Personality Disorders — MCQs
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A 25-year-old female presented to the emergency department after an intentional overdose of clonazepam following an argument with her fiancé. Her history revealed a pattern of unstable relationships and previous similar incidents, along with self-inflicted injuries such as cut marks on her wrists. What is the most likely diagnosis?
Markedly inappropriate sensitivity, self-importance, and suspiciousness are clinical features of which personality disorder?
Kleptomania is defined as:
A well-dressed man presents with a feeling of being trapped in a woman's body. What is he most likely suffering from?
Which of the following is NOT characteristic of Type A personality?
Which personality disorder can be a part of the autistic spectrum of disorders?
Which of the following statements regarding personality disorder clusters is false?
What is true about the treatment of personality disorder?
Persons with intermittent explosive disorder generally display all of the following except?
Kleptomania is defined as?
Personality Disorders Indian Medical PG Practice Questions and MCQs
Question 101: A 25-year-old female presented to the emergency department after an intentional overdose of clonazepam following an argument with her fiancé. Her history revealed a pattern of unstable relationships and previous similar incidents, along with self-inflicted injuries such as cut marks on her wrists. What is the most likely diagnosis?
- A. Narcissistic personality disorder
- B. Borderline personality disorder (Correct Answer)
- C. Histrionic personality disorder
- D. Anxious personality disorder
Explanation: ### Explanation **Correct Answer: B. Borderline Personality Disorder (BPD)** The clinical presentation is a classic case of **Borderline Personality Disorder (Cluster B)**. The diagnosis is based on a pervasive pattern of instability in interpersonal relationships, self-image, and affect, along with marked impulsivity. * **Key Indicators in this case:** 1. **Emotional Instability:** Triggered by an argument with her fiancé (fear of abandonment). 2. **Impulsivity:** Intentional overdose (self-harming behavior). 3. **Recurrent Suicidal Behavior:** History of "previous similar incidents" and "cut marks on wrists" (non-suicidal self-injury is a hallmark of BPD). 4. **Unstable Relationships:** A documented pattern of turbulent interactions. --- ### Why the other options are incorrect: * **A. Narcissistic Personality Disorder:** Characterized by grandiosity, a need for admiration, and a lack of empathy. While they may react poorly to criticism, they typically do not engage in recurrent self-mutilation or overdoses. * **C. Histrionic Personality Disorder:** These individuals are attention-seeking and excessively emotional. While they may use suicidal threats to gain attention, the chronic pattern of self-harm (cutting) and profound identity disturbance seen here is more specific to BPD. * **D. Anxious (Avoidant) Personality Disorder:** Characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. They avoid relationships due to fear of rejection rather than engaging in "unstable/stormy" ones. --- ### High-Yield Clinical Pearls for NEET-PG: * **Defense Mechanism:** The most characteristic defense mechanism in BPD is **Splitting** (viewing people as "all good" or "all bad"). * **Treatment of Choice:** **Dialectical Behavior Therapy (DBT)** is the gold-standard psychotherapy. * **Pharmacotherapy:** SSRIs may be used for mood symptoms, but no drug is curative for the personality itself. * **Mnemonic (PRAISED):** Paranoid ideas, Relationship instability, Abandonment avoidance, Impulsivity, Suicidal behavior, Emptiness, Dissociation/Affective instability.
Question 102: Markedly inappropriate sensitivity, self-importance, and suspiciousness are clinical features of which personality disorder?
