Conduct Disorder (CD) has traditionally been associated with overt aggression and rule violations, with a higher prevalence in males. However, recent updates in ICD-11 and psychiatric research have shed light on the unique presentation of conduct disorder in females. Understanding these distinctions is crucial for accurate diagnosis, treatment, and support strategies.

ICD-11 Classification of Conduct Disorder

In ICD-11, Conduct Disorder falls under 6C91 – Conduct-dissocial disorder within the chapter on mental, behavioral, and neurodevelopmental disorders. This classification emphasizes persistent patterns of behavior violating societal norms and the rights of others, with diagnostic subcategories that help differentiate different forms of CD:

Subtypes of Conduct Disorder (ICD-11)

1. 6C91.0 – Conduct-dissocial disorder, childhood-onset (before age 10)
2. 6C91.1 – Conduct-dissocial disorder, adolescent-onset (after age 10)
3. 6C91.Z – Conduct-dissocial disorder, unspecified
4. 6C91.2 – Socialized conduct disorder (CD with intact peer relationships)
5. 6C91.3 – Unsocialized conduct disorder (CD with severe relational impairments)

Notably, ICD-11 acknowledges gender differences, helping clinicians recognize the less overt but equally impairing symptoms in females.

While males with CD often exhibit physical aggression, property destruction, and impulsivity, females display a more covert pattern of antisocial behavior. Some key distinctions include:

Feature	Males with Conduct Disorder	Females with Conduct Disorder
Aggression	Physical aggression, fights	Relational aggression (gossiping, social exclusion)
Rule violations	Truancy, vandalism, physical altercations	Running away, truancy, early sexual behavior
Delinquency	Gang involvement, theft	Prostitution, exploitative relationships
Emotional Regulation	Externalizing behaviors (anger, impulsivity)	Internalizing symptoms (anxiety, depression, self-harm)
Comorbidities	ADHD, substance use disorders	PTSD, depression, borderline traits

Females with conduct disorder may not display obvious aggression but instead engage in manipulative, deceitful, or exploitative behaviors that harm others while maintaining social relationships.

Why Are Females Often Misdiagnosed?

Historically, conduct disorder was underdiagnosed in females due to gendered expectations of aggression. Many females with CD were misdiagnosed with mood disorders (e.g., depression, borderline personality disorder) or simply labeled as “troubled” rather than being recognized as having a conduct-dissocial disorder.

Key misdiagnosis pitfalls include:

• Ignoring relational aggression: While girls may not engage in fights, they use coercion, social manipulation, and exclusion to dominate others.
• Overlooking trauma histories: Many girls with CD have a background of abuse, neglect, or exploitation, contributing to emotion dysregulation and high-risk behaviors.
• Confusing symptoms with borderline personality disorder (BPD): Self-harm, emotional instability, and interpersonal chaos can overlap with both CD and BPD, leading to misclassification.

Clinical and Social Implications of CD in Females

Females with conduct disorder face distinct challenges compared to their male counterparts. Some major implications include:

1. Increased Risk of Victimization

• Adolescent females with CD face higher risks of sexual exploitation, intimate partner violence, and early pregnancies.
• They may enter abusive relationships due to impaired judgment and early exposure to trauma.

2. High Co-occurrence with Mood and Anxiety Disorders

• Unlike males, females with CD often experience comorbid depression, PTSD, or anxiety.
• This internalizing aspect makes them more vulnerable to self-harm and suicidal ideation.

3. Negative Long-Term Outcomes Without Early Intervention

• Women with untreated conduct disorder have a higher likelihood of developing antisocial personality disorder (ASPD) in adulthood.
• Increased risks of substance use disorders, poor academic performance, and chronic legal issues.

Treatment Approaches for Females with Conduct Disorder

Given the gender-specific aspects of conduct disorder, intervention strategies must go beyond traditional behavioral management techniques. Some effective approaches include:

1. Trauma-Informed Care

• Since many girls with CD have a history of neglect or abuse, therapy should address attachment wounds and emotional dysregulation.
• Trauma-focused CBT (TF-CBT) and Dialectical Behavior Therapy (DBT) help regulate self-destructive behaviors and impulsivity.

2. Family and Peer-Based Interventions

• Girls with CD benefit from family therapy, especially functional family therapy (FFT) or multisystemic therapy (MST).
• Group-based interventions should focus on healthy peer relationships and social skill development.

3. Addressing Comorbidities

• Medication for underlying conditions (e.g., SSRIs for mood disorders, stimulants for ADHD) may be necessary.
• Social support programs can prevent future victimization and promote positive role modeling.

Conclusion: A Call for Gender-Specific Awareness and Care

Conduct Disorder in females remains underrecognized and misdiagnosed due to societal expectations and clinical bias. With ICD-11 providing a more refined diagnostic framework, mental health professionals must adapt their assessment and intervention strategies to account for the unique presentations in girls.

By prioritizing early intervention, trauma-informed care, and gender-sensitive approaches, we can improve long-term outcomes for females struggling with conduct disorder.

Final Thought:

If we fail to recognize conduct disorder in females, we risk labeling them unfairly, missing opportunities for intervention, and allowing cycles of trauma and dysfunction to persist. The time for gender-aware mental health care is now!