The DSM-5 Limited Prosocial Emotions Specifier for Conduct Disorder: Comorbid Problems, Prognosis, and Antecedents

OBJECTIVE: A limited prosocial emotions (LPE) subtype of conduct disorder (CD) has been added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Empirical studies on this categorically defined subtype are scarce, whereas existing work is predominantly cross-sectional. Hypotheses surrounding the LPE subtype that relate to comorbidity, prognosis, developmental antecedents, and overlap with psychopathic personality, received no or little scrutiny. METHOD: These knowledge gaps were addressed in a community sample of 1,839 children 8 to 10 years of age who enrolled in the study in early childhood (age 3-5), and were followed up in early adolescence (age 11-13). Parents and teachers completed questionnaires that tap theoretically and clinically relevant features. RESULTS: Children with the LPE subtype exhibited more CD symptoms and comorbid problems, including fearlessness, and symptoms of oppositional defiant disorder and attention-deficit/hyperactivity disorder. These children were also at a higher risk for future CD symptoms at the 3-year follow-up. Additionally, fearlessness, callous-unemotional traits, interpersonal traits, and harsh parenting assessed in early childhood, were identified as developmental antecedents of the LPE subtype. Findings, finally, tentatively suggest that the LPE subtype is a heterogeneous group differentiated on other psychopathic personality traits. CONCLUSION: The LPE subtype appears to identify a troubled, etiologically distinct group of children with conduct problems who are at a heightened risk for future maladjustment. Findings can inform the underlying mechanisms related to the LPE subtype, and can lead to the development and improvement of prevention and intervention programs for children with conduct problems.