Palm Beach State College Limited Prosocial Emotions Specifier Responses

Case Conceptualization

Andrew, a 15-year-old Caucasian male has had several instances of aggression since the age of five (Kress & Paylo, 2019). As early as elementary school, Andrew has exhibited aggressive behaviors which have continued to escalate reported by his mother (Kress & Paylo, 2019). His aggressive behaviors have been directed at his siblings, peers, and parents (Kress & Paylo, 2019). His mother first expressed her concerns when she saw Andrew kill a frog at age 6 and he showed no signs of emotion afterward (Kress & Paylo, 2019). She reported that he has had numerous incidents of killing animals (Kress & Paylo, 2019). Most recently, he was expelled from school after he threatened to kill another student with a knife in his possession (Kress & Paylo, 2019).

Diagnostic Impressions

312.82 F91.1 Conduct Disorder, Childhood-Onset Type with limited prosocial emotions: Lack of remorse or guilt, Severe

Rationale for Diagnostic Impressions

Andrew appears to have symptoms that correlate to F91.1 Conduct Disorder (American Psychiatric Association, 2013). Andrew has demonstrated aggressive behaviors consistently for ten years from age 5 to his current age of 15. Andrew has demonstrated a repetitive and persistent pattern of behavior by violating others’ basic rights as well as violating age-appropriate societal norms (Criterion A, American Psychiatric Association, 2013). It has been reported that Andrew has threatened peers (Criterion A1, American Psychiatric Association, 2013). He has initiated physical altercations (Criterion A2) many times (American Psychiatric Association, 2013). In his most recent altercation with another student, he had a knife in his possession, however, it is not clear not known if he used the knife in the altercation. If it becomes known that he used the knife, then he would meet Criterion A3 (American Psychiatric Association, 2013). He has been physically violent (Criterion A4) to others as evidenced by an assault on a girl at his school when he was 11 years old. Andrew has hurt and killed several animals (Criterion A5, American Psychiatric Association, 2013). He has been caught cheating and lying which meets Criterion A11 and stealing which meets Criterion A12 (American Psychiatric Association, 2013).

Andrew’s multiple acts of hurting and killing animals are consistent with the specifier of limited prosocial behaviors, a lack of remorse, or guilt (American Psychiatric Association, 2013). His mother reported that Andrew showed no emotions after killing a frog at age 6 (Kress & Paylo, 2019).

Andrew is exhibiting severe clinical distress and his current and past behaviors have had a significant impact on his social and academic functioning meeting Criterion B (American Psychiatric Association, 2013). Andrew failed the seventh grade and has few friends (Kress & Paylo, 2019). He is now in the ninth grade (Kress & Paylo, 2019). After his recent physical altercation causing him to be expelled from school, he was taken to a secure residential intensive treatment center (Kress & Paylo, 2019). Andrew does not meet the criteria for antisocial personality disorder as he is under the age of 18, therefore he meets Criterion C of the diagnosis of conduct disorder (American Psychiatric Association, 2013). Andrew’s mother reported that his symptoms appeared at age 6 when he began hurting and killing animals. This is characteristic of the Childhood-onset type of conduct disorder, in which individuals show at least one symptom of conduct disorder prior to age 10 years (American Psychiatric Association, 2013). Andrew’s multiple instances of aggressive and violent behavior since age 6 is consistent with a specifier of “severe” (American Psychiatric Association, 2013). In order to be considered severe, conduct problems in excess of those required to make the diagnosis are present (American Psychiatric Association, 2013). Andrew’s case presentation outlines numerous conduct problems.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson