Conduct Disorder — MCQs
A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:
In which of the following conditions is behavior therapy considered most effective?
A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?
A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
What is the primary characteristic of antisocial personality disorder?
All of the following are disruptive, impulse control and conduct disorders except:
A 15-year-old adolescent is brought in for evaluation due to repeated failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse. What is the most likely diagnosis?
Which of the following is not a central characteristic of childhood autism?
A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
Conduct Disorder Indian Medical PG Practice Questions and MCQs
Question 1: A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:
- A. Attention deficit hyperactivity disorder
- B. Autism
- C. Conduct disorder (Correct Answer)
- D. Nothing abnormal (teenage phenomenon)
Explanation: ***Conduct disorder*** - This diagnosis is strongly indicated by the child's pattern of **aggressive behavior** (assaulting batchmates), **coercion/theft** (stealing money), and frequent **rule-breaking** (fighting, disciplinary problems). - These actions represent a persistent disregard for societal norms and the rights of others, characteristic of **conduct disorder** in a 13-year-old. *Attention deficit hyperactivity disorder* - While children with **ADHD** may have disciplinary problems due to impulsivity and inattention, the hallmark features of **aggression** and **theft** are not primary symptoms. - The core symptoms of ADHD are problems with **inattention, hyperactivity**, and **impulsivity**, which are not the central focus of this presentation. *Autism* - **Autism spectrum disorder** is characterized by persistent deficits in **social communication and interaction**, and **restricted, repetitive patterns of behavior**. - The described behaviors of fighting, stealing, and assaulting are not typical manifestations of autism. *Nothing abnormal (teenage phenomenon)* - While some behavioral changes are normal during adolescence, a consistent pattern of **assault, theft, and severe disciplinary problems** goes beyond normal teenage rebellion. - These behaviors indicate a significant underlying issue requiring professional intervention, not just a passing phase.
Question 2: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 3: A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?
- A. Bipolar disorder
- B. Schizoaffective disorder
- C. Antisocial personality
- D. Borderline personality disorder (Correct Answer)
Explanation: ***Borderline personality disorder*** - Patients with **borderline personality disorder** often exhibit **impulsivity**, intense mood swings, and a pattern of unstable interpersonal relationships, leading to aggressive outbursts. - Their unpredictable behavior and tendency to form intense, unstable attachments or a "favorite person" dynamic are characteristic, as seen in her differing demeanor towards a particular resident doctor. *Bipolar disorder* - While bipolar disorder involves **mood swings**, the behavioral patterns are typically characterized by distinct episodes of **mania** or hypomania and depression, with less emphasis on chronic interpersonal instability and aggression. - The aggression in bipolar disorder is often associated with the manic phase but lacks the consistent pattern of relationship instability and "favorite person" dynamic described. *Schizoaffective disorder* - This disorder involves a combination of **psychotic symptoms** (like delusions or hallucinations) and **mood symptoms** (like depression or mania), which are not explicitly described here as the primary issue. - The aggressive behavior is not primarily driven by psychosis, and the specific interpersonal dynamic with staff is more suggestive of a personality disorder. *Antisocial personality* - **Antisocial personality disorder** is characterized by a pervasive pattern of disregard for and violation of the **rights of others** and may include aggression, but it often involves a lack of empathy and manipulativeness rather than the intense emotional dysregulation and unstable interpersonal patterns seen in borderline personality. - While aggressive behavior is present, the specific description of verbally abusing staff while showing a "different demeanor" towards a particular doctor points away from the typical presentation of antisocial disregard for others.
Question 4: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
- A. Narcissistic personality disorder
- B. Paranoid personality disorder
- C. Schizotypal personality disorder
- D. Antisocial personality disorder (Correct Answer)
Explanation: ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder.
Question 5: What is the primary characteristic of antisocial personality disorder?
- A. Violation of rules of society (Correct Answer)
- B. Attention-seeking behavior
- C. Unstable interpersonal relationship
- D. Grandiose behavior
Explanation: ***Violation of rules of society*** - A primary characteristic of Antisocial Personality Disorder (ASPD) is a pervasive pattern of **disregard for and violation of the rights of others**, often manifested by **failure to conform to social norms and laws**. - Individuals with ASPD frequently engage in **deceitfulness, impulsivity, irritability, aggressiveness**, and a consistent **irresponsibility** that leads them to break societal rules. *Attention-seeking behavior* - While some individuals with ASPD might engage in behaviors that attract attention, **attention-seeking is a core feature of Histrionic Personality Disorder**, not ASPD. - Individuals with ASPD are more focused on manipulation and exploitation rather than seeking to be the center of attention for its own sake. *Unstable interpersonal relationship* - **Unstable interpersonal relationships** are a hallmark feature of **Borderline Personality Disorder**, characterized by intense, chaotic, and often short-lived relationships. - In ASPD, relationships are often superficial and formed to exploit others, reflecting a lack of empathy rather than instability driven by fear of abandonment. *Grandiose behavior* - **Grandiose behavior** and an exaggerated sense of self-importance are primary characteristics of **Narcissistic Personality Disorder**. - Although individuals with ASPD may exhibit some self-importance, it is typically linked to their manipulative tendencies and sense of entitlement rather than primary grandiosity.
