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A 14-year-old girl arrives in triage with a defensive knife wound to her left forearm. She is sullen and withholding, but admits to having been in a knife fight with œa group of girls from school. Except for her injury, the physical examination is otherwise normal, although the emergency department staff notes the presence of several gang-related tattoos. On parallel history, the patient™s mother admits that she has not seen her daughter for more than a week, but that these disappearances are so frequent that the mother has stopped attempting to discipline her daughter. The truant officer has come to her home frequently to inquire about her daughter™s school absence. Several days ago, a police officer arrived at the mother™s door to question her regarding her daughter™s suspected role in a recent case of arson involving a nearby abandoned building. Tearfully, the mother reports that she is very concerned for her daughter™s safety. She admits that from early childhood, her daughter has been quick to anger and to resort to physical violence. On occasion, several of her outbursts have resulted in injuries to her mother and siblings that required medical attention. The patient™s history and presentation is most consistent with which disorder?
Antisocial personality disorder (APD)
Conduct disorder (CD)
Major depressive disorder
Posttraumatic stress disorder (PTSD)
Schizoid personality disorder
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Option B (Conduct disorder [CD]) is correct. Children or adolescents with CD often initiate aggressive behavior, or react aggressively toward other people and animals. They are often involved in physical fights, with weapons that can cause serious physical harm to others. The deliberate destruction of property is also characteristic of this disorder. Deceitfulness is not uncommon, along with serious violations of parental, societal, or school rules. Frequent truancy and running away from home for lengthy periods, are hallmarks of this disorder. The behavior must be of a severity to cause significant decline in social, school, or occupational function and should be greater in severity as compared to the behavior of similarly aged peers.
Option A (Antisocial personality disorder [APD]) is incorrect. Although her behavior meets a number of criteria for this diagnosis, an individual must be at least 18 years of age to be diagnosed with antisocial personality disorder. Of note, one of the criteria for diagnosing APD is evidence of conduct disorder with onset before 15 years of age.
Option C (Major depressive disorder) is incorrect. Although in children and adolescents depression can often present with increased irritability, it is not associated with the types of conduct disturbance described earlier.
Option D (Posttraumatic stress disorder [PTSD]) is incorrect. Although PTSD can often present with increased irritability or outbursts of anger, it is not associated with the types of conduct disturbance described earlier.
Option E (Schizoid personality disorder) is incorrect. Individuals with schizoid personality disorder are withdrawn and aloof and avoid interpersonal contact. They seek out solitary, isolated activities.
