A 22 year-old male comes to your office because he needs an urgent prescription for alprazolam. He shouts at your staff for keeping him too long in the waiting room even though he arrived late for his appointment. He called himself Jack Snyder even though his driver’s license shows a different name. Your office staff reports that he has a very ‘negative vibe around him’. Finally, when you meet him in the room, he states, ‘Doc, I respect you. But listen, if I don’t get some xanax today, I might seriously harm someone in this office or outside.I took buprenorphine from a friend. It’s crap. It’s not helping me to calm down’. As you explore his history, he informs you that during his school years, teachers warned him to respect the rights of other students, to control his impulsive behavior, and to take the safety of others seriously. He has a history of arrests for shoplifting and imprisonments for violent behavior and possession of drug paraphernalia. He has a family history of alcoholism, drug abuse, imprisonments and hysteria. During his school years, he was diagnosed with conduct disorder. When you inform him that he needs another follow up, he shouts, ‘I am in between jobs. I don’t have money to pay for these visits. I still owe a lot of money to a lot of people. My girlfriend left me last week’. In the physical and mental health examination, you notice an aggressive individual with a manipulative attitude, low frustration tolerance, high propensity for anger, poor impulse control and poor judgment. His orientation and cognition appear normal. He has no delusions or hallucinations. He has a tattoo on his right deltoid which indicates a gang affiliation. What is the most likely diagnosis in this patient?
