when he was drunk then the police convinced him and brought him to the hospital.

Family History Father died when he was 10 Mother got into a deep mourn after her husband’s death The oldest of 5 siblings Took care of his siblings especially his youngest brother

Own History He was a problematic child at school Escaped from school many times Very low grades His mother took him from school because of his lying and escaping behaviors.

Own history Be in prison for 1.5 year at military service for insulting and using abusive language to his superior. Be in prison for 3.5 years for full attempting to kill someone. Attempted to commit suicide 1 year ago Beating his wife heavily.

“I am going to cut her into peaces, she destroyed my life “I am going to cut her into peaces, she destroyed my life. I am going to kill her, I have nothing to loose.”

Etiology Family characteristics Socio-cultural factors Psychological factors Neuro-biological factors

Family Characteristics Low SES people Fathers are away from the family Mothers are depressive or have personality disorders Chaotic family structure Denial by the parents at an early age

Socio-cultural Factors Society’s view towards low SES children The approved behaviors are not a way to get a status

Psychological Factors Lack of role models Cannot develop consciousness and adopt social norms Cannot tolerate the obstacles when forming mature relationships Psychoanalytic view: lack of attachment at infancy

Neuro-biological Factors Very low dopamine High serotonin

DSM-IV Aggression towards people and animals Abusive language, threatening Physical violence Using harmful weapons Cruelty Sexual abuse

DSM-IV Destroying property Dishonesty and robbery Starting a fire consciously Giving harm to someone's property consciously Dishonesty and robbery Constant lying Stealing some things by facing the victim

DSM-IV Disruption of the rules Not coming to the house without the permission of the parent (before age 13) Not coming to the house at least 2 days (before age 13) Escaping from school (before age 13)

DSM-IV 1) Beginning in Childhood 2) Beginning in Adolescence

Assessment They do not feel discomfort from their behaviors and cannot communicate well. There can be depression and anxiety in this disorder

Assessment (for Ali) Judgement problems Very slow talk Pessimism Sleepless Refuse to take medications Very disordered and unclean

Prognosis The prognoses of the conduct disorder beginning in adolescence is more positive than the beginning in childhood. During the recovery of the symptoms depression occurs.

Treatment Medication Psychotherapy Abnormal electrical activity in limbic system Neurological medications for aggression and tantrum (for short term) Litium for emotional and behavioral stability Psychotherapy Behavioral and cognitive therapy Communication skills, problem solving, motive and anger controlling

“I am fine and feel good, I want to go out from here “I am fine and feel good, I want to go out from here. I will try to compromise with my wife and see my children. But if she does not want to, I am going to go to Adapazarı and live there.”

THANK YOU