Histrionic personality disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Histrionic personality disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Histrionic personality disorder US Medical PG Question 1: A 34-year-old female presents to a counselor at the urging of her parents because they are concerned that she might be depressed. After recently breaking up with her long-term boyfriend, she moved back in with her parents because she could not handle making decisions alone. Soon after their breakup, she started going on 5–7 dates a week. She has been unemployed for 3 years, as her boyfriend took care of all the bills. In the past year, she thought of looking for a job but never felt confident enough to start the process. Her mom arranges her doctor's appointments and handles her car maintenance. She describes feeling uneasy when she is alone. She has hypothyroidism treated with levothyroxine. She does not smoke or drink alcohol. Vital signs are normal. Mental status exam shows a neutral affect. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis?
- A. Avoidant personality disorder
- B. Histrionic personality disorder
- C. Borderline personality disorder
- D. Separation anxiety disorder
- E. Dependent personality disorder (Correct Answer)
Histrionic personality disorder Explanation: ***Dependent personality disorder***
- The patient exhibits a pervasive and excessive need to be cared for, leading to **submissive and clinging behavior** and fears of separation, as evidenced by her inability to make decisions, reliance on parents, and discomfort when alone.
- Her history of unemployment and reliance on her boyfriend, followed by moving back with parents and having her mom handle appointments and car maintenance, strongly supports an inability to function independently and an excessive need for reassurance and support, characteristic of **dependent personality disorder**.
*Avoidant personality disorder*
- This disorder is characterized by a pervasive pattern of **social inhibition**, feelings of inadequacy, and hypersensitivity to negative evaluation, which are not the primary features here.
- While she may lack confidence in looking for a job, her constant search for new relationships (5-7 dates a week) and reliance on others for decision-making point away from the **social avoidance** central to this diagnosis.
*Histrionic personality disorder*
- This disorder is marked by **excessive emotionality** and **attention-seeking behavior**, often through seductive or provocative means.
- Although she is actively dating, the core issue appears to be her need for care and support rather than a desire to be the center of attention or dramatize her emotions.
*Borderline personality disorder*
- Characterized by a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity, such as **frantic efforts to avoid abandonment** or **recurrent suicidal behavior**.
- While she might fear abandonment (expressed as uneasiness when alone), the overall clinical picture lacks the impulsivity, mood swings, self-harm, or intense anger typically seen in borderline personality disorder.
*Separation anxiety disorder*
- This disorder typically manifests with excessive fear or anxiety concerning separation from attachment figures, often seen in childhood, but can occur in adults.
- While she expresses **uneasiness when alone**, the pervasive pattern of **submissive behavior**, difficulty making decisions, and chronic dependency on others for all aspects of life points more towards a personality disorder rather than an anxiety disorder primarily focused on separation.
Histrionic personality disorder US Medical PG Question 2: A 35-year-old computer programmer presents to the psychiatrist at the request of his mother for his oddities. He explains that he wears an aluminum foil cap while he works because he does not want extraterrestrial life to steal his thoughts. He spends his free time building a radio transmitter to contact distant planets. He denies any delusions or hallucinations. He claims that nothing is wrong with his eccentricities and is happy the way his life is. Which of the following personality disorders does this male most likely have?
- A. Schizotypal (Correct Answer)
- B. Schizoid
- C. Narcissistic
- D. Borderline
- E. Paranoid
Histrionic personality disorder Explanation: ***Schizotypal***
- This patient exhibits **eccentric behavior**, **odd beliefs** (aliens stealing thoughts), and **magical thinking** (radio transmitter for distant planets) without reaching the level of frank delusions or hallucinations.
- The patient's lack of concern about his "eccentricities" and satisfaction with his life are consistent with the **ego-syntonic nature** often seen in personality disorders.
*Schizoid*
- Characterized by a **detachment from social relationships** and a restricted range of emotional expression, often preferring solitary activities.
- While they may display some oddities, their primary feature is a **lack of interest in social interaction**, which is not the prominent feature described here.
