A 13-year-old girl is brought to the office for a routine visit. Although the patient is doing well in school and has friends, her mother is concerned about a change in her behavior over the past several months. They had previously enjoyed spending time together, but now the patient is frequently moody and spends most of her time on the computer in her locked bedroom. The mother also observes that her daughter gets upset for no reason and has used swear words on occasion. When the mother recently complimented her party outfit, the girl screamed, "I look hideous and I'm not going," and stormed out of the room. Later that day, she seemed fine and went to the party. On examination, the patient is pleasant and cooperative but makes little eye contact and asks if she can keep her tank top on during the examination. Which of the following is the most likely explanation for this girl's behavior?

Question

A 13-year-old girl is brought to the office for a routine visit.  Although the patient is doing well in school and has friends, her mother is concerned about a change in her behavior over the past several months.  They had previously enjoyed spending time together, but now the patient is frequently moody and spends most of her time on the computer in her locked bedroom.  The mother also observes that her daughter gets upset for no reason and has used swear words on occasion.  When the mother recently complimented her party outfit, the girl screamed, "I look hideous and I'm not going," and stormed out of the room.  Later that day, she seemed fine and went to the party.  On examination, the patient is pleasant and cooperative but makes little eye contact and asks if she can keep her tank top on during the examination.  Which of the following is the most likely explanation for this girl's behavior?

Quizplus · Accepted Answer

This patient's intense self-consciousness, concerns about appearance and social acceptance, moodiness, increasing need for privacy, and transient emotional outbursts are characteristic of normal adolescence. Adolescence involves the developmental tasks of separating from the family, developing a sense of identity, and adjusting to the hormonal and physical changes of puberty. This girl's reluctance to remove her tank top for the physical examination is likely related to her self-consciousness regarding pubertal development. Although differentiating normal adolescent behavior from early signs of psychiatric disorders can be difficult, this patient's engagement with school and friends is reassuring. In contrast, adolescents exhibiting persistent anger, sadness, impulsivity, sleep or appetite disturbance, declining academic performance, and social isolation from peers warrant further evaluation. (Choice A) Patients with body dysmorphic disorder are excessively preoccupied with perceived defects in their physical appearance and engage in time-consuming, repetitive behaviors (eg, mirror checking, excessive grooming) that cause significant impairment in functioning. This patient's appearance concerns and self-consciousness about her changing body are typical of early adolescence. (Choice B) Although this girl exhibits mood lability that can be seen in borderline personality disorder, she lacks the pervasive pattern of instability in interpersonal relationships and self-image, marked impulsivity, and self-injury that characterize the disorder. Personality disorders are not diagnosed in adolescence, as the personality is still forming. (Choice C) Cyclothymic disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic and depressive symptoms that are insufficient to meet the criteria for hypomanic or major depressive episodes. Symptoms must be present for at least a year in children and adolescents and cause significant distress and impairment; this is not the case in this patient. (Choice D) Disruptive mood dysregulation disorder, a new diagnosis in DSM-5, is characterized by persistent irritability and frequent, developmentally inappropriate temper outbursts. This patient's transient emotional outburst related to insecurity about social acceptance is consistent with normal adolescent development. (Choice F) This patient does not exhibit the argumentative, defiant, and vindictive behavior required for the diagnosis of oppositional defiant disorder. Educational objective: Adolescence often involves some degree of moodiness, intense self-consciousness, and transient emotional outbursts. Assessment of severity, persistence, and degree of social and academic impairment can help differentiate normal adolescent behavior from behavioral changes requiring further evaluation. __________ References: Adolescent psychosocial, social, and cognitive development. (http://www.ncbi.nlm.nih.gov/pubmed/23908362) Ongoing development of social cognition in adolescence. (http://www.ncbi.nlm.nih.gov/pubmed/22934659)

A 13-Year-Old Girl Is Brought to the Office for a Routine