The DSM-5 with Limited Prosocial Emotions Specifier for Conduct Disorder: a Systematic Literature Review

Abstract

DSM-5 added a categorically defined specifier ('with Limited Prosocial Emotions'; LPE) for the diagnosis of conduct disorder (CD). This paper systematically reviews the evidence base for this specifier in children and adolescents who are diagnosed with CD. Computer-assisted searches were executed and identified 181 potentially relevant papers. Eventually, nine papers were included in this review, referring to eight unique samples. All studies constructed an LPE measure by pulling the same items from the same rating scales that were used in the development of the DSM-5 LPE specifier. The prevalence of youth with CD who met criteria for this novel LPE specifier (CD + LPE) ranged from 6.1% to 83.7%. The studies greatly varied in the features used to test the viability of the DSM-5 LPE specifier. The most commonly used features relate to severity of antisocial behavior, low neuroticism (or lack of anxiety and depression), and treatment responsiveness. Available work altogether showed that CD + LPE youth displayed higher levels of past antisocial behaviour than CD Only youth, but failed to reveal other group differences that corroborate with expectations. Effect sizes typically were in the small to moderate range, suggesting that the practical usefulness of the group differences is limited. Empirical work shows that this specifier should not be used for clinical decision-making when relying on items from measures that have been used in the development of the LPE specifier. Crucially, limitations that hallmark the few studies on the topic hamper any firm conclusion about the usefulness of the specifier.

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

“…This finding, and its consistency with some research, 8,23 supports speculations that the LPE specifier has diagnostic value in the absence of CD or CP. 47 Yet, not all studies have revealed such differences, 6,48 underscoring the need for further study on features and outcomes of LPE Only.…”

“…Nevertheless, well-known scales that have been used in the development of and research on the LPE specifier, typically failed to provide support for the LPE subtyping scheme (Supplement 1, available online). 6 Thus, this scale might be informative for future work. Second, diagnostic interviews designed to assess the LPE specifier or to determine the presence of CD, were not performed.…”

“…4,5 Such discrepant findings might be explained by the loss of statistical power that hallmarks categorical conceptualizations of disorders, but also by differences in number and content of the items used to measure CU traits and the LPE specifier. 6 Hence, it is of indisputable relevance to study the CU construct as categorically J o u r n a l P r e -p r o o f defined in DSM-5. A literature review showed that available support for the categorically defined LPE specifier in youth with CD is poor.…”

Role of Callous and Unemotional (CU) Traits on the Development of Youth with Behavioral Disorders: A Systematic Review

“…Since the introduction of CU traits as a conduct disorder specifier by the APA in 2013, more than 50 literature reviews about CU traits in children and adolescents have been published (e.g., Web of Science, 2013–2020). Although most of the reviews cover several aspects, they mainly study and discuss (a) diagnostic legitimacy, e.g., [ 6 , 24 , 66 ]; (b) assessment, including the validity of measurement instruments, e.g., [ 15 , 23 ]; (c) etiology, e.g., [ 33 , 35 ]; (d) developmental trajectories and outcomes, e.g., [ 28 , 51 ] and (e) intervention, e.g., [ 28 , 67 ]. Even flourishing literature review on CU traits (see above), to date and as far as we know, no review deals about links between CU traits and each dimension of human functioning.…”

Psychometric properties of the German version of the Youth Psychopathic traits Inventory – short version

“…In the last two decades, researchers have become increasingly interested in psychopathy or psychopathic traits in juveniles. As a result, for example, limited pro social emotions (a term related to callous-unemotional traits, one of the features of psychopathy) have been included as a specifier of Conduct Disorder (CD) in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [ 2 ] in order to capture a high-risk subgroup of juveniles with CD [ 19 , 29 ].…”