*Narcissistic*
- Individuals with narcissistic personality disorder display a **pervasive pattern of grandiosity**, a need for admiration, and a lack of empathy.
- Their behaviors are typically driven by a need for **external validation** and a sense of superiority, which are absent in this case.
*Borderline*
- Marked by **instability in interpersonal relationships**, self-image, affects, and impulsivity; traits like fear of abandonment, unstable identity, and self-harm are common.
- The patient's presentation does not align with the **emotional dysregulation and interpersonal chaos** characteristic of borderline personality disorder.
*Paranoid*
- Characterized by a **pervasive distrust and suspiciousness of others**, interpreting their motives as malevolent.
- While the patient has unusual beliefs, his primary concern is about alien intervention, not **suspicion of human intentions** or behaviors.
Histrionic personality disorder US Medical PG Question 3: A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
- A. Dependent
- B. Schizotypal
- C. Histrionic
- D. Antisocial
- E. Paranoid
- F. Avoidant (Correct Answer)
Histrionic personality disorder Explanation: ***Avoidant***
- This patient exhibits symptoms consistent with **agoraphobia**, which is an **anxiety disorder** characterized by fear of situations where escape might be difficult or help unavailable, often leading to social isolation.
- **Avoidant Personality Disorder** has the strongest genetic association with anxiety disorders, particularly **social anxiety disorder and agoraphobia**, sharing common genetic vulnerability factors related to fear of negative evaluation and social avoidance.
- Studies demonstrate significant genetic overlap between avoidant personality disorder and anxiety spectrum disorders, making this the most likely genetically associated personality disorder.
*Schizotypal*
- **Schizotypal Personality Disorder** is genetically linked to the **schizophrenia spectrum** (not anxiety disorders), characterized by cognitive-perceptual distortions, eccentric behavior, and social deficits.
- While schizotypal patients may avoid social situations, this is due to odd thinking and discomfort with close relationships, not anxiety about specific situations like crowds or public transportation.
*Dependent*
- **Dependent Personality Disorder** is characterized by an excessive need to be taken care of, leading to **submissive and clinging behavior**, and fears of separation.
- This patient's withdrawal is due to fear of public places, not a reliance on others or fear of abandonment.
*Antisocial*
- **Antisocial Personality Disorder** involves a pervasive pattern of **disregard for and violation of the rights of others**, often presenting as deceitful and impulsive behavior.
- The patient's symptoms are rooted in anxiety and social avoidance rather than a lack of empathy or antisocial behavior.
*Paranoid*
- **Paranoid Personality Disorder** is characterized by a pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent.
- The patient's withdrawal stems from fear of specific situations (crowds, public transport) rather than paranoid ideation or general suspicion of people's intentions.
*Histrionic*
- **Histrionic Personality Disorder** is marked by **excessive emotionality and attention-seeking behavior**, often displaying dramatic and superficial interactions.
- The patient's isolation and fear of public spaces are directly opposite to the attention-seeking nature of histrionic traits.
Histrionic personality disorder US Medical PG Question 4: A 25-year-old woman presents to her primary care physician with a chief complaint of diffuse muscle aches and pains. She states that she has trouble doing everyday tasks such as showering, cooking, and cleaning due to the pain. The patient has a past medical history of anxiety and bulimia nervosa and is currently not taking any medications. Upon further questioning, the patient states that her symptoms started last week when her boyfriend left her for another individual. The patient was quite upset, as she states she always had tended to all his needs and never argued with him. Since he has left, she has been unable to decide what she should do with herself during the day. The patient has been living with her mother for the past day and states that has helped greatly, as her mother helps her plan her days and gives her chores to do. Regardless, the patient states that her pain persists. The physician sets up a referral for the patient to work with a psychiatrist. Upon hearing this, the patient becomes visually bothered and questions if the physician is actually trying to help her. Which of the following personality disorder does this patient most likely suffer from?
