Personality Disorders — MCQs

Personality Disorders Indian Medical PG Practice Questions and MCQs

Question 111: All of the following are cluster C personality disorders except?

A. Anxious
B. Avoidant
C. Schizoid (Correct Answer)
D. Dependent

Explanation: ### Explanation Personality disorders in the DSM-5 are categorized into three clusters (A, B, and C) based on shared descriptive characteristics. Understanding this classification is high-yield for NEET-PG. **1. Why Schizoid is the Correct Answer:** **Schizoid Personality Disorder** belongs to **Cluster A**, which is characterized by odd or eccentric behaviors. Individuals with Schizoid personality are typically detached from social relationships, prefer solitary activities, and exhibit a restricted range of emotional expression (the "loner" profile). **2. Analysis of Incorrect Options (Cluster C Disorders):** Cluster C is characterized by **anxious or fearful** behaviors. It includes: * **Avoidant (Option B):** Characterized by extreme social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Unlike Schizoid individuals, they *desire* social contact but fear rejection. * **Anxious (Option A):** In the ICD-10 classification, Avoidant Personality Disorder is referred to as **Anxious (Avoidant) Personality Disorder**. Therefore, both terms refer to the same Cluster C entity. * **Dependent (Option D):** Characterized by an excessive need to be taken care of, leading to submissive and clinging behavior and fear of separation. * *Note: Obsessive-Compulsive Personality Disorder (OCPD) is the third member of Cluster C.* **Clinical Pearls for NEET-PG:** * **Cluster A (Odd/Eccentric):** Paranoid, Schizoid, Schizotypal. (Mnemonic: **PSS**) * **Cluster B (Dramatic/Erratic):** Antisocial, Borderline, Histrionic, Narcissistic. (Mnemonic: **ABHN**) * **Cluster C (Anxious/Fearful):** Avoidant, Dependent, OCPD. (Mnemonic: **ADO**) * **Distinction:** Schizoid (no desire for friends) vs. Avoidant (desires friends but is too shy/fearful). * **Schizotypal** is often considered a premorbid personality for Schizophrenia and features "magical thinking."

Question 112: A 21-year-old girl is disturbed by the appearance of her nose, which she believes is disfiguring, although others do not perceive it that way. What is the likely diagnosis?

A. Delusional disorder
B. Obsessive compulsive disorder
C. Body dysmorphic disorder (Correct Answer)
D. Specific phobia

Explanation: ### Explanation **Correct Answer: C. Body dysmorphic disorder (BDD)** **Why it is correct:** Body Dysmorphic Disorder is characterized by a distressing or impairing preoccupation with one or more **perceived defects or flaws** in physical appearance that are **not observable or appear slight** to others. In this case, the patient’s belief that her nose is "disfiguring" despite others perceiving it as normal is the classic presentation. Patients often perform repetitive behaviors (mirror checking, excessive grooming) or mental acts in response to these concerns. **Why the other options are incorrect:** * **A. Delusional Disorder (Somatic type):** While BDD can occur with absent insight (delusional intensity), BDD is the more specific diagnosis for appearance-related concerns. In BDD, the focus is specifically on "defect in appearance," whereas somatic delusions usually involve bodily functions or sensations (e.g., infestation, foul odor). * **B. Obsessive Compulsive Disorder (OCD):** While BDD is categorized under "OCD and Related Disorders" in DSM-5 due to repetitive behaviors, the specific focus on physical appearance makes BDD the most accurate diagnosis. * **D. Specific Phobia:** This involves an irrational fear of a specific object or situation (e.g., heights, spiders). It does not involve distorted self-perception or preoccupation with physical flaws. **High-Yield Clinical Pearls for NEET-PG:** * **Common Site:** The nose is the most common feature of concern (Rhinoplasty seekers). * **Gender:** It is equally common in males and females, though females are more likely to have comorbid eating disorders. * **Treatment of Choice:** **SSRIs** (often requiring higher doses than in depression) and **Cognitive Behavioral Therapy (CBT)**. * **Key Distinction:** Patients with BDD often seek cosmetic surgery or dermatological treatments, which rarely resolve the underlying psychological distress.

Question 113: All of the following are cluster B personality disorders except?

