Personality Disorders — MCQs

A 27-year-old woman presents with sleep difficulty following a breakup one month ago. She also reports difficulties with work, decision-making, and socializing without external support. She has a history of low self-confidence and fears of rejection and abandonment since early adulthood. She appears anxious and sad but brightens easily. What is the most likely diagnosis in this patient?

Q127Easy

A 25-year-old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks locks in his house. What is the most likely diagnosis?

Q128Easy

Antisocial personality is seen with which of the following conditions?

Q129Easy

What is Folie à deux?

Q130

A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

Personality Disorders Indian Medical PG Practice Questions and MCQs

Question 121: Which of the following is a temperament type?

A. Novelty seeking (Correct Answer)
B. Histrionic
C. Anankastic
D. Narcissistic

Explanation: ### Explanation The correct answer is **Novelty seeking**. **1. Why Novelty Seeking is Correct:** This question is based on **Cloninger’s Tridimensional (later Biosocial) Model of Personality**. According to Cloninger, personality is composed of two components: **Temperament** (genetically determined, biological) and **Character** (learned through experience). * **Temperament types (4):** Novelty seeking (dopamine), Harm avoidance (serotonin), Reward dependence (norepinephrine), and Persistence. * **Character types (3):** Self-directedness, Cooperativeness, and Self-transcendence. **Novelty seeking** is the tendency to respond strongly to novelty and cues for reward, mediated primarily by the **dopaminergic** system. **2. Why the Other Options are Incorrect:** * **Histrionic (B), Anankastic (C), and Narcissistic (D)** are not temperament types; they are specific **Personality Disorders** as defined by the DSM-5 and ICD-10. * **Histrionic and Narcissistic** belong to Cluster B (dramatic/erratic). * **Anankastic** is the ICD-10 term for **Obsessive-Compulsive Personality Disorder (OCPD)**, which belongs to Cluster C (anxious/fearful). **3. High-Yield Clinical Pearls for NEET-PG:** * **Neurotransmitter Correlation:** Remember the "D-S-N" mnemonic for Cloninger’s temperaments: **D**opamine = **N**ovelty seeking; **S**erotonin = **H**arm avoidance; **N**orepinephrine = **R**eward dependence. * **Anankastic Personality:** Frequently tested as a synonym for OCPD. Key features include perfectionism, rigidity, and preoccupation with rules. * **Temperament vs. Character:** Temperament is considered "hard-wired" at birth, while Character develops throughout adulthood.

Question 122: A 16-year-old girl presents with a history of multiple wrist-slashing suicide attempts, primarily related to domestic conflict. She experiences significant mood fluctuations and exhibits a pervasive pattern of unstable interpersonal relationships. What is the most probable diagnosis?

A. Borderline personality disorder (Correct Answer)
B. Major depression
C. Histrionic personality disorder
D. Adjustment disorder

Explanation: **Explanation:** The clinical presentation of recurrent self-harm (wrist-slashing), affective instability (mood fluctuations), and a pattern of unstable interpersonal relationships in a young patient is classic for **Borderline Personality Disorder (BPD)**. **Why Borderline Personality Disorder is correct:** According to DSM-5 criteria, BPD is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity. Key features present in this case include: * **Recurrent suicidal behavior or self-mutilation:** Often used as a maladaptive coping mechanism for emotional pain or to prevent perceived abandonment. * **Affective instability:** Rapid shifts in mood (dysphoria, irritability, or anxiety) usually lasting a few hours. * **Unstable relationships:** A pattern of alternating between extremes of idealization and devaluation (splitting). **Why other options are incorrect:** * **Major Depression:** While mood symptoms are present, the chronic pattern of personality instability and the specific nature of "domestic conflict" triggering self-harm point toward a personality disorder rather than a primary mood disorder. * **Histrionic Personality Disorder:** Patients are attention-seeking and emotionally shallow, but they typically lack the profound self-destructiveness, chronic suicidality, and intense anger seen in BPD. * **Adjustment Disorder:** This is a short-term response to a specific stressor. The "pervasive pattern" and "multiple attempts" described suggest a long-standing personality trait rather than a transient reaction. **NEET-PG High-Yield Pearls:** * **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. * **Pharmacotherapy:** Used only as an adjunct for specific symptoms (e.g., SSRIs for impulsivity, low-dose antipsychotics for cognitive-perceptual symptoms). * **Age Note:** While personality disorders are usually diagnosed at 18, BPD can be diagnosed in adolescents if features are persistent for at least one year.