- A. Paranoid
- B. Borderline
- C. Avoidant
- D. Histrionic
- E. Dependent (Correct Answer)
Histrionic personality disorder Explanation: ***Dependent***
- The patient exhibits strong **submissiveness** and a pervasive need to be taken care of, as evidenced by her inability to make decisions and relying on her mother to plan her days and give her chores.
- She shows a fear of **separation** and an urgent search for a new relationship or support system, highlighted by her difficulty functioning after her boyfriend left and her extreme devotion to his needs.
*Paranoid*
- Characterized by a pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent.
- This patient does not display these features; her discomfort with the referral is more about fear of abandonment and lack of self-reliance, not suspicion.
*Borderline*
- Involves instability in relationships, self-image, affects, and marked **impulsivity**, often with frantic efforts to avoid real or imagined abandonment.
- While there is a fear of abandonment, the patient's primary presentation is submissiveness and need for care, rather than the characteristic impulsivity, emotional lability, and unstable self-image seen in borderline personality disorder.
*Avoidant*
- Marked by **social inhibition**, feelings of inadequacy, and hypersensitivity to negative evaluation, leading to avoidance of social interaction.
- This patient seeks close relationships and relies on others, which is opposite to the social withdrawal and avoidance characteristic of avoidant personality disorder.
*Histrionic*
- Characterized by excessive **emotionality** and attention-seeking behavior, often dramatic and theatrical.
- While the patient might seek attention in her relationship, her core issue of submissiveness and reliance on others for decision-making does not align with the overtly dramatic and exhibitionistic traits of histrionic personality disorder.
Histrionic personality disorder US Medical PG Question 5: A 12-year-old boy is brought in by his parents as they are concerned about his behavior. He is constantly arguing with his parents and blatantly defying their every request. In school, he is known for being intentionally tardy and for defying his teachers. Upon further questioning of the patient you learn about some of his recent behaviors such as beginning smoking to bother his parents. You also notice that he is disrespectful towards you. You then learn that he has also gotten into weekly fights with his peers at school with no apparent cause. In addition, last week he was seen hitting one of the local neighborhood cats with a baseball bat trying to kill it. The patient lives at home with his two parents in a pre-World War II house that was recently renovated. Physical exam is unremarkable.
Laboratory values are as follows:
Na: 140 mmol/L
K: 4.5 mmol/L
Cl: 100 mmol/L
Glucose: 80 mg/dL
Ca: 10 mmol/L
Mg: 3 mEq/L
Cr: 0.8 mg/dL
BUN: 10 mg/dL
Serum lead: < .01 µg/dL
Hb: 15 g/dL
Hct: 45%
MCV: 95
Urine toxicology: negative
As the patient leaves the office you notice him stealing all of the candy from the office candy bowl. The patient seems unconcerned about his behavior overall. Which of the following statements is most likely to be true in this patient?
- A. This patient will likely function normally despite continuing to defy authority figures
- B. Environmental exposures are likely causing this patient's behavior
- C. The patient's symptoms could progress to antisocial personality disorder (Correct Answer)
- D. This patient is suffering from antisocial personality disorder and will likely be incarcerated in adulthood
- E. Strong D2 antagonists are first-line pharmacotherapy
Histrionic personality disorder Explanation: ***The patient's symptoms could progress to antisocial personality disorder***
- The patient's pattern of **aggression towards people and animals**, **deceitfulness or theft**, and **serious violations of rules** (e.g., truancy, defying authority) are all diagnostic criteria for **conduct disorder**.
- If conduct disorder symptoms persist into adulthood (age 18 or older), it can lead to a diagnosis of **antisocial personality disorder (ASPD)**, as ASPD requires evidence of conduct disorder before age 15.
*This patient will likely function normally despite continuing to defy authority figures*
- The described behaviors go beyond simple defiance; they include **aggression, severe rule violations, and lack of remorse**. These are significant indicators of a **conduct disorder**, which is associated with poor long-term outcomes and functional impairment, not normal functioning.