- A. Antisocial PD
- B. Histrionic PD
- C. Schizoid PD
- D. Paranoid PD (Correct Answer)
Explanation: ### Explanation The correct answer is **Paranoid Personality Disorder (PPD)**. **1. Why Paranoid PD is correct:** Paranoid Personality Disorder is characterized by a pervasive and unwarranted **distrust and suspiciousness** of others. According to ICD and DSM criteria, key features include: * **Marked Sensitivity:** An excessive sensitivity to setbacks, rebuffs, and perceived slights. * **Self-importance:** A distorted, self-referential attitude where the individual believes others are specifically targeting them, often leading to an inflated sense of self-righteousness. * **Suspiciousness:** A tendency to interpret neutral or friendly actions of others as hostile or contemptuous. They frequently harbor "unjustified doubts" about the loyalty of friends or partners. **2. Why other options are incorrect:** * **Antisocial PD:** Characterized by a disregard for social norms, impulsivity, lack of empathy, and a history of conduct disorder. While they may be aggressive, they lack the pervasive "sensitivity to rebuffs" seen in PPD. * **Histrionic PD:** Defined by excessive emotionality and **attention-seeking** behavior. They are suggestible and uncomfortable when not the center of attention, which contrasts with the guarded nature of PPD. * **Schizoid PD:** Characterized by **social detachment** and a restricted range of emotional expression. Unlike PPD, individuals with Schizoid PD are indifferent to praise or criticism and lack the "suspiciousness" or "sensitivity" regarding others' motives. **3. NEET-PG High-Yield Pearls:** * **PPD Mnemonic (SUSPECT):** **S**pousal infidelity suspected, **U**nforgiving (grudges), **S**uspicious, **P**erceives attacks, **E**nemy in everyone, **C**onfiding in others is feared, **T**hreats seen in benign events. * **Defense Mechanism:** The primary defense mechanism used in Paranoid PD is **Projection** (attributing one's own unacknowledged feelings onto others). * **Differential:** Unlike Schizophrenia, PPD does **not** involve fixed psychotic delusions or hallucinations.
Question 103: Kleptomania is defined as:
- A. A delusion disorder
- B. An obsession
- C. An impulse control disorder (Correct Answer)
- D. A compulsive seclusion
Explanation: **Explanation:** **Kleptomania** is characterized by the recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value. 1. **Why Option C is Correct:** Kleptomania is classified as an **Impulse Control Disorder**. The underlying medical concept involves a specific cycle: the individual experiences a rising sense of **tension** before committing the theft, followed by **pleasure, gratification, or relief** at the time of committing the act. Unlike professional shoplifting, the act is not pre-planned and is not motivated by anger or vengeance. 2. **Why Other Options are Incorrect:** * **Option A (Delusional Disorder):** Delusions are fixed, false beliefs. Kleptomania involves a behavioral urge, not a disturbance in thought content or reality testing. * **Option B (Obsession):** Obsessions are intrusive, repetitive thoughts that cause anxiety. While the urge to steal is repetitive, it is "ego-syntonic" during the act (provides pleasure), whereas obsessions are "ego-dystonic" (distressing). * **Option D (Compulsive Seclusion):** This is not a standard psychiatric term. While some patients may isolate due to shame, seclusion is not a defining feature of the pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Gender Ratio:** More common in females (approx. 3:1). * **Comorbidity:** Highly associated with Mood disorders (Depression), Anxiety disorders, and Bulimia Nervosa. * **Legal Aspect:** In forensic psychiatry, kleptomania is rarely accepted as a legal defense for theft because the individual usually knows the act is wrong. * **Treatment:** Cognitive Behavioral Therapy (CBT) is the mainstay; SSRIs or Naltrexone may be used to reduce the "urge."
Question 104: A well-dressed man presents with a feeling of being trapped in a woman's body. What is he most likely suffering from?
- A. Paraphilia
- B. Transsexualism
- C. Gender identity disorder (Correct Answer)
- D. Erotomania
Explanation: **Explanation:** The core clinical feature described—a persistent sense of discomfort with one’s biological sex and a strong desire to be the opposite gender (feeling "trapped in the wrong body")—is the hallmark of **Gender Identity Disorder (GID)**. In ICD-10, this is characterized by the desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex. **Why the other options are incorrect:** * **Paraphilia:** These are disorders of sexual preference involving intense, persistent sexual interests in atypical objects, situations, or individuals (e.g., pedophilia, exhibitionism). They relate to sexual arousal patterns, not gender identity. * **Transsexualism:** While often used interchangeably in older texts, Transsexualism is considered a *subset* or the most extreme form of GID where the individual seeks medical intervention (hormones/surgery) to transition. GID is the broader, more encompassing diagnostic category used in standard examinations. * **Erotomania (de Clerambault’s Syndrome):** This is a delusional disorder where the patient believes that another person, usually of higher social status, is deeply in love with them. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Update:** Note that DSM-5 has replaced the term "Gender Identity Disorder" with **Gender Dysphoria** to reduce stigma, focusing on the "distress" rather than the identity itself. * **Transvestic Disorder vs. GID:** In Transvestic Disorder (a paraphilia), a person dresses in opposite-gender clothes for **sexual arousal**, whereas in GID, it is to achieve gender congruence. * **Dual-Role Transvestism:** Dressing in clothes of the opposite sex to enjoy a temporary experience of membership in the opposite sex, but *without* a desire for permanent sex change.