A. Antisocial
B. Narcissistic
C. Avoidant (Correct Answer)
D. Borderline

Explanation: ### Explanation Personality disorders in the DSM-5 are categorized into three clusters (A, B, and C) based on shared descriptive characteristics. **1. Why Avoidant Personality Disorder is the Correct Answer:** Avoidant Personality Disorder belongs to **Cluster C**, which is characterized by **anxious and fearful** behaviors. Individuals with this disorder experience intense feelings of inadequacy, extreme sensitivity to negative evaluation, and social inhibition. Unlike Cluster B, which is defined by externalizing behaviors, Cluster C disorders are characterized by internalizing anxiety. **2. Analysis of Incorrect Options (Cluster B Disorders):** Cluster B is known as the **"Dramatic, Emotional, or Erratic"** cluster. The options provided are classic examples: * **Antisocial:** Disregard for the rights of others, lack of remorse, and impulsivity. * **Narcissistic:** Grandiosity, need for admiration, and lack of empathy. * **Borderline:** Instability in relationships, self-image, and affect, often accompanied by self-harm. * *(Note: Histrionic Personality Disorder is the fourth member of this cluster).* **3. NEET-PG High-Yield Clinical Pearls:** * **Cluster A (The "Odd/Eccentric"):** Includes Schizoid, Schizotypal, and Paranoid. (Mnemonic: **"Weird"**) * **Cluster B (The "Dramatic/Erratic"):** Includes Antisocial, Borderline, Histrionic, and Narcissistic. (Mnemonic: **"Wild"**) * **Cluster C (The "Anxious/Fearful"):** Includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorder (OCPD). (Mnemonic: **"Worried"**) * **Key Distinction:** Avoidant PD patients *desire* social interaction but fear rejection, whereas Schizoid PD patients (Cluster A) prefer isolation and have no interest in social relationships.

Question 114: Which of the following is a characteristic feature of Borderline Personality Disorder?

A. Chronic feeling of emptiness
B. Unstable interpersonal relationships (Correct Answer)
C. Grandiosity
D. Low self-esteem

Explanation: **Explanation:** **Borderline Personality Disorder (BPD)** is a Cluster B personality disorder characterized by a pervasive pattern of instability in affect, self-image, and interpersonal relationships. 1. **Why Option B is correct:** A hallmark of BPD is a pattern of **unstable and intense interpersonal relationships** characterized by alternating between extremes of idealization and devaluation (a defense mechanism known as **"Splitting"**). Patients often experience a frantic effort to avoid real or imagined abandonment. 2. **Why other options are incorrect:** * **Option A:** While a "chronic feeling of emptiness" is indeed a diagnostic criterion for BPD (DSM-5), the question asks for a characteristic feature, and "unstable interpersonal relationships" is considered the core defining behavioral manifestation in clinical vignettes. (Note: In many exams, if both are present, the interpersonal instability is the primary "textbook" descriptor). * **Option C:** **Grandiosity** is a characteristic feature of **Narcissistic Personality Disorder**, not BPD. * **Option D:** While BPD patients have an unstable self-image, **Low self-esteem** is more characteristic of **Avoidant Personality Disorder** or Depressive disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Defense Mechanism:** "Splitting" (seeing people as all good or all bad) is the most frequently tested concept associated with BPD. * **Micropsychotic Episodes:** Under extreme stress, BPD patients may experience transient paranoid ideation or dissociative symptoms. * **Self-Harm:** Recurrent suicidal behavior, gestures, or self-mutilating behavior (e.g., cutting) is a major diagnostic criterion. * **Treatment:** The gold standard psychotherapy for BPD is **Dialectical Behavior Therapy (DBT)**.

Question 115: Acrophobia is a fear of what?

A. Heights (Correct Answer)
B. Snakes
C. Cats
D. Death

Explanation: **Explanation:** **Acrophobia** is defined as an irrational and extreme fear of **heights**. It belongs to the category of **Specific Phobias** (ICD-11/DSM-5), which are characterized by significant anxiety triggered by a specific object or situation, leading to avoidance behavior or intense distress. The term is derived from the Greek word *'akron'*, meaning peak or edge. **Analysis of Options:** * **B. Snakes:** The fear of snakes is termed **Ophidiophobia**. This is one of the most common zoophobias (fear of animals). * **C. Cats:** The fear of cats is known as **Ailurophobia** (or Elurophobia). * **D. Death:** The fear of death or the dying process is termed **Thanatophobia**. **Clinical Pearls for NEET-PG:** 1. **Treatment of Choice:** For specific phobias like acrophobia, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Exposure Therapy** (specifically Systematic Desensitization or Flooding). 2. **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptomatic relief of performance-related anxiety but are not first-line for long-term management of phobias. 3. **Other High-Yield Phobias:** * **Agoraphobia:** Fear of open spaces or situations where escape might be difficult. * **Glossophobia:** Fear of public speaking. * **Nyctophobia:** Fear of darkness. * **Cynophobia:** Fear of dogs.

