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Conduct Disorder — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryConduct DisorderMRCPsych Paper B

A 14-year-old boy is assessed after 12 months of escalating behavioural problems at home and school. He has repeatedly bullied and physically intimidated other pupils, deliberately started a fire that risked serious property damage, shoplifted on several occasions and is frequently truant. These behaviours have caused marked disruption to his education and family life. When confronted, he expresses little guilt about the harm caused. Which is the single most likely diagnosis?

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Correct answer: A — Conduct disorder

The answer is conduct disorder. The persistent pattern includes aggression towards others, deliberate fire-setting, theft and serious violation of rules through repeated truancy, with substantial educational and family consequences. NICE identifies aggression, property destruction, deceitfulness or theft, and serious rule violations as core conduct-disorder symptoms in young people over 11. Oppositional defiant disorder mainly involves angry, argumentative and defiant behaviour and does not account for these more serious violations of others' rights. ADHD may coexist but requires a characteristic pattern of inattention and/or hyperactivity-impulsivity. Autism spectrum disorder requires persistent social-communication differences and restricted or repetitive behaviours. Separation anxiety does not explain the antisocial pattern.

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