Conduct Disorder and its Homoeopathic Perspective

Dr  Mehak Gupta
MD Scholar, Department of Psychiatry, Bakson Homoeopathic Medical College and Hospital

Dr Payal Gupta
MD Scholar, Department of Organon, Bakson Homoeopathic Medical College and Hospital, Greater Noida, UP

Conduct Disorder is a behavioural problem which is characterized by violation of major age appropriate societal norms or rules. It begins in childhood or adolescence ⁽¹⁾. Some children create problems for their parents and teachers due to their typical unacceptable behaviours. These are hostile aggressive and disruptive behaviours; mischievous and rebellious manners; great difficulty in following rules and behaving in a socially unacceptable way; ‘bad’ or offending acts or deeds. ⁽²⁾

Along with these unacceptable behaviours children with Conduct Disorder encounter a number of associated difficulties like lack of social judgement, lack of risk assessment, difficulties in interpersonal relationships or a lack of communication skills, higher rates of injuries, school expulsions, etc. Adolescents are more prone to exhibit such behaviour.

Conduct disorder is a major health and social problem. It is the most common psychiatric disorder in childhood, with a prevalence of around 5% across the world, which is rising. Although delinquent adolescents do the greatest damage to society, the disorder usually starts below the age of 7 years with the oppositional defiant subtype ⁽³⁾. Among Indian studies, Deivasigamani has reported the prevalence of Conduct Disorder to be 11.13%.⁽⁴⁾ Sarkar reported the prevalence rate of antisocial behavior to be 7.1%.⁽⁵⁾ While recently Srinath have reported prevalence rate of antisocial behavior as low as 0.2%. ADHD is a common comorbidity in children with conduct disorder. ⁽⁶⁾

It is often associated with numerous behavioural problems that have a significant emotional and social impact on both the child and parents. The child is perceived differently by the society and often deprived of the fundamental necessities required for a sustained life. When the child enters his/her adolescent years, he/she is likely to express problems which are categorized under behavioural problems.

If not managed properly at a very young age the behaviour patterns develop into problems like adapting in relationship and holding a job later. They often break rules and behave in an anti- social way in adulthood. ⁽²⁾

DSM- 5 DIAGNOSTIC CRITERIA FOR CONDUCT DISORDER ⁽⁷⁾
A repetitive and persistent pattern of behaviour in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months.

Aggression to People and Animals

1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, and gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
7. Has forced someone into sexual activity.

Destruction of Property

1. Has deliberately engaged in fire setting with the intention of causing serious damage.
2. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

1. Has broken into someone else’s house, building, or car.
2. Often lies to obtain goods or favours or to avoid obligations (i.e., “cons” others).
3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

Serious Violations of Rules

1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
3. Is often truant from school, beginning before age 13 years.

B. The disturbance in behaviour causes clinically significant impairment in social, academic, occupational functioning.

Here the chances of the symptoms being carried forward into adulthood are much higher. Mood disorder, drug and alcohol abuse are frequently associated with conduct disorder. Forty percent (40%) of conduct disordered adolescents will eventually progress into Antisocial Personality Disorder ⁽¹⁾.

Along with these behavioural problems the most common associated disorders are Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder, Depression, Anxiety etc. There is no documented cure for Conduct Disorder, but services and supports play an important role and can enable the person to thrive throughout their lifetime. The modern school treatment consists of special education and behavioural therapy. A therapy focused on modifying harmful behaviours associated with psychological distress.

HOMOEOPATHIC PERSPECTIVE:

The Homoeopathic approach works on the fundamental principle of Similia Similibus Curantur. Master Samuel Hahnemann in his Organon of Medicine lays down principles for case taking and selection of remedy. It is based on the theory of individualization and symptom similarity.

The Homoeopathic approach in treatment of Conduct disorder in children has a promising and a favourable outcome. The approach includes the complete understanding of the child‘s evolutionary history that includes the child‘s development, his upbringing, his environment, his interpersonal relationships and his coping mechanisms. The history taking also includes mother‘s complete history during pregnancy as it has a considerable effect on the constitution of the child in its formative years. It also includes enquiring about the state of physical and mental health of the parents during the time of conception.

A correlation is established at the end of the history so that the problem is understood from all dimensions. This further helps establish goals of therapy and criteria for follow up.

A thorough study for understanding the clinical presentation of Conduct Disorder and the manifestation of behavioural problems in individuals should be done based on these principles. The treatment should be carried out with ongoing supportive therapies and interventions if any. Existing evidence and clinical experience suggest that through Homoeopathy, we can control existing symptoms and prevent further worsening of the symptoms. Homoeopathy can help persons with conduct disorder in understanding their potential with the existing disorder.

