Antisocial Personality Disorder — MCQs
Which personality disorder is characterized by unstable interpersonal relationships and impulsive behavior?
Which of the following is not a central characteristic of childhood autism?
A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?
A young person presents with self-mutilating behaviour and impulsivity. What are they most likely suffering from?
Which of the following is a characteristic feature of Histrionic Personality Disorder?
OCD is associated with which personality disorder?
A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
A 15-year-old adolescent is brought in for evaluation due to repeated failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse. What is the most likely diagnosis?
A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:
Antisocial Personality Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Which personality disorder is characterized by unstable interpersonal relationships and impulsive behavior?
- A. Obsessive-compulsive
- B. Borderline (Correct Answer)
- C. Histrionic
- D. Schizoid
Explanation: **Borderline** - **Borderline personality disorder** is defined by a pervasive pattern of **instability in interpersonal relationships, self-image, and affects**, along with marked impulsivity. - Patients often experience intense, short-lived emotional episodes and may engage in **self-harm** or suicidal behaviors. *Obsessive-compulsive* - This disorder is characterized by a preoccupation with **orderliness, perfectionism**, and mental and interpersonal control, often at the expense of flexibility and efficiency. - Individuals tend to be meticulous, rigid, and resistant to delegating tasks, but generally do not exhibit unstable relationships or impulsivity. *Histrionic* - This personality disorder involves excessive **emotionality and attention-seeking behavior**, often dramatic and theatrical. - While they seek attention in relationships, their relationships are not necessarily unstable in the impulsive and intense way seen in borderline personality disorder; rather, they are often superficial. *Schizoid* - Individuals with **schizoid personality disorder** exhibit a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - They tend to be loners and indifferent to praise or criticism, which is contrary to the intense and unstable relationships seen in borderline personality disorder.
Question 2: Which of the following is not a central characteristic of childhood autism?
- A. Callous and unemotional traits (Correct Answer)
- B. Impaired communication
- C. Restricted, repetitive behaviour
- D. Impaired social interaction
Explanation: ***Callous and unemotional traits*** - While some individuals with autism may struggle with empathy, **callous and unemotional traits** are not a core diagnostic feature of autism spectrum disorder (ASD); they are more commonly associated with conditions like **conduct disorder** or **antisocial personality disorder**. - **Emotional dysregulation** and **difficulty recognizing others' emotions** are common in autism, but this differs from a pervasive pattern of callousness. *Impaired communication* - **Impaired verbal and nonverbal communication** is a fundamental diagnostic criterion for autism spectrum disorder, ranging from absent speech to difficulties with conversations and understanding social cues. - This can manifest as problems with **initiating or maintaining conversations**, **lack of eye contact**, and **unusual tone of voice**. *Restricted, repetitive behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic feature of ASD. - Examples include **stereotyped motor movements**, **insistence on sameness**, **highly restricted or fixated interests**, and **unusual sensory sensitivities**. *Impaired social interaction* - **Persistent deficits in social communication and social interaction** across multiple contexts are defining characteristics of autism. - This includes difficulties with **social-emotional reciprocity**, **nonverbal communication**, and **developing, maintaining, and understanding relationships**.
Question 3: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
- A. Schizophrenia
- B. Major depressive disorder plus psychosis (Correct Answer)
- C. Schizoaffective disorder
- D. Schizotypal personality disorder
Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.
Question 4: A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?
