Identifying Information: Mason Daniels is a 13-year-old boy in 7th grade, referred for psychiatric evaluation due to repeated sudden anger outbursts and aggressive behavior.
Chief Concern (Parent Report): “He has a short fuse. He’s fine most of the time, but when something sets him off, he explodes and loses control.”
History of Present Illness
Since early childhood, Mason has had brief episodes of explosive anger that occur every 3–6 weeks. These episodes are triggered by minor frustrations, teasing, or being corrected by adults. During these episodes, he may throw objects, yell, or exhibit physical aggression. Between episodes, his behavior and mood are normal.
Examples of past incidents:
· At age 12, he threw a metal lunch tray at a classmate who took his seat.
· At age 11, he shoved a peer during a minor disagreement on a school trip.
After each episode, Mason feels guilty, apologizes, and sometimes cries. He reports, “I don’t want to hurt anyone. I get angry too fast.” No premeditation or planning is involved in any of the incidents.
Functioning Between Episodes: Mason gets along with most peers and teachers. He completes his homework and earns mostly B’s. He enjoys video games and plays basketball. Teachers describe him as “sensitive, polite, and easily embarrassed.”
Developmental and Medical History
· No history of ADHD, learning disorders, or autism spectrum behaviors.
· No neurological abnormalities; MRI, physical exam, and EEG were normal.
· No substance use (including nicotine or alcohol).
· No hallucinations, delusions, or symptoms of mania or depression.
Psychiatric and Family History: No previously diagnosed mental illness. Family history of “anger issues” on the paternal side, but no known psychiatric conditions.
Mental Status Observations (During Evaluation): Mason is cooperative, engaged, and reflective. He expresses regret and insight about his behavior. Mood is neutral with appropriate affect—no signs of persistent irritability, psychosis, mania, or depressive symptoms.
Key Clinical Features
· Recurrent behavioral outbursts that are impulsive, intense, and disproportionate to triggers.
· No premeditation, no persistent irritability, and guilt after outbursts.
· Between episodes: calm, functioning well, no behavioral problems.
· No pattern of violation of rights, theft, deceit, or cruelty.
· No persistent defiance or vindictiveness
Questions
1. Which DSM-5-TR diagnostic criteria best fit Mason’s symptoms? Support your diagnosis with reasoning.
2. List three differential diagnoses to be ruled out for Mason. Provide an appropriate rationale for your differentials listed.
3. Does Mason meet the criteria for Conduct Disorder or Oppositional Defiant Disorder? Why or why not?
4. What treatment approaches would you recommend? Explain both pharmacological and non-pharmacological management.
5. How does Mason’s guilt after episodes help guide the diagnosis?
6. What collaborative strategies should clinicians use when working with Mason’s school, family, and community supports to promote emotional regulation, safety, and functional resilience?
7. Based on DSM-5-TR, what are potential long-term outcomes or risks associated with Mason’s symptom presentation if left untreated? What protective factors are present?