Question 123: Mentalization-Based Therapy is primarily used in the treatment of which of the following personality disorders?

A. Antisocial personality disorder
B. Obsessive-compulsive personality disorder
C. Avoidant personality disorder
D. Borderline personality disorder (Correct Answer)

Explanation: **Explanation:** **Mentalization-Based Therapy (MBT)** is a psychotherapeutic approach specifically developed by Anthony Bateman and Peter Fonagy to treat **Borderline Personality Disorder (BPD)**. 1. **Why BPD is correct:** Mentalization is the capacity to understand the mental states (emotions, beliefs, and intentions) of oneself and others. Patients with BPD often have a deficit in this capacity, leading to emotional dysregulation, impulsive behavior, and unstable relationships. MBT focuses on improving this "reflective functioning," helping patients stabilize their sense of self and better manage interpersonal stressors. 2. **Why other options are incorrect:** * **Antisocial PD:** While MBT is being researched for antisocial traits, the primary gold-standard treatment remains behavioral management or specialized cognitive therapies. * **Obsessive-Compulsive PD:** The mainstay of treatment is Cognitive Behavioral Therapy (CBT) or psychodynamic psychotherapy focusing on rigidity and perfectionism. * **Avoidant PD:** This is typically managed with Social Skills Training, CBT, or exposure therapy to address social inhibition and feelings of inadequacy. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for BPD:** **Dialectical Behavior Therapy (DBT)** is the most frequently tested first-line treatment, but **MBT** and **Schema Therapy** are high-yield alternatives. * **Pharmacotherapy in BPD:** No FDA-approved drug exists; however, SSRIs (for mood/impulsivity) and low-dose antipsychotics (for cognitive-perceptual symptoms) are used symptomatically. * **Key Feature of BPD:** "Splitting" (viewing people as all good or all bad) is the hallmark defense mechanism.

Question 124: Which of the following is a Cluster B personality disorder?

A. Schizoid personality disorder
B. Narcissistic personality disorder (Correct Answer)
C. Dependent personality disorder
D. Antisocial personality disorder

Explanation: **Explanation:** Personality disorders in the DSM-5 are categorized into three clusters based on shared descriptive characteristics. **Cluster B** is characterized by behaviors that are **dramatic, emotional, or erratic.** **1. Why Narcissistic Personality Disorder is Correct:** Narcissistic Personality Disorder (NPD) is a classic Cluster B disorder. Individuals with NPD exhibit a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy. Their behavior is typically dramatic and self-centered, fitting the "erratic" profile of this cluster. **2. Analysis of Incorrect Options:** * **A. Schizoid Personality Disorder:** This belongs to **Cluster A** (Odd/Eccentric). These individuals are socially detached and prefer solitary activities, showing a restricted range of emotional expression. * **C. Dependent Personality Disorder:** This belongs to **Cluster C** (Anxious/Fearful). It is characterized by an excessive need to be taken care of, leading to submissive and clinging behavior. * **D. Antisocial Personality Disorder:** While this **is** also a Cluster B disorder, the question format in medical exams often requires identifying the "best" or "most specific" fit if multiple are present, or it serves as a distractor in single-choice formats. *Note: In standard classification, both B and D are Cluster B; however, in the context of this specific question's key, Narcissistic is the highlighted representative.* **Clinical Pearls for NEET-PG:** * **Cluster A (The "Mad"):** Schizoid, Schizotypal, Paranoid. * **Cluster B (The "Bad"):** Antisocial, Borderline, Histrionic, Narcissistic. * **Cluster C (The "Sad"):** Avoidant, Dependent, Obsessive-Compulsive (OCPD). * **High-Yield Distinction:** Do not confuse **OCPD** (Cluster C - ego-syntonic) with **OCD** (Anxiety disorder - ego-dystonic). * **Treatment:** Dialectical Behavior Therapy (DBT) is the gold standard for Borderline Personality Disorder (Cluster B).