- A. Bipolar disorder
- B. Schizoaffective disorder
- C. Antisocial personality
- D. Borderline personality disorder (Correct Answer)
Explanation: ***Borderline personality disorder*** - Patients with **borderline personality disorder** often exhibit **impulsivity**, intense mood swings, and a pattern of unstable interpersonal relationships, leading to aggressive outbursts. - Their unpredictable behavior and tendency to form intense, unstable attachments or a "favorite person" dynamic are characteristic, as seen in her differing demeanor towards a particular resident doctor. *Bipolar disorder* - While bipolar disorder involves **mood swings**, the behavioral patterns are typically characterized by distinct episodes of **mania** or hypomania and depression, with less emphasis on chronic interpersonal instability and aggression. - The aggression in bipolar disorder is often associated with the manic phase but lacks the consistent pattern of relationship instability and "favorite person" dynamic described. *Schizoaffective disorder* - This disorder involves a combination of **psychotic symptoms** (like delusions or hallucinations) and **mood symptoms** (like depression or mania), which are not explicitly described here as the primary issue. - The aggressive behavior is not primarily driven by psychosis, and the specific interpersonal dynamic with staff is more suggestive of a personality disorder. *Antisocial personality* - **Antisocial personality disorder** is characterized by a pervasive pattern of disregard for and violation of the **rights of others** and may include aggression, but it often involves a lack of empathy and manipulativeness rather than the intense emotional dysregulation and unstable interpersonal patterns seen in borderline personality. - While aggressive behavior is present, the specific description of verbally abusing staff while showing a "different demeanor" towards a particular doctor points away from the typical presentation of antisocial disregard for others.
Question 5: A young person presents with self-mutilating behaviour and impulsivity. What are they most likely suffering from?
- A. Dependent personality disorder
- B. Adjustment disorder
- C. Borderline personality disorder (Correct Answer)
- D. Paranoid personality disorder
Explanation: ***Borderline personality disorder*** - **Self-mutilating behavior** (e.g., cutting) and **impulsivity** are hallmark features of borderline personality disorder. - Individuals with BPD often experience intense emotional dysregulation, unstable relationships, and a fear of abandonment, leading to these behaviors. *Dependent personality disorder* - Characterized by an excessive need to be cared for, leading to submissive and clinging behavior, and fears of separation. - While it can involve unstable relationships due to dependency, it typically does not manifest with recurrent **self-mutilating behaviors** or significant **impulsivity** as core features. *Adjustment disorder* - This disorder is a short-term, stress-related condition that occurs in response to a specific **identifiable stressor**. - While individuals might exhibit behavioral symptoms, it is by definition time-limited and reactive to an external event, and **self-mutilating behavior** and chronic **impulsivity** are not primary diagnostic criteria. *Paranoid personality disorder* - Defined by a pervasive distrust and suspicion of others, interpreting their motives as malevolent. - This disorder is primarily characterized by paranoid ideation and guardedness, rather than the intrinsic **impulsivity** and **self-harm** seen in borderline personality disorder.
Question 6: Which of the following is a characteristic feature of Histrionic Personality Disorder?
- A. Attention-seeking behavior (Correct Answer)
- B. Disregard for social norms
- C. Emotional instability
- D. Exaggerated emotional expression
Explanation: ***Attention-seeking behavior*** - Individuals with **Histrionic Personality Disorder** exhibit pervasive and excessive **emotionality** and **attention-seeking behaviors**. - This often manifests as discomfort when not being the center of attention and using physical appearance to draw attention to themselves. *Disregard for social norms* - This is a primary characteristic of **Antisocial Personality Disorder**, involving a persistent pattern of **disregard for and violation of the rights of others**, not HPD. - Individuals with antisocial personality disorder often engage in deceitfulness, impulsivity, and lack of remorse. *Emotional instability* - While histrionic individuals can have rapidly shifting emotions, profound **emotional instability**, including rapid mood swings and intense anger, is more characteristic of **Borderline Personality Disorder**. - **Borderline Personality Disorder** also features instability in relationships and self-image, which differs from the attention-seeking nature of HPD. *Exaggerated emotional expression* - While individuals with HPD often display **exaggerated emotional expression**, it is a component of their broader and more encompassing **attention-seeking behavior**, making "attention-seeking behavior" the more definitive characteristic among the choices. - The emotional displays are often shallow and theatrical, serving the purpose of drawing and maintaining attention.
Question 7: OCD is associated with which personality disorder?