Question 105: Which of the following is NOT characteristic of Type A personality?
- A. Hostility
- B. Experiencing time pressure
- C. Competitiveness
- D. Mood fluctuations (Correct Answer)
Explanation: **Explanation:** The concept of **Type A Personality**, first described by cardiologists Friedman and Rosenman, refers to a set of behavioral patterns associated with a high-stress lifestyle and an increased risk of coronary artery disease (CAD). **Why "Mood Fluctuations" is the correct answer:** Mood fluctuations (affective instability) are not a core feature of Type A behavior. Instead, they are characteristic of **Cluster B personality disorders**, most notably **Borderline Personality Disorder**. Type A individuals are generally consistent in their drive and temperament, even if that temperament is chronically stressed or irritable. **Analysis of Incorrect Options:** * **Hostility (A):** This is considered the most "toxic" component of Type A personality. Research indicates that chronic anger and cynicism are the strongest predictors of cardiovascular morbidity. * **Time Pressure (B):** Also known as "hurry sickness," these individuals have an urgent sense of time, often multitasking, speaking rapidly, and becoming impatient with delays. * **Competitiveness (C):** Type A individuals are highly achievement-oriented and possess a strong competitive drive, often striving for success in both professional and social spheres. **High-Yield Clinical Pearls for NEET-PG:** * **Type A:** High risk for **Myocardial Infarction (MI)** and hypertension. Key traits: Ambition, Rigidity, Hostility, and Impatience. * **Type B:** The opposite of Type A; relaxed, easy-going, and less prone to stress-related diseases. * **Type C:** "Cancer-prone" personality; characterized by suppressed emotions, compliance, and helplessness. * **Type D:** "Distressed" personality; characterized by joint social inhibition and negative affectivity; also linked to poor cardiac outcomes.
Question 106: Which personality disorder can be a part of the autistic spectrum of disorders?
- A. Schizoid
- B. Schizotypical
- C. Borderline
- D. All the above (Correct Answer)
Explanation: **Explanation:** The relationship between Personality Disorders (PDs) and Autism Spectrum Disorder (ASD) is rooted in the significant overlap of clinical features, including social deficits, communication difficulties, and rigid behavioral patterns. Recent psychiatric research and clinical observations suggest that several PDs may represent "phenotypic variants" or co-morbid manifestations of the broader autistic spectrum. **Why "All the above" is correct:** 1. **Schizoid PD:** Characterized by social withdrawal and emotional coldness. Many individuals with high-functioning autism were historically misdiagnosed with Schizoid PD due to their preference for solitary activities and lack of interest in social relationships. 2. **Schizotypal PD:** Features eccentric behavior and odd beliefs. There is a strong genetic and symptomatic link between the "social awkwardness" of ASD and the "oddness" of Schizotypal PD. Both are considered part of the extended schizophrenia-autism spectrum. 3. **Borderline PD (BPD):** Emerging evidence suggests a high prevalence of undiagnosed ASD in females presenting with BPD. Emotional dysregulation, sensory sensitivities, and "meltdowns" in ASD can mimic the affective instability and impulsivity seen in BPD. **Clinical Pearls for NEET-PG:** * **Differential Diagnosis:** When a patient presents with lifelong social impairment, always consider ASD before labeling them with a Cluster A (Schizoid/Schizotypal) or Cluster B (Borderline) personality disorder. * **Gender Bias:** Females with ASD are frequently misdiagnosed as having Borderline Personality Disorder due to "masking" behaviors. * **High-Yield Fact:** Schizotypal PD is the personality disorder most genetically linked to Schizophrenia, but it shares the most significant "social-communication" deficit overlap with ASD.
Question 107: Which of the following statements regarding personality disorder clusters is false?