Question 125: Which DSM-IV personality disorder is not classified as a personality disorder in ICD-10 and is placed with schizophrenia?

A. Schizoid
B. Paranoid
C. Narcissistic
D. Schizotypal (Correct Answer)

Explanation: ### Explanation The correct answer is **Schizotypal Personality Disorder**. **1. Why Schizotypal is the Correct Answer:** In the **DSM-IV (and DSM-5)**, Schizotypal disorder is classified as a **Cluster A Personality Disorder**, characterized by odd beliefs, magical thinking, and social deficits. However, in the **ICD-10**, it is not listed under "Specific Personality Disorders" (F60). Instead, it is classified under **F21: Schizotypal Disorder**, grouped within the same category as **Schizophrenia and Delusional Disorders**. This is because ICD-10 views Schizotypal disorder as a "prodromal" or genetic variant of schizophrenia rather than a distinct personality type. **2. Analysis of Incorrect Options:** * **A. Schizoid:** Characterized by emotional coldness and detachment from social relationships. Both DSM and ICD-10 classify this as a Personality Disorder. * **B. Paranoid:** Characterized by pervasive distrust and suspiciousness. Both systems classify this as a Personality Disorder. * **C. Narcissistic:** Characterized by grandiosity and lack of empathy. While it is a major diagnosis in DSM, it is notably **absent** as a specific category in ICD-10 (often placed under "Other specific personality disorders"). However, it is not grouped with schizophrenia. **3. NEET-PG High-Yield Pearls:** * **Cluster A (Odd/Eccentric):** Includes Paranoid, Schizoid, and Schizotypal. * **Schizotypal vs. Schizoid:** Schizotypal involves *eccentricity/magical thinking*, whereas Schizoid involves *social isolation/apathy*. * **ICD-11 Update:** In the latest ICD-11, Schizotypal disorder remains grouped with Schizophrenia, further emphasizing the "Schizophrenia Spectrum" concept. * **Key Feature:** Schizotypal patients often experience "Ideas of Reference" (not delusions of reference).

Question 126: A 27-year-old woman presents with sleep difficulty following a breakup one month ago. She also reports difficulties with work, decision-making, and socializing without external support. She has a history of low self-confidence and fears of rejection and abandonment since early adulthood. She appears anxious and sad but brightens easily. What is the most likely diagnosis in this patient?

A. Acute stress disorder
B. Major depressive disorder
C. Borderline personality disorder
D. Dependent personality disorder (Correct Answer)

Explanation: **Explanation:** The patient’s clinical presentation is most consistent with **Dependent Personality Disorder (DPD)**. The core feature of DPD is a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. **Why Option D is Correct:** The patient exhibits several DSM-5 criteria for DPD: * **Indecisiveness:** Difficulty making everyday decisions without excessive advice and reassurance. * **Lack of Autonomy:** Difficulty initiating projects or doing things on her own due to a lack of self-confidence. * **Fear of Abandonment:** Intense fear of being left to care for herself, often triggered by the end of a relationship. * **Socialization Issues:** Reliance on external support to function socially and professionally. **Why Other Options are Incorrect:** * **A. Acute Stress Disorder:** Requires exposure to a traumatic event (e.g., death, serious injury) and lasts for 3 days to 1 month. A breakup is a stressor, but the patient’s symptoms (low confidence, fear of rejection) are long-standing (since early adulthood). * **B. Major Depressive Disorder:** While she is sad, she "brightens easily," suggesting her mood is reactive rather than persistently depressed. The primary pathology here is her personality structure. * **C. Borderline Personality Disorder (BPD):** While BPD also involves fear of abandonment, it is characterized by "affective instability," impulsivity, and intense anger. This patient is submissive rather than volatile. **NEET-PG High-Yield Pearls:** * **Cluster B vs. Cluster C:** BPD (Cluster B) reacts to abandonment with **rage and manipulation**, whereas DPD (Cluster C) reacts with **submissiveness and seeking a replacement relationship**. * **Defense Mechanism:** The primary defense mechanism used in DPD is **Regression**. * **Management:** Psychotherapy (specifically CBT or Assertiveness Training) is the treatment of choice. Pharmacotherapy is only used for comorbid anxiety or depression.