- Undiagnosed and untreated conduct disorder can lead to **academic difficulties, substance abuse, legal problems, and inability to maintain relationships**, making normal functioning unlikely.
*Environmental exposures are likely causing this patient's behavior*
- While environmental factors can contribute, the **severity and widespread nature** of the behaviors (at home, school, with peers, and animals), coupled with the **lack of remorse and intentional malice**, point more strongly to an underlying psychiatric diagnosis like conduct disorder rather than solely environmental causes.
- The provided lab results rule out common environmental toxins like **lead poisoning**, and the recent house renovation doesn't provide direct evidence of a toxic exposure causing these specific behavioral manifestations.
*This patient is suffering from antisocial personality disorder and will likely be incarcerated in adulthood*
- **Antisocial personality disorder (ASPD)** cannot be diagnosed before age 18. This patient is 12 years old, making ASPD an incorrect diagnosis at this stage, although his current behaviors are consistent with **conduct disorder**, which is a precursor.
- While there is an increased risk of incarceration for individuals with ASPD, stating it as a **definitive outcome** or that he "will likely be incarcerated" is deterministic and not universally true, as interventions can impact outcomes.
*Strong D2 antagonists are first-line pharmacotherapy*
- **First-line treatment for conduct disorder** typically involves **psychosocial interventions**, such as parent management training, cognitive behavioral therapy, and multisystemic therapy.
- While **D2 antagonists** (antipsychotics) may be used in severe cases, particularly for **aggression and impulsivity** when other treatments fail or if there are comorbid conditions, they are not considered **first-line pharmacotherapy** for conduct disorder itself.
Histrionic personality disorder US Medical PG Question 6: A 10-year-old boy is brought to the physician by his parents because they are concerned about his “strange behavior”. The parents state that he has always been a lonely kid without many friends, but recently he has been having behavioral problems that seem to be unprovoked and are occurring more frequently. The child throws tantrums for no reason and does not respond to punishment or reward. He also has a “strange obsession” with collecting rocks that he finds on his way to and from school to the point where his room is filled with rocks. He plays alone in his room, lining the rocks up, organizing them by size, shape, or color, and he will randomly bark or make high-pitched noises without provocation. His teachers say he daydreams a lot and is very good at art, being able to recreate his favorite cartoon characters in great detail. On physical assessment, the patient does not make eye contact with the physician but talks incessantly about his rock collection. The child’s grammar and vocabulary seem normal but his speech is slightly labored, and he can’t seem to tell that the physician is not really interested in hearing about his rock collection. Which of the following is the most likely diagnosis?
- A. Autism spectrum disorder (Correct Answer)
- B. Obsessive-compulsive disorder
- C. Tourette’s syndrome
- D. Pick disease
- E. Attention deficit hyperactivity disorder
Histrionic personality disorder Explanation: ***Autism spectrum disorder***
- This case presents classic features of **autism spectrum disorder (ASD)**, including **social deficits** (lonely, no friends, no eye contact, lack of awareness of others' interest), **repetitive behaviors and fixated interests** (rock collection, lining them up, organizing), and **stereotyped movements/vocalizations** (random barking, high-pitched noises).
- The child's excellent artistic skills and normal grammar/vocabulary despite other communication difficulties are also consistent with the varying presentations within the **autism spectrum**, which can include areas of exceptional talent alongside core deficits.
*Obsessive-compulsive disorder*
- While the rock collection and organizing might resemble an **obsession/compulsion**, OCD typically involves **intrusive thoughts (obsessions)** causing distress and **repetitive behaviors (compulsions)** performed to alleviate that distress.
- The presented social deficits, communication difficulties, and stereotyped movements are not characteristic of OCD alone.
*Tourette’s syndrome*
- **Tourette's syndrome** is characterized by **multiple motor tics** and **one or more vocal tics**. The barking and high-pitched noises could be tics, but Tourette's does not explain the profound social impairments, repetitive behaviors/interests, and communication difficulties described.
