Diagnosis, Reasoning, and Evidence for Diagnosis of a Case Study

Previous Diagnoses

The patient in the case study, B, has been diagnosed with numerous disorders, yet none of the prescribed treatments or medications have helped to alleviate his symptoms. He was diagnosed with Anxiety Disorder, but the benzodiazepine prescribed increased his anxiety. Similarly, stimulant medication for a possible ADHD diagnosis did not help B and in fact exasperated him, a clear sign that ADHD was an incorrect diagnosis. B does not exhibit key symptoms of OCD or Schizophrenia, the other diagnoses he received, such as persistent thoughts, ideas, and behaviors that occur in OCD or hallucinations and delusions associated with Schizophrenia.

Possible Diagnosis

It is likely that B is suffering from Oppositional defiant disorder (ODD). ODD is grouped among the Disruptive Behavior Disorders (DBD) and is one of the most common clinical disorders in children and adolescents. ODD is characterized by oppositional behavior, vindictiveness, hostility, and verbal and/or physical threats that interfere with social or academic functioning (Action, 2007, p. 126). Additionally, the DSM-V explains that in order to meet the diagnosis of ODD, the patient must exhibit four of eight different characteristics (American Psychiatric Association, 2013). B meets six of these including often losing his temper, often arguing with adults, often refuses to comply with adult requests, often touchy and easily annoyed, often angry and resentful, and often spiteful or vindictive. Not only does B’s mother explain this symptomology in B’s life, but he also exhibits behaviors in the clinician’s office including hitting his mother, yelling, and being argumentative and demanding. The DSM-V states that in order to meet this diagnosis, the patient must have exhibited these behaviors for at least six months, and B has been exhibiting these behaviors for over one year.

Next, the DSM-V states that for diagnosis, the disturbance in behavior must “cause clinically significant impairments in academic, social, or occupational functioning” (American Psychiatric Association, 2013). B’s mother states that B has no friends, which displays social impairment. It is also likely that B’s lack of attention interferes with his school work and educational ability.

Lastly, the DSM-V criteria state that the behaviors do not occur exclusively during a psychotic or mood disorder and that the behaviors do not meet the criteria for Conduct Disorder (CD). While B has anxiety issues, mood disorder has been ruled out as a diagnosis due to his lack of response to medication. Additionally, Schizophrenia has been ruled out. It appears that B does not have CD because his aggression seems to come out of frustration and is not characterized as destructive or physically cruel. He also does not exhibit common behaviors of CD such as stealing, intentional injury, or sexual acting out (American Psychiatric Association, 2013). Since B is under the age of 18, it is not necessary to rule out Antisocial Personality Disorder, which the DSM-V specifies must be ruled out for cases age 18 or older.

Based on this evidence, ODD is the most likely diagnosis for B.

References

Action, A. O. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of American Academy of Child and Adolescent Psychiatry, 46(7), 126-141.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.