Question 6: All of the following are disruptive, impulse control and conduct disorders except:
- A. Conduct disorder
- B. Oppositional defiant disorder
- C. Intermittent explosive disorder
- D. Munchausen syndrome (Correct Answer)
Explanation: ***Munchausen syndrome*** - This is an older term for **factitious disorder imposed on self**, where an individual feigns or induces illness to assume the sick role. - It is classified under **somatic symptom and related disorders**, not disruptive, impulse control, and conduct disorders. *Conduct disorder* - This disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. - It is explicitly listed as a **disruptive, impulse control, and conduct disorder** in the DSM-5. *Oppositional defiant disorder* - This involves a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months. - It is a primary diagnosis within the category of **disruptive, impulse control, and conduct disorders**. *Intermittent explosive disorder* - Characterized by recurrent behavioral outbursts representing a failure to control aggressive impulses, often disproportionate to the provocation. - This disorder is a core example of an **impulse control disorder** within the disruptive, impulse control, and conduct disorders section of the DSM-5.
Question 7: A 15-year-old adolescent is brought in for evaluation due to repeated failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse. What is the most likely diagnosis?
- A. Conduct disorder (Correct Answer)
- B. Oppositional defiant disorder
- C. Intermittent explosive disorder
- D. Antisocial personality disorder
Explanation: ***Conduct disorder*** - This diagnosis is characterized by repeated patterns of behavior that **violate the rights of others** or major societal norms, consistent with the patient's presentation of **deceitfulness, impulsivity, and lack of remorse**. - For individuals under 18, it is the appropriate diagnosis, as **Antisocial Personality Disorder** cannot be diagnosed before turning 18. *Oppositional defiant disorder* - This condition involves a pattern of **angry/irritable mood, argumentative/defiant behavior**, or vindictiveness. It does not typically include the severe violations of societal norms or the rights of others seen in this case. - While there is defiance, it generally lacks the **aggression** towards people/animals, **destruction of property**, or **deceitfulness/theft** that characterize conduct disorder. *Intermittent explosive disorder* - This disorder is marked by **recurrent behavioral outbursts** representing a failure to control aggressive impulses. - The outbursts are typically **disproportionate** to the provocation but do not necessarily involve the persistent pattern of violating others' rights or societal rules as described. *Antisocial personality disorder* - This diagnosis requires an individual to be at least **18 years old** and have a history of conduct disorder symptoms before age 15. - Although the symptoms align with the criteria for **antisocial behavior**, the patient's age (15 years old) precludes this diagnosis.
Question 8: Which of the following is not a central characteristic of childhood autism?
- A. Callous and unemotional traits (Correct Answer)
- B. Impaired communication
- C. Restricted, repetitive behaviour
- D. Impaired social interaction
Explanation: ***Callous and unemotional traits*** - While some individuals with autism may struggle with empathy, **callous and unemotional traits** are not a core diagnostic feature of autism spectrum disorder (ASD); they are more commonly associated with conditions like **conduct disorder** or **antisocial personality disorder**. - **Emotional dysregulation** and **difficulty recognizing others' emotions** are common in autism, but this differs from a pervasive pattern of callousness. *Impaired communication* - **Impaired verbal and nonverbal communication** is a fundamental diagnostic criterion for autism spectrum disorder, ranging from absent speech to difficulties with conversations and understanding social cues. - This can manifest as problems with **initiating or maintaining conversations**, **lack of eye contact**, and **unusual tone of voice**. *Restricted, repetitive behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic feature of ASD. - Examples include **stereotyped motor movements**, **insistence on sameness**, **highly restricted or fixated interests**, and **unusual sensory sensitivities**. *Impaired social interaction* - **Persistent deficits in social communication and social interaction** across multiple contexts are defining characteristics of autism. - This includes difficulties with **social-emotional reciprocity**, **nonverbal communication**, and **developing, maintaining, and understanding relationships**.
Question 9: A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
- A. Conduct disorder
- B. Oppositional defiant disorder (Correct Answer)
- C. Autism spectrum disorder
- D. Attention deficit hyperactivity disorder
Explanation: **Oppositional defiant disorder** - The boy's behaviors of **not following rules**, arguing with teachers and students, and **provoking parents** are characteristic features of ODD. - ODD is defined by a pattern of **angry/irritable mood**, argumentative/defiant behavior, or vindictiveness. *Conduct disorder* - Conduct disorder involves more serious violations of the **rights of others** or major **societal norms**, such as aggression towards people or animals, destruction of property, deceitfulness, or theft. - The scenario describes defiant and argumentative behavior, not the severe actions typical of conduct disorder. *Autism spectrum disorder* - ASD is characterized by persistent deficits in **social communication and interaction** across multiple contexts, and **restricted, repetitive patterns of behavior, interests, or activities.** - The provided symptoms do not align with the core diagnostic criteria for autism spectrum disorder. *Attention deficit hyperactivity disorder* - ADHD involves a persistent pattern of **inattention** and/or **hyperactivity-impulsivity** that interferes with functioning or development. - While some defiant behavior can coexist with ADHD, the primary presentation here is one of opposition and defiance, not predominantly inattention or hyperactivity.
Question 10: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
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