- The global pattern of symptoms points beyond Tourette's.
*Pick disease*
- **Pick disease** is a rare form of **frontotemporal dementia** that primarily affects adults, typically presenting with **personality changes**, **behavioral disinhibition**, and **language difficulties**.
- It is an adult-onset neurodegenerative disorder and would not be diagnosed in a 10-year-old child presenting with developmental differences.
*Attention deficit hyperactivity disorder*
- **ADHD** is characterized by **persistent patterns of inattention** and/or **hyperactivity-impulsivity**. While "daydreaming" could suggest inattention, the core features of social impairment, repetitive behaviors, and specific vocalizations are not typical of ADHD.
- The child's "strange obsession" and social isolation point away from a primary diagnosis of ADHD.
Histrionic personality disorder US Medical PG Question 7: The prison doctor sees a 25-year-old man for some minor injuries sustained during a recent lunchroom brawl. The patient has a long history of getting into trouble. During his interview, he seems very charming and carefully deflects all responsibility to others and gets irritable and hostile once probed on the issues. He is married and has 2 young children for whom he does not pay child support. Which of the following details is most critical for diagnosing this patient’s condition?
- A. Criminal record
- B. History of substance abuse
- C. Family history
- D. Evidence of lack of remorse
- E. Childhood history (Correct Answer)
Histrionic personality disorder Explanation: ***Childhood history***
- A diagnosis of **Antisocial Personality Disorder (ASPD)** requires evidence of **conduct disorder** symptoms beginning before age 15. The childhood history provides insight into the chronicity and developmental pattern of pervasive disregard and violation of the rights of others.
- The patient's current presentation of deceitfulness, impulsivity, irritability, and irresponsibility, along with a "long history of getting into trouble," aligns with ASPD criteria, which must be contextualized by their early onset of behavioral problems.
*Criminal record*
- While a criminal record often accompanies ASPD, it is a consequence of the disorder rather than a diagnostic criterion in itself. Many individuals with ASPD engage in criminal behavior, but the diagnosis focuses on a broader pattern of *disregard for the rights of others*, not just legal infractions.
- While it supports the pattern of antisocial behavior, it doesn't provide the crucial developmental information (onset before age 15) required for diagnosis.
*History of substance abuse*
- **Substance abuse** is highly comorbid with ASPD, often used as a coping mechanism or as a direct consequence of impulsive and risky behaviors. However, it is not a direct criterion for ASPD itself.
- While relevant to the patient's overall clinical picture and management, it does not directly contribute to the diagnostic criteria for ASPD.
*Family history*
- A family history of mental health disorders, including personality disorders, can increase the risk of developing ASPD, indicating a genetic predisposition. However, it is not a diagnostic criterion.
- While useful for understanding risk factors, family history does not provide specific information about the patient's individual behavioral patterns or the onset of symptoms crucial for diagnosis.
*Evidence of lack of remorse*
- **Lack of remorse** is an important diagnostic criterion for ASPD, demonstrating a profound deficit in empathy and moral reasoning. It's evident in the patient's deflection of responsibility.
- While a critical symptom, it's one of several criteria. Without evidence of a conduct disorder in childhood, even significant interpersonal impairment and lack of remorse in adulthood may not lead to an ASPD diagnosis.
Histrionic personality disorder US Medical PG Question 8: A 45-year-old woman repetitively visits the general surgery clinic worried that her inguinal hernia is incarcerated. 2 months ago, she was seen in the emergency department where she presented with a left lower abdominal swelling. The mass was easily reduced and the patient was referred to the general surgery clinic for elective surgical repair. Because her condition was deemed not urgent, she was informed that she was down on the surgical waiting list. Despite this, she continues to visit the clinic and the ED worried that her bowels are ‘trapped and dying.’ Each time she is reassured and any protrusion present is quickly reduced. She has previously frequently visited her primary care physician for complaints of abdominal pain and inconsistent bowel habits, but no etiology could be identified. She continues to intermittently have these symptoms and spends hours every day worrying about what may be going on. She has no other significant past medical history. Which of the following is the most appropriate diagnosis?