Question 116: Which of the following is NOT characteristic of Borderline Personality Disorder?

A. Unstable self-image
B. Impulsivity
C. Self-mutilation behavior
D. Attention-seeking behavior (Correct Answer)

Explanation: **Explanation:** The core psychopathology of **Borderline Personality Disorder (BPD)** revolves around a pervasive pattern of instability in interpersonal relationships, self-image, and affect, alongside marked impulsivity. **Why "Attention-seeking behavior" is the correct answer:** While patients with BPD may seek attention during crises, **attention-seeking behavior** is the hallmark characteristic of **Histrionic Personality Disorder (HPD)**. In HPD, the individual feels uncomfortable when they are not the center of attention and uses physical appearance or provocative behavior to draw focus. In contrast, BPD is defined more by the fear of abandonment and emotional dysregulation rather than a primary need for the spotlight. **Analysis of Incorrect Options:** * **A. Unstable self-image:** This is a diagnostic criterion for BPD. Patients often experience a "fragmented sense of self," leading to frequent changes in goals, values, and career aspirations. * **B. Impulsivity:** BPD is characterized by impulsivity in at least two areas that are potentially self-damaging (e.g., spending, unsafe sex, substance abuse, binge eating). * **C. Self-mutilation behavior:** Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior (like cutting) is a classic feature of BPD, often used as a mechanism to cope with emotional numbness or intense psychic pain. **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 for BPD. * **Micropsychotic Episodes:** Under extreme stress, BPD patients may experience transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 117: A young lady was admitted after an overdose of diazepam following a relationship breakup. She has a previous history of self-harm by wrist-slitting. What is the most likely diagnosis?

A. Narcissistic personality disorder
B. Dependent personality disorder
C. Borderline personality disorder (Correct Answer)
D. Histrionic personality disorder

Explanation: **Explanation:** The clinical presentation of a young female with **affective instability** (triggered by a breakup), **impulsivity** (overdose), and a history of **recurrent self-harm** (wrist-slitting) is a classic description of **Borderline Personality Disorder (BPD)**. **Why BPD is the correct answer:** BPD is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affects. Key diagnostic features include a frantic effort to avoid real or imagined abandonment (the breakup trigger) and recurrent suicidal behavior, gestures, or self-mutilating behavior. In NEET-PG scenarios, the combination of "relationship instability" and "self-harm" is the hallmark of BPD. **Why other options are incorrect:** * **Narcissistic PD:** Characterized by grandiosity, a need for admiration, and a lack of empathy. While they react poorly to criticism, they typically do not engage in repetitive self-harm. * **Dependent PD:** These individuals have an excessive need to be taken care of, leading to submissive and clinging behavior. While they fear separation, they usually lack the impulsivity and self-destructive aggression seen in BPD. * **Histrionic PD:** Features attention-seeking behavior and excessive emotionality. While they may use "suicidal threats" to gain attention, the history of actual physical self-mutilation (wrist-slitting) strongly points toward BPD. **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:** The gold standard psychotherapy for BPD is **Dialectical Behavior Therapy (DBT)**. * **Demographics:** More commonly diagnosed in females. * **Micro-psychotic episodes:** Under extreme stress, BPD patients may experience transient paranoid ideation or dissociative symptoms.

Question 118: Which of the following is characteristic of a dependent personality disorder?

A. Self-doubt and fear of abandonment (Correct Answer)
B. Odd and eccentric behavior
C. Attention-seeking behavior
D. Punctuality and perfectionism

Explanation: **Explanation:** **Dependent Personality Disorder (DPD)** is characterized by a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. 1. **Why Option A is correct:** Individuals with DPD suffer from profound **self-doubt** and lack of self-confidence. They feel incapable of functioning independently or making everyday decisions without excessive advice and reassurance from others. This stems from an intense **fear of abandonment** (separation anxiety), causing them to remain in subordinate or even abusive relationships to avoid being alone. 2. **Why the other options are incorrect:** * **Option B (Odd and eccentric behavior):** This is the hallmark of **Cluster A** personality disorders, specifically Schizotypal Personality Disorder. * **Option C (Attention-seeking behavior):** This is characteristic of **Histrionic Personality Disorder**, where the individual feels uncomfortable when they are not the center of attention. * **Option D (Punctuality and perfectionism):** These are core features of **Obsessive-Compulsive Personality Disorder (OCPD)**, characterized by rigidity and a preoccupation with orderliness. **High-Yield Clinical Pearls for NEET-PG:** * **Cluster Classification:** DPD belongs to **Cluster C** (the "Anxious/Fearful" cluster), along with Avoidant and OCPD. * **Defense Mechanism:** The primary defense mechanism used is **Regression**. * **Key Diagnostic Feature:** They often volunteer to do unpleasant tasks just to get others to like or stay with them. * **Differential:** Unlike Borderline Personality Disorder (which also fears abandonment), DPD individuals respond to abandonment with **submissiveness and seeking a replacement**, rather than rage and impulsivity.