Question 127: A 25-year-old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks locks in his house. What is the most likely diagnosis?

A. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
B. Obsessive-Compulsive Personality Disorder (OCPD)
C. Phobia
D. Somatoform disorder

Explanation: ### Explanation **Correct Answer: A. Obsessive-Compulsive Disorder (OCD)** The patient presents with classic symptoms of **Obsessive-Compulsive Disorder (OCD)**. The underlying medical concept involves two components: 1. **Obsessions:** Recurrent, intrusive, and distressing thoughts (e.g., the doubt that the car door is unlocked). 2. **Compulsions:** Repetitive behaviors performed to neutralize the anxiety caused by the obsession (e.g., frequent checking). Crucially, these symptoms are **Ego-dystonic** (the patient recognizes the thoughts as irrational or excessive and finds them distressing), which is the hallmark of OCD. **Why other options are incorrect:** * **B. Obsessive-Compulsive Personality Disorder (OCPD):** Unlike OCD, OCPD is **Ego-syntonic**. Individuals with OCPD are preoccupied with perfectionism, orderliness, and control, but they do not typically have discrete obsessions or compulsions. They believe their way of doing things is "correct" and do not feel the need to resist their behaviors. * **C. Phobia:** This involves an intense, irrational fear of a specific object or situation leading to avoidance. It does not involve the ritualistic "checking" behaviors seen here. * **D. Somatoform disorder:** This involves physical symptoms (like pain or fatigue) that suggest a medical condition but cannot be fully explained by one. It does not involve intrusive thoughts or repetitive rituals. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic:** OCD (Patient vs. Symptoms). * **Ego-syntonic:** OCPD (Symptoms are part of the patient's "self"). * **First-line Treatment for OCD:** Selective Serotonin Reuptake Inhibitors (SSRIs) at high doses and Cognitive Behavioral Therapy (CBT) using **Exposure and Response Prevention (ERP)**. * **Neurobiology:** OCD is associated with structural abnormalities in the **Orbitofrontal cortex, Anterior Cingulate Cortex, and Caudate nucleus**.

Question 128: Antisocial personality is seen with which of the following conditions?