- A. Borderline
- B. Narcissistic
- C. Histrionic
- D. Anankastic (Correct Answer)
Explanation: ***Anankastic*** - **Anankastic personality disorder** is the ICD-10 equivalent of **obsessive-compulsive personality disorder (OCPD)**, which shares many features with **Obsessive-Compulsive Disorder (OCD)**, such as perfectionism, orderliness, and preoccupation with details. - While OCPD and OCD are distinct, they often co-occur, and traits of anankastic personality can predispose individuals to develop or exacerbate OCD symptoms. *Borderline* - **Borderline personality disorder** is characterized by **instability in interpersonal relationships**, self-image, affects, and marked impulsivity, which are not typical features of OCD. - Individuals with borderline personality disorder often exhibit behaviors like frantic efforts to avoid abandonment, identity disturbance, and chronic feelings of emptiness. *Narcissistic* - **Narcissistic personality disorder** is defined by a **pervasive pattern of grandiosity**, a need for admiration, and a lack of empathy, which are distinct from the anxiety-driven compulsions of OCD. - Key features include a sense of entitlement and exploitation of others, contrasting with the self-critical perfectionism seen in OCD. *Histrionic* - **Histrionic personality disorder** is characterized by **excessive emotionality** and attention-seeking behavior, often theatrical and dramatic, which are not direct associations with OCD. - Individuals with histrionic personality disorder are notably uncomfortable when not the center of attention and may use physical appearance to draw attention to themselves.
Question 8: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
- A. Narcissistic personality disorder
- B. Paranoid personality disorder
- C. Schizotypal personality disorder
- D. Antisocial personality disorder (Correct Answer)
Explanation: ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder.
Question 9: A 15-year-old adolescent is brought in for evaluation due to repeated failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse. What is the most likely diagnosis?
- A. Conduct disorder (Correct Answer)
- B. Oppositional defiant disorder
- C. Intermittent explosive disorder
- D. Antisocial personality disorder
Explanation: ***Conduct disorder*** - This diagnosis is characterized by repeated patterns of behavior that **violate the rights of others** or major societal norms, consistent with the patient's presentation of **deceitfulness, impulsivity, and lack of remorse**. - For individuals under 18, it is the appropriate diagnosis, as **Antisocial Personality Disorder** cannot be diagnosed before turning 18. *Oppositional defiant disorder* - This condition involves a pattern of **angry/irritable mood, argumentative/defiant behavior**, or vindictiveness. It does not typically include the severe violations of societal norms or the rights of others seen in this case. - While there is defiance, it generally lacks the **aggression** towards people/animals, **destruction of property**, or **deceitfulness/theft** that characterize conduct disorder. *Intermittent explosive disorder* - This disorder is marked by **recurrent behavioral outbursts** representing a failure to control aggressive impulses. - The outbursts are typically **disproportionate** to the provocation but do not necessarily involve the persistent pattern of violating others' rights or societal rules as described. *Antisocial personality disorder* - This diagnosis requires an individual to be at least **18 years old** and have a history of conduct disorder symptoms before age 15. - Although the symptoms align with the criteria for **antisocial behavior**, the patient's age (15 years old) precludes this diagnosis.
Question 10: A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:
- A. Attention deficit hyperactivity disorder
- B. Autism
- C. Conduct disorder (Correct Answer)
- D. Nothing abnormal (teenage phenomenon)
Explanation: ***Conduct disorder*** - This diagnosis is strongly indicated by the child's pattern of **aggressive behavior** (assaulting batchmates), **coercion/theft** (stealing money), and frequent **rule-breaking** (fighting, disciplinary problems). - These actions represent a persistent disregard for societal norms and the rights of others, characteristic of **conduct disorder** in a 13-year-old. *Attention deficit hyperactivity disorder* - While children with **ADHD** may have disciplinary problems due to impulsivity and inattention, the hallmark features of **aggression** and **theft** are not primary symptoms. - The core symptoms of ADHD are problems with **inattention, hyperactivity**, and **impulsivity**, which are not the central focus of this presentation. *Autism* - **Autism spectrum disorder** is characterized by persistent deficits in **social communication and interaction**, and **restricted, repetitive patterns of behavior**. - The described behaviors of fighting, stealing, and assaulting are not typical manifestations of autism. *Nothing abnormal (teenage phenomenon)* - While some behavioral changes are normal during adolescence, a consistent pattern of **assault, theft, and severe disciplinary problems** goes beyond normal teenage rebellion. - These behaviors indicate a significant underlying issue requiring professional intervention, not just a passing phase.
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