Question 119: A person exhibiting a habit of repeated self-inflicted injuries is most characteristic of which personality disorder?

A. Borderline personality disorder (Correct Answer)
B. Schizoid personality disorder
C. Histrionic personality disorder
D. Narcissistic personality disorder

Explanation: **Explanation:** **Borderline Personality Disorder (BPD)** is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affect, along with marked impulsivity. **Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior** (such as cutting or burning) is a core diagnostic criterion (DSM-5). These acts are often used as a maladaptive coping mechanism to regulate intense emotional pain, feelings of emptiness, or to counteract "numbing" (dissociation). **Why other options are incorrect:** * **Schizoid Personality Disorder:** Characterized by social detachment and a restricted range of emotional expression. These individuals prefer solitary activities and lack a desire for close relationships, but they do not typically engage in self-harm. * **Histrionic Personality Disorder:** Features excessive emotionality and attention-seeking behavior. While they may be dramatic or manipulative, self-inflicted injury is not a defining characteristic. * **Narcissistic Personality Disorder:** Defined by grandiosity, a need for admiration, and a lack of empathy. Their fragility relates to their ego/status rather than the self-destructive impulsivity seen in BPD. **High-Yield Clinical Pearls for NEET-PG:** * **Defense Mechanism:** The hallmark 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 for BPD, specifically designed to manage self-harm and emotional dysregulation. * **Micro-psychotic episodes:** Under extreme stress, BPD patients may experience transient paranoid ideation or dissociative symptoms. * **Gender:** More commonly diagnosed in females in clinical settings.

Question 120: A 40-year-old married male presents with beliefs of being multitalented and excessive overconfidence. He dismisses advice from family and friends, suspecting ulterior motives. He is also consistently suspicious of his wife. These features are characteristic of which of the following conditions?

A. Borderline personality disorder
B. Schizoid personality disorder
C. Paranoid personality disorder (Correct Answer)
D. Histrionic personality disorder

Explanation: **Explanation:** The clinical presentation highlights a pervasive pattern of **distrust and suspiciousness** of others, which is the hallmark of **Paranoid Personality Disorder (PPD)**. 1. **Why Paranoid Personality Disorder is correct:** The patient exhibits key diagnostic criteria for PPD: * **Unjustified Suspicion:** He suspects "ulterior motives" behind advice from family. * **Pathological Jealousy:** He is "consistently suspicious of his wife" without adequate justification (morbid jealousy). * **Excessive Self-Importance:** Patients with PPD often display overconfidence and a sense of being "multitalented" as a defensive mechanism to maintain autonomy and avoid appearing vulnerable to perceived enemies. 2. **Why other options are incorrect:** * **Borderline Personality Disorder:** Characterized by instability in relationships, self-image, and affect, along with marked impulsivity and fear of abandonment. It does not primarily feature pervasive suspicion. * **Schizoid Personality Disorder:** Characterized by social detachment and a restricted range of emotional expression. These individuals are "loners" who prefer solitary activities and lack interest in praise or criticism, rather than being suspicious or overconfident. * **Histrionic Personality Disorder:** Characterized by excessive emotionality and attention-seeking behavior. While they may be dramatic, they lack the characteristic suspiciousness and hostility seen in PPD. **High-Yield Clinical Pearls for NEET-PG:** * **PPD Mnemonic (SUSPECT):** **S**pousal infidelity suspected, **U**nforgiving (bears grudges), **S**uspicious, **P**erceives attacks, **E**nemy or friend (doubts loyalty), **C**onfiding in others is feared, **T**hreats seen in benign remarks. * **Defense Mechanism:** The primary defense mechanism used in PPD is **Projection** (attributing one's own unacknowledged feelings onto others). * **Differential:** Unlike Delusional Disorder (Persecutory type), the suspicions in PPD are not fixed, non-bizarre delusions but rather a pervasive worldview.

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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