A. Drug abuse (Correct Answer)
B. Paranoid schizophrenia
C. OCD
D. None of the above

Explanation: **Explanation:** **Antisocial Personality Disorder (ASPD)** is characterized by a pervasive pattern of disregard for, and violation of, the rights of others, beginning in childhood (as Conduct Disorder) and continuing into adulthood. **Why Option A is Correct:** There is a strong clinical and epidemiological correlation between ASPD and **Substance Use Disorders (SUD)**. Individuals with ASPD exhibit high levels of impulsivity, sensation-seeking behavior, and a lack of remorse, which are significant risk factors for drug abuse. Approximately 70-80% of individuals with ASPD have a co-occurring substance use disorder. This relationship is bidirectional: ASPD predisposes individuals to drug use, and chronic drug use can exacerbate antisocial behaviors. **Why Other Options are Incorrect:** * **B. Paranoid Schizophrenia:** This is a psychotic disorder characterized by delusions and hallucinations. While a patient with schizophrenia may commit a crime during a psychotic episode, it is fundamentally different from the lifelong personality trait of ASPD. * **C. OCD (Obsessive-Compulsive Disorder):** This is an anxiety-related disorder characterized by intrusive thoughts and ritualistic behaviors. It is often associated with *Anankastic (Obsessive-Compulsive) Personality Disorder*, which is characterized by rigidity and perfectionism—the polar opposite of the impulsive and rule-breaking nature of ASPD. **High-Yield Clinical Pearls for NEET-PG:** * **Age Criteria:** A diagnosis of ASPD cannot be made before age **18**. However, there must be evidence of **Conduct Disorder** before age 15. * **The "Low Arousal" Theory:** Patients with ASPD often have lower resting heart rates and skin conductance, leading them to seek stimulation through risky behaviors (like drug abuse). * **Cluster B:** ASPD belongs to Cluster B (Dramatic/Erratic) personality disorders, along with Borderline, Histrionic, and Narcissistic PDs. * **Treatment:** ASPD is notoriously difficult to treat; psychotherapy (CBT) is the mainstay, but pharmacotherapy is only used to manage comorbid conditions like aggression or substance abuse.

Question 129: What is Folie à deux?

A. Obsessive-compulsive disorder
B. Shared delusional disorder (Correct Answer)
C. Hysteria
D. Neurasthenia

Explanation: **Explanation:** **Folie à deux** (literally "madness of two") is a rare clinical syndrome characterized by the transmission of delusional beliefs from one individual to another. In modern psychiatric classification (ICD-10), it is termed **Shared Psychotic Disorder** or **Induced Delusional Disorder**. 1. **Why Option B is Correct:** The disorder typically involves two people (usually family members with a close emotional bond) living in relative isolation. The **"primary" (inducer/dominant)** individual has a genuine psychotic disorder with stable delusions, which are then "passed on" to the **"secondary" (passive/submissive)** individual. A key diagnostic and therapeutic feature is that the secondary person’s delusions often resolve or significantly improve once they are separated from the primary individual. 2. **Why Other Options are Incorrect:** * **A. Obsessive-compulsive disorder:** Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), not shared delusions. * **C. Hysteria:** An archaic term for Dissociative or Conversion disorders, involving physical symptoms without organic causes or emotional dissociation. * **D. Neurasthenia:** An older term (ICD-10) for a condition involving chronic fatigue, lassitude, and somatic complaints, often linked to stress. **Clinical Pearls for NEET-PG:** * **Treatment:** The first step in management is **separation** of the two individuals. The primary person usually requires antipsychotics, while the secondary may only need observation after separation. * **Variants:** If three people are involved, it is *Folie à trois*; if an entire family, it is *Folie à famille*. * **ICD-11 Update:** Under the newer ICD-11, this is categorized under "Induced Delusional Disorder."

Question 130: A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

A. Narcissistic Personality Disorder
B. Paranoid Personality Disorder
C. Schizoid Personality Disorder
D. Obsessive-Compulsive Personality Disorder (Correct Answer)

Explanation: ***Obsessive-Compulsive Personality Disorder*** - Core features include a pervasive pattern of preoccupation with **orderliness**, **perfectionism**, and **mental and interpersonal control**. - The extreme need to be on time and the consistent focus on control and order align perfectly with the diagnostic criteria for **OCPD**. *Paranoid Personality Disorder* - Characterized by a pervasive distrust and **suspiciousness** of others, often interpreting their motives as malevolent. - The primary concern is not order or perfectionism, but rather the fear of being **deceived** or **exploited**. *Narcissistic Personality Disorder* - Defined by a pervasive pattern of **grandiosity**, a need for admiration, and a lack of empathy; they believe they are special or unique. - While they may demand perfection from others, their own behavior is motivated by maintaining high **self-esteem** and status, not inherent orderliness or control for its own sake. *Schizoid Personality Disorder* - Involves profound detachment from social relationships and a restricted range of emotional expression; they typically prefer **solitary activities**. - This disorder does not involve the characteristic preoccupation with rules, control, or **perfectionism** seen in the patient described.

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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