The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5
In DSM 5, conduct disorder (CD) has been expanded with a new specifier ‘with Limited Prosocial Emotions’ (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous–unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly.
KeywordsDSM 5 Conduct disorder LPE specifier Age-of-onset Aggression
This study is funded jointly by the Netherlands Foundation for Mental Health (FPG), and the Netherlands Organization for Scientific Research (NWO)—National Initiative Brain and Cognition (NIHC). NIHC is an independent taskforce that receives financial support from NWO, the Dutch Ministries of Education, Culture and Science (OCW), Health, Welfare and Sport (VWS), Security and Justice (VenJ) and Defence. Both funders did not play any role in the conduct of this study.
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Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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