- A. Cluster C: Borderline personality disorder (Correct Answer)
- B. Cluster B: Antisocial personality disorder
- C. Cluster C: Obsessive compulsive personality disorder
- D. Cluster B: Histrionic personality disorder
Explanation: ### Explanation Personality disorders are classified into three clusters (A, B, and C) based on shared descriptive characteristics. Understanding this classification is high-yield for NEET-PG. **1. Why Option A is the Correct Answer (The False Statement):** **Borderline Personality Disorder (BPD)** belongs to **Cluster B**, not Cluster C. Cluster B is characterized by dramatic, emotional, or erratic behavior. BPD involves instability in interpersonal relationships, self-image, and affect, along with marked impulsivity. **2. Analysis of Other Options:** * **Option B (Cluster B: Antisocial):** Correct classification. Individuals show a pervasive pattern of disregard for the rights of others and lack of remorse. * **Option C (Cluster C: Obsessive-Compulsive):** Correct classification. Cluster C is the "Anxious/Fearful" cluster. OCPD involves a preoccupation with orderliness, perfectionism, and control. * **Option D (Cluster B: Histrionic):** Correct classification. It involves excessive emotionality and attention-seeking behavior. **3. NEET-PG High-Yield Summary Table:** | Cluster | Description | Disorders | | :--- | :--- | :--- | | **Cluster A** | "Mad/Odd/Eccentric" | Paranoid, Schizoid, Schizotypal | | **Cluster B** | "Bad/Dramatic/Erratic" | Antisocial, Borderline, Histrionic, Narcissistic | | **Cluster C** | "Sad/Anxious/Fearful" | Avoidant, Dependent, Obsessive-Compulsive (OCPD) | **Clinical Pearls:** * **Schizoid vs. Schizotypal:** Schizoid involves social withdrawal (prefers being alone), while Schizotypal involves "magical thinking" and odd eccentricities. * **OCPD vs. OCD:** OCPD is **ego-syntonic** (the person feels their way is right), whereas OCD is **ego-dystonic** (the person is distressed by their obsessions/compulsions). * **Splitting:** This is the hallmark defense mechanism of Borderline Personality Disorder (viewing people as "all good" or "all bad").
Question 108: What is true about the treatment of personality disorder?
- A. Antipsychotic drugs are used.
- B. Selective serotonin reuptake inhibitors (SSRIs) are used in treatment.
- C. Behavioral therapy is used.
- D. All of the above. (Correct Answer)
Explanation: **Explanation:** Personality disorders (PD) are characterized by enduring, inflexible patterns of behavior and inner experience. The management of PD is multifaceted, involving both **pharmacotherapy** and **psychotherapy**, as no single modality is curative. * **Why Option D is Correct:** The treatment approach is integrative. While psychotherapy is the mainstay, medications are used to manage "symptom clusters" (e.g., impulsivity, mood instability, or cognitive-perceptual distortions). * **Antipsychotics (Option A):** Low-dose antipsychotics (e.g., Risperidone, Olanzapine) are particularly effective in **Cluster A** (Paranoid, Schizoid, Schizotypal) for managing psychotic-like symptoms and in **Borderline PD** for controlling anger and transient psychosis. * **SSRIs (Option B):** These are the first-line pharmacological agents for managing affective instability, impulsivity, and comorbid depression or anxiety, especially in **Borderline** and **Avoidant PD**. * **Behavioral Therapy (Option C):** Psychotherapy is the gold standard. Specific modalities like **Dialectical Behavior Therapy (DBT)**—a form of cognitive-behavioral therapy—is the treatment of choice for Borderline PD. **High-Yield Clinical Pearls for NEET-PG:** 1. **Borderline PD:** The most common PD in clinical settings. **DBT** is the most effective treatment. 2. **Obsessive-Compulsive PD:** Unlike OCD, this is *ego-syntonic*. SSRIs are used for rigidity. 3. **Antisocial PD:** Generally considered the most difficult to treat; management focuses on behavioral limits. 4. **Pharmacotherapy Goal:** Medications do not "cure" the personality but treat the associated symptoms (e.g., mood swings, aggression).
Question 109: Persons with intermittent explosive disorder generally display all of the following except?