- A. Illness anxiety disorder
- B. Conversion disorder
- C. Factitious disorder
- D. Malingering
- E. Somatic symptom disorder (Correct Answer)
Histrionic personality disorder Explanation: ***Somatic symptom disorder***
- This patient exhibits **multiple somatic symptoms** (abdominal pain, inconsistent bowel habits, fear of incarcerated hernia), along with excessive thoughts, feelings, and behaviors related to these symptoms, causing significant distress and functional impairment.
- Her persistent worry about the incarcerated hernia despite reassurance, and frequent clinic visits for unrelated physical complaints without identifiable etiology, align with the diagnostic criteria for **somatic symptom disorder**.
*Illness anxiety disorder*
- Characterized by a preoccupation with having or acquiring a serious illness, but with **minimal or no somatic symptoms** present.
- In this case, the patient clearly has actual physical symptoms (abdominal pain, inconsistent bowel habits, and the inguinal swelling itself), differentiating it from illness anxiety disorder where the primary concern is the *fear* of illness rather than the experience of symptoms.
*Conversion disorder*
- Involves neurological symptoms (e.g., paralysis, blindness, seizures) that are **incompatible with recognized neurological conditions** and are not intentionally produced.
- The patient's symptoms are primarily somatic and not neurological, and she is worried about an *existing* medical issue (hernia) rather than developing unexplained neurological deficits.
*Factitious disorder*
- Individuals **consciously feign or induce symptoms** to assume the sick role, without obtaining external rewards.
- There is no indication the patient is intentionally producing her symptoms or faking her medical concerns; her distress appears genuine, and she is not seeking a "sick role" but rather relief from her worries.
*Malingering*
- Characterized by the **intentional production of false or grossly exaggerated physical or psychological symptoms** with an obvious external motivation (e.g., avoiding work, obtaining money, evading criminal prosecution).
- The patient's presentation does not suggest any clear external incentives for her exaggerated concerns; her anxiety about her health appears to be the primary driver.
- Note: Malingering is not classified as a mental disorder in DSM-5, but rather as a condition that may be a focus of clinical attention.
Histrionic personality disorder US Medical PG Question 9: A 29-year-old woman presents with convulsions. The patient’s brother says that he found her like that an hour ago and immediately called an ambulance. He also says that she has been extremely distraught and receiving supportive care from a social worker following a sexual assault by a coworker a few days ago. He says that the patient has no history of seizures. She has no significant past medical history and takes no medications. The patient’s vital signs include: temperature 37.0°C (98.6°F), pulse 101/min, blood pressure 135/99 mm Hg, and respiratory rate 25/min. On physical examination, the patient is rolling from side to side, arrhythmically thrashing around, and muttering strangely. Her eyes are closed, and there is resistance to opening them. Which of the following is the most likely diagnosis in this patient?
- A. Body dysmorphic disorder
- B. Somatic symptom disorder
- C. Illness anxiety disorder
- D. Somatic symptom disorder with predominant pain
- E. Functional neurological symptom disorder (Conversion disorder) (Correct Answer)
Histrionic personality disorder Explanation: ***Functional neurological symptom disorder (Conversion disorder)***
- This patient presents with **neurological symptoms (pseudoseizures)** inconsistent with known neurological conditions, following a significant **psychological stressor (sexual assault).**
- Key features like **resistance to eye opening**, **arrhythmic thrashing**, **eyes closed during episode**, and general atypical presentation for a true seizure strongly suggest functional neurological symptom disorder (conversion disorder), as these are classic features of *psychogenic non-epileptic seizures (PNES)*.
- The temporal relationship to trauma and absence of prior seizure history further support this diagnosis.
*Body dysmorphic disorder*
- This disorder involves a **preoccupation with perceived flaws in physical appearance**, which are often minor or not observable to others.