Studies state that drugs such as Absinthium, Tarentula Hispanica, Opium, Chamomilla, Nitric acid, are found more effective in hyperactive children and drugs like Bufo rana for early sexual activity ⁽²⁾.

Anacardium
The child exhibits wickedness and malice with no remorse for its actions. This is often accompanied by gastric complaints ⁽¹⁾. Slow to comprehend. Marked irritability; disturbed by everything; cursing. Unsocial; complains of weak memory. Slight causes make him excessively angry. A strong feature is that all moral feeling is taken out of him. He feels cruel. Can do bodily injury without feeling. Cruel, malicious, wicked ⁽⁸⁾.

Cantharis
The child is furious and doesn’t allow anyone to touch it. This child also has associated urinary complaints ⁽¹⁾.

Head hot, frenzy, delirium, with great excitement and rage, paroxysms renewed by dazzling or bright objects, by touching the larynx or by trying to drink water as in rabies. This kind of mental conduct in Cantharis is similar to what will take place in Hyos., Phos., and Secale; a violent delirious state intermingled with sexual ideas and talk. In some instances he deliriously sings lewd songs and prattles on the subject of human genitals, urine and faeces, a wild raving on subjects not talked about in health except among the depraved ⁽⁸⁾.

Chamomilla
The child exhibits restlessness with a lot of shouting and crying. The complaints can be traced back to the time of dentition ⁽¹⁾.

The nervous child when punished will go into convulsions. Quarrelsome. Easily chagrined or excited to anger ⁽⁸⁾.

Hepar Sulph
The child is offended by the slightest provocation. It exhibits a short temper. This child is often oversensitive to cold air drafts and catches cold ⁽¹⁾.

Every little thing that disturbs the patient makes him intensely angry, abusive and impulsive. The impulses will overwhelm him and make him wish to kill his best friend in an instant. Impulses also that are without cause sometimes crop out in Hepar ⁽⁸⁾. The slightest cause irritates him. Dejected and sad. Ferocious. Hasty speech ⁽⁹⁾

Tarentula Hispanica
The child exhibits fearlessness along with restlessness. The restlessness reduces on listening to music ⁽¹⁾. A strong aversion to colours such as green, red and black. Loss of all shame. Desire to run about, to dance and jump up and down. Great fantastic dancing. Sometimes, music ameliorates all the symptoms and it other times it aggravates them. He becomes violently excited from music.

She sees monsters, animals, faces, insects and ghosts. She sees strangers in the room. Tarentula patients feign all sorts of sickness, especially fainting. They not only imagine themselves sick, but they pretend to be sick when they are not. Constantly, complaining and threatening; threatens her nurse and her attendants; strikes her head with her hands; strikes her body, her attendants and her best friends. Violence is a strong feature of the remedy. Violence with anger, Tears his clothing. Consolation causes weeping ⁽⁸⁾.  Sudden alteration of mood. Destructive impulses; moral relaxation. Ungrateful, discontented. Guided by whims ⁽⁹⁾.

The literature states that a combined effort of parent, homoeopath and behavioural psychologist can bring about the desired change in the abnormal behaviour of the child.  There is a need to create more awareness among parents regarding how Homeopathic treatment can accelerate and complement the response to conventional therapies.

REFERENCES:

1. Behavioural Disorders of childhood; National Health Portal of India, https://www.nhp.gov.in/Behavioral-disorders-of-chilhood_mtl last accessed on 30.09.2020.
2. Central Council for Research in Homoeopathy, National Campaign on Homoeopathy for Mother and Child Care, ‘Behaviour problems in children and homoeopathy’- Department of AYUSH, Ministry of Health and Family Welfare, Government Of India.
3. Scott S. National Conduct Problems Clinic, Maudsley Hospital, and Institute of Psychiatry, King’s College, London.
4. Deivasigamani TR. Psychiatric morbidity in primary school children: An epidemiological study. Indian J Psychiatry 1990; 32:235-40.
5. Sarkar AB, Kapur M, Kaliaperumal VG. The prevalence and pattern of psychological disturbance in school going middle childhood children. NIMHANS J 1995; 13:33-41.
6. Srinath S, Girimaji SC, Gururaj G. Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas of Bangalore, India. Indian J Med Res 2005; 122:67-79.
7. American Psychiatric Association (APA). Diagnostic and Statistical manual of mental disorders. Fifth edition, special edition: 2017. Print
8. Kent J.T, Lectures on Homoeopathic Materia Medica New Delhi- B. Jain Publishers, Low price edition 2006- 2007
9. Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory, New Delhi- B. Jain Publishers, Reprint edition 2007, 2008