- A. Aggressive outbursts and violence
- B. Destruction of property
- C. Remorse, regret and embarrassment about their actions
- D. Bulimia (Correct Answer)
Explanation: **Explanation:** **Intermittent Explosive Disorder (IED)** is an impulse-control disorder characterized by discrete episodes of losing control of aggressive impulses [1]. **Why Bulimia is the Correct Answer:** Bulimia Nervosa is an eating disorder characterized by binge eating and compensatory behaviors [3]. While both IED and Bulimia involve issues with impulse control, **Bulimia is not a diagnostic feature or a general display of IED.** IED specifically focuses on reactive, "out-of-proportion" physical or verbal aggression. While comorbidities can exist, Bulimia is a distinct psychiatric diagnosis and not a characteristic manifestation of IED. **Analysis of Incorrect Options:** * **A & B (Aggressive outbursts and Destruction of property):** These are core diagnostic criteria for IED [1]. The aggression is impulsive, unplanned, and grossly disproportionate to any provocation or psychosocial stressor. It often results in physical assault or the breaking of objects. * **C (Remorse, regret, and embarrassment):** This is a key clinical feature that distinguishes IED from Antisocial Personality Disorder [1], [2]. Patients with IED typically feel genuine guilt or regret after the "arousal" of the episode subsides, whereas those with Antisocial Personality Disorder lack remorse [1], [2]. **NEET-PG Clinical Pearls:** * **Diagnostic Threshold:** According to DSM-5, episodes must occur at least twice weekly for 3 months (low intensity) or three times within a year (high intensity involving property damage/injury) [1]. * **Neurobiology:** IED is often associated with **low levels of Serotonin (5-HT)** in the cerebrospinal fluid and hyperactivity in the amygdala. * **Treatment of Choice:** **SSRIs** (like Fluoxetine) are the first-line pharmacological treatment to reduce impulsive aggression, often combined with Cognitive Behavioral Therapy (CBT).
Question 110: Kleptomania is defined as?
- A. An irresistible urge to set fire
- B. An irresistible urge to steal things (Correct Answer)
- C. Compulsive hair pulling
- D. Pathological gambling
Explanation: **Explanation:** **Kleptomania** is classified under **Impulse Control Disorders** in ICD-10 and DSM-5. It is characterized by a recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. The core psychological mechanism involves a rising sense of tension before the act, followed by gratification, pleasure, or relief during the theft. Unlike shoplifting, the act is not motivated by anger, vengeance, or financial gain. **Analysis of Options:** * **Option A (Pyromania):** This is the deliberate and purposeful setting of fires on more than one occasion. Like kleptomania, it involves tension before the act and relief afterward. * **Option C (Trichotillomania):** This is characterized by the recurrent pulling out of one's own hair, leading to noticeable hair loss. It is often associated with OCD-spectrum disorders. * **Option D (Pathological Gambling):** Now classified as a "Substance-Related and Addictive Disorder" in DSM-5, it involves persistent and maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. **High-Yield Clinical Pearls for NEET-PG:** * **Gender Predominance:** Kleptomania is more common in **females** (3:1 ratio). * **Comorbidity:** Highly associated with mood disorders (Depression), anxiety disorders, and eating disorders (especially Bulimia Nervosa). * **Legal Aspect:** The stolen objects are often discarded, returned surreptitiously, or hoarded. * **Treatment:** Cognitive Behavioral Therapy (CBT) is the mainstay. Pharmacotherapy includes **SSRIs** (to treat underlying impulsivity/depression) and **Naltrexone** (to reduce the "rush" or urge).
Practice by Chapter
Classification of Personality Disorders
Practice Questions
Cluster A Personality Disorders
Practice Questions
Cluster B Personality Disorders
Practice Questions
Cluster C Personality Disorders
Practice Questions
Borderline Personality Disorder
Practice Questions
Antisocial Personality Disorder
Practice Questions
Narcissistic Personality Disorder
Practice Questions
Psychotherapy for Personality Disorders
Practice Questions
Dialectical Behavior Therapy
Practice Questions
Mentalization-Based Therapy
Practice Questions
Pharmacological Approaches
Practice Questions
Outcome and Prognosis
Practice Questions
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