- The patient's symptoms of pseudoseizures and thrashing are **neurological manifestations** and do not align with concerns about physical appearance.
*Somatic symptom disorder*
- This diagnosis involves **one or more somatic symptoms that are distressing or result in significant disruption** of daily life, with **excessive thoughts, feelings, or behaviors** related to the somatic symptoms.
- While somatic symptom disorder can include neurological complaints, the acute presentation of pseudoseizures with specific neurological signs (eye closure resistance, arrhythmic movements) directly linked to recent severe trauma makes functional neurological symptom disorder the more precise diagnosis.
*Illness anxiety disorder*
- Characterized by a **preoccupation with having or acquiring a serious illness** based on misinterpretation of bodily symptoms, with minimal or no somatic symptoms present.
- The patient is experiencing active neurological symptoms (pseudoseizures), not health anxiety or unfounded fear of having an illness.
*Somatic symptom disorder with predominant pain*
- In this specifier, the primary symptom is **pain**, which is distressing and associated with excessive thoughts, feelings, or behaviors related to the pain.
- The patient's primary presentation is **pseudoseizures with motor symptoms**, not pain, making this diagnosis inconsistent with her clinical picture.
Histrionic personality disorder US Medical PG Question 10: A 33-year-old man with documented antisocial personality disorder and substance use disorder is convicted of assault. The defense attorney requests psychiatric testimony that the defendant's personality disorder diminished his capacity to conform his conduct to the law. His history includes multiple prior convictions, repeated lying, failure to sustain employment, lack of remorse, and disregard for others' safety. However, he understood the wrongfulness of his actions and planned the assault in advance. Evaluate the relationship between antisocial personality disorder and criminal responsibility.
- A. Chronic pattern of behavior demonstrates inability to conform conduct to law
- B. Combination of personality disorder and substance use negates criminal responsibility
- C. Comorbid substance use disorder supports insanity defense
- D. Antisocial personality disorder does not meet criteria for insanity defense as patients retain capacity to understand wrongfulness (Correct Answer)
- E. Personality disorders qualify for diminished capacity due to impaired impulse control
Histrionic personality disorder Explanation: ***Antisocial personality disorder does not meet criteria for insanity defense as patients retain capacity to understand wrongfulness***
- In forensic psychiatry, individuals with **antisocial personality disorder** are generally considered criminally responsible because they retain the **cognitive capacity** to distinguish right from wrong.
- The legal system distinguishes between a "cannot conform" (e.g., severe psychosis) and a "will not conform" (personality disorder); since the defendant **planned the assault**, he demonstrated **volitional control**.
*Chronic pattern of behavior demonstrates inability to conform conduct to law*
- A history of repeated legal infractions reflects a **choice to disregard social norms** rather than an organic or psychotic inability to process reality.
- Under most legal standards, inclusive of the **M'Naghten Rule**, a repetitive criminal history does not constitute the "mental disease or defect" required for an **insanity defense**.
*Combination of personality disorder and substance use negates criminal responsibility*
- Combined pathology does not equate to a loss of **mens rea** (guilty mind); substance use is often viewed as **voluntary intoxication**, which rarely excuses criminal acts.
- The presence of these disorders does not inherently impair the defendant's **rational understanding** of the wrongfulness of the specific criminal act.
*Comorbid substance use disorder supports insanity defense*
- **Substance use disorders** are specifically excluded from the definition of "mental disease or defect" in the context of the **insanity defense** in many jurisdictions.
- To qualify for insanity, a condition must typically involve a disconnection from reality, whereas substance use is considered a **behavioral choice** with known legal risks.
*Personality disorders qualify for diminished capacity due to impaired impulse control*
- **Diminished capacity** is a specific legal defense that usually requires a severe mental impairment that prevents the formation of **specific intent**, which is not seen here as the defendant **planned the assault**.
- While patients with personality disorders exhibit **impulsivity**, they still possess the foundational **legal sanity** required to be held responsible for premeditated actions.
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