CASE PRESENTATION: SARAH 2
CASE PRESENTATION
I. Key Clinical Issues
A. Client Demographics
The client, Sarah, is a thirteen year old, white female. She lives with her mother and
father. Her mother is an attorney. Her father is an investment banker.
B. Presenting Problem
The client presents with challenging behaviord including threats of physical violence,
defiance, and disobedience. Sarah has been suspended from school on multiple
occasions for threating students and stealing other’s belongings. Sarah’s parents state
her behaviors continue at home. Sarah oftens sneaks out of the house, becomes angry
when disciplined, and is overall defiant. Sarah underwent psychological evaluation
and behaved in a standoffish and apathetic manner towards the process. From this
evaluation, it was revealed that Sarah’s mother had suffered from placenta
detachment during pregnanct and Sarah presented developmental delays at a young
age.
II. Diagnosis
A. Diagnostic Impressions:
1. Oppositional Defiant Disorder: Client shows behaviors congruent with DSM-5
diagnostic criteria including often being angry, resentful, and defiant (American
Psychiatric Association, 2013).
2. Conduct Disorder: Client exhibits behaviors similar to those in the DSM-5
including excessive bullying of others and destruction of property (American
Psychiactric Association, 2013).
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CASE PRESENTATION: SARAH 3
3. Antisocial Personality Disorder: Client shows symptoms similar to those in the
DSM-5 for APD including reckless disregard to self and others and irritability and
aggressiveness (America Psychiatric Association, 2013).
B. Differential Diagnosis:
1. Antisocial Personality Disorder: According to the DSM-5, in order to be
diagnosed with ASPD, the client must be atleast 18 years of age.
2. Oppositional Defiant Disorder: According to the DSM-5, a client with ODD
will often annoy others for enjoyment. From the information given, Sarah does
not attempt to annoy people, but rather approaches with anger and fear. If more
information was present, ODD could be another diagnosis to consider.
C. Full DSM Diagnosis: Conduct Disorder
1. Aggression to People and Animals: Sarah has deomstrated aggression to peers
through threats of physical violence and punching another student. Sarah has
also stolen other’s property with no regard for their feelings or possible
response.
2. Destruction of Property: Sarah has cut a chainlink fence to sneak out of the
house. Sarah has also broken into a local swim club to go skinny dipping.
3. Deceitfulness and Theft: Sarah has lied about owning a pen and tried to steal it
only for the truth to come out that the pen belonged to another student.
4. Serious Violations of Rules: Sarah demonstrates severe defiance of authority
figures and becomes angry and violent when reprimanded for certain behaviors.
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CASE PRESENTATION: SARAH 4
III. Etiology of the Problem/Disorder
A. Biological Theory: Conduct Disorder is contributed to through genetic and biological
factors (American Psychiatric Association, 2013). If Sarah’s parents struggle with
depression, bipolar, or another psychiatric condition, it is more likely to pass on
conduct disorder to their children. During Sarah’s mother’s pregnancy, the placenta
detached which can cause a lack of oxygen to the brain and affect the development of
the baby, in this case Sarah. Sarah also hit her head as a young child and that could
have affected her developmentally.
B. Psychosocial Theory: Parenting styles and factors can contribute to conduct disorder.
From the information provided, Sarah’s parents may be neglectful. Both parents work
full-time and stressful jobs. Sarah says herself that if she stays out of the way, her
parents leave her alone. For a child that craves attention and affection, the child will
settle for any attention given including negative attention (De Sanctis et al., 2008).
Therefore, Sarah may take part in these behaviors in order to gain the attention of her
parents.
IV. Treatment Recommendations
A. Biological Intervention: The first step in a biological intervention is for Sarah to
receive a full diagnosis from a mental health professional. In order to treat from the
biological viewpoint, the doctor may prescribe medication to balance the chemicals in
the brain that may help Sarah to combat the impulsivity and defiant behaviors.
Pharmacotherapy can help a client combat negative symptoms through providing the
ability to change the way one thinks and feels (Parritz & Troy, 2018).
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CASE PRESENTATION: SARAH 5
B. Psychosocial Intervention: The first step in a psychosocial intervention is for Sarah
to receive a full diagnosis from a mental health professional. The next step is to work
with a psychiatrist and therapist to find the right therapy for Sarah. Cognitive
behavioral therapy is beneficial to clients who need to process thoughts and feelings
and apply new methods to their behaviors in order to change or alter their negative
behaviors to become more positive or productive (Parritz & Troy, 2018). In Sarah’s
case, family therapy would be very beneficial to help heal the family dynamics of
parental neglect and possible resentment from both sides. Therapy can help a client to
make positive changes and empower them to live a more positive life.
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CASE PRESENTATION: SARAH 6
Resources
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
Fifth Edition. American Psychiatric Publishing.
De Sanctis, V. A., Trampush, J. W., Harty, S. C., Marks, D. J., Newcorn, J. H., Miller, C. J., &
Halperin, J. M. (2008). Childhood maltreatment and conduct disorder: independent
predictors of adolescent substance use disorders in youth with attention
deficit/hyperactivity disorder. Journal of clinical child and adolescent psychology : the
official journal for the Society of Clinical Child and Adolescent Psychology, American
Psychological Association, Division 53, 37(4), 785–793.
https://doi.org/10.1080/15374410802359650
Parritz, R. A. & Troy, M. F. (2018). Disorders of childhood: development and psychopathology.
Third Edition. Wadsworth.
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