Conduct Disorder — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryConduct DisorderMRCPsych Paper B

A 15-year-old boy is assessed after a 12-month pattern of behavioural problems at home, school and in the community. He repeatedly bullies younger children, steals from shops, deliberately sets fires that damage property, truants from school and stays out overnight despite parental prohibition. He understands the likely consequences of his actions but shows no remorse. Which diagnosis best explains this pattern?

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Correct answer: A — Conduct disorder

Conduct disorder is the best answer. Over 12 months, the young person has shown aggression towards others through bullying, destruction of property through fire-setting, theft and serious rule violations such as truancy and staying out overnight. These are core conduct-disorder domains identified by NICE for young people over 11 years. Lack of remorse further supports a severe antisocial pattern. Oppositional defiant disorder primarily involves angry, argumentative and defiant behaviour without the major violations of others’ rights seen here. Intermittent explosive disorder consists of recurrent disproportionate aggressive outbursts rather than this broad pattern of planned and persistent antisocial behaviour. ADHD may contribute to impulsivity, and autism may involve behavioural difficulties, but neither independently accounts for this organised pattern of theft, aggression, property destruction and rule-breaking.

Reference: National Institute for Health and Care Excellence. Antisocial behaviour and conduct disorders in children and young people: recognition and management (CG158), section 1.3.10. 2013; last updated 2017 and reviewed 2025. https://www.nice.org.uk/guidance/cg158/chapter/recommendations