Personality Disorders — MCQs
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Which of the following is a characteristic of Type A personality?
A 43-year-old principal of a medical college presents for psychiatric evaluation. He reports that throughout his life he has worked hard and lived a disciplined life. He always follows all the rules and does the 'right thing', however, no one really likes him. The principal appears to have which of the following personality traits?
Which of the following is NOT characteristic of a Type A personality?
Which of the following is characteristic of a Type D personality disorder?
A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?
Which of the following is characteristic of schizoid personality disorder?
A 27-year-old female presents with social withdrawal and significant reluctance to socialize with colleagues. She has no friends and declined a date with a male colleague she liked, stating, "Nobody would like me, and I don't want to hurt myself." What is the most likely diagnosis?
Which is the treatment of choice for Obsessive-Compulsive Disorder (OCD)?
Which of the following personality disorders is characterized by a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation?
Which of the following statements is false with respect to Borderline personality disorder?
Personality Disorders Indian Medical PG Practice Questions and MCQs
Question 11: Which of the following is a characteristic of Type A personality?
- A. Competitive (Correct Answer)
- B. Dependent
- C. Suspicious
- D. Odd and eccentric
Explanation: ### Explanation **Concept Overview:** The concept of **Type A and Type B personality patterns** was described by Friedman and Rosenman. Type A is not a formal DSM-5 personality disorder but a behavioral pattern significantly associated with an increased risk of **Coronary Artery Disease (CAD)**. **Why "Competitive" is Correct:** Type A personality is characterized by a chronic, incessant struggle to achieve more in less time. Key features include: * **Competitiveness:** A strong desire to excel and outperform others. * **Time Urgency:** A constant sense of "hurrying," impatience, and multitasking. * **Hostility:** Easily provoked anger or irritability (this is the most cardiotoxic component). * **Ambition:** High-achieving and work-oriented nature. **Analysis of Incorrect Options:** * **B. Dependent:** This is the hallmark of **Dependent Personality Disorder** (Cluster C), characterized by a pervasive need to be taken care of, leading to submissive and clinging behavior. * **C. Suspicious:** This is characteristic of **Paranoid Personality Disorder** (Cluster A), where individuals interpret the motives of others as malevolent without sufficient basis. * **D. Odd and Eccentric:** This describes the general category of **Cluster A Personality Disorders** (Paranoid, Schizoid, and Schizotypal), often referred to as the "Mad" cluster. **NEET-PG High-Yield Pearls:** * **Type B Personality:** The opposite of Type A; characterized by being relaxed, easy-going, and less stressed by achievement. * **Type C Personality:** Associated with **Cancer**; characterized by being cooperative, unassertive, and suppressing negative emotions. * **Type D Personality:** "Distressed" personality; characterized by social inhibition and negative affectivity, also linked to poor cardiac outcomes. * **Key Association:** If a question asks which component of Type A is most strongly linked to Myocardial Infarction, the answer is **Hostility/Anger**.
Question 12: A 43-year-old principal of a medical college presents for psychiatric evaluation. He reports that throughout his life he has worked hard and lived a disciplined life. He always follows all the rules and does the 'right thing', however, no one really likes him. The principal appears to have which of the following personality traits?
- A. Schizoid
- B. Paranoid
- C. Anankastic (Correct Answer)
- D. Borderline
Explanation: **Explanation:** The clinical vignette describes a classic presentation of **Anankastic Personality Disorder**, also known as **Obsessive-Compulsive Personality Disorder (OCPD)** in the DSM-5. **1. Why Anankastic is correct:** The core features of this disorder include a pervasive pattern of **perfectionism, rigidity, and preoccupation with rules, order, and discipline**. The patient’s history of living a "disciplined life" and strictly following "all the rules" to do the "right thing" aligns with the ego-syntonic nature of OCPD. These individuals are often high achievers (e.g., a college principal) but struggle with interpersonal relationships because their inflexibility and moral rigidity make them appear cold or demanding to others, explaining why "no one really likes him." **2. Why other options are incorrect:** * **Schizoid:** Characterized by social detachment and a restricted range of emotional expression. While they may be loners, they lack the drive for perfectionism and rule-following seen here. * **Paranoid:** Defined by pervasive distrust and suspiciousness of others. There is no evidence of the patient feeling exploited or bearing grudges. * **Borderline:** Characterized by instability in relationships, self-image, and affect, along with impulsivity. This patient’s rigid, disciplined lifestyle is the opposite of the chaotic pattern seen in Borderline PD. **Clinical Pearls for NEET-PG:** * **Ego-syntonic vs. Ego-dystonic:** OCPD is *ego-syntonic* (the person views their traits as desirable), whereas OCD (the anxiety disorder) is *ego-dystonic* (the person is distressed by their obsessions). * **Key Mnemonic:** Remember the **"Four Ps"** of Anankastic PD: **P**erfectionism, **P**reoccupation with rules, **P**unctuality, and **P**leasureless (work over play). * **ICD-10 Terminology:** NEET-PG often uses the term **Anankastic**, which is the ICD-10 nomenclature for OCPD.
Question 13: Which of the following is NOT characteristic of a Type A personality?
- A. Hostility
- B. Sense of time urgency
- C. Competitiveness
- D. Relaxed attitude (Correct Answer)
Explanation: **Explanation:** The concept of **Type A and Type B personality patterns** was originally described by cardiologists Friedman and Rosenman. It is a high-yield topic in Psychiatry and Behavioral Sciences due to its established association with an increased risk of **Coronary Artery Disease (CAD)**. **Why "Relaxed attitude" is the correct answer:** A relaxed attitude is the hallmark of a **Type B personality**. Individuals with Type B patterns are generally easy-going, patient, and less prone to stress. They lack the frantic drive and urgency seen in Type A individuals. Therefore, it is NOT a characteristic of Type A. **Analysis of incorrect options (Characteristics of Type A):** * **Hostility:** This is considered the most "toxic" component of Type A behavior and is the strongest predictor of cardiovascular morbidity. It involves frequent anger and cynicism. * **Sense of time urgency:** Also known as "hurry sickness," these individuals are constantly racing against the clock, multitasking, and becoming impatient with delays. * **Competitiveness:** Type A individuals possess a high achievement drive and a persistent desire to surpass others, often at the expense of their own well-being. **NEET-PG Clinical Pearls:** * **Type A:** High risk for CAD, hypertension, and stress-related disorders. * **Type B:** Low stress, "laid back," and lower risk of heart disease. * **Type C:** Characterized by emotional suppression (especially anger) and compliance; traditionally associated with a higher risk of **Cancer**. * **Type D:** "Distressed" personality, characterized by negative affectivity and social inhibition; also linked to poor cardiac outcomes.
Question 14: Which of the following is characteristic of a Type D personality disorder?
- A. Odd and eccentric behavior
- B. Self-pessimism (Correct Answer)
- C. Reward dependence
- D. Achievement-oriented
Explanation: **Explanation:** **Type D Personality** (the "D" stands for **Distressed**) is a psychological construct characterized by two stable traits: **Negative Affectivity** and **Social Inhibition**. 1. **Why Option B is Correct:** Individuals with Type D personality frequently experience negative emotions across time and situations. This includes **self-pessimism**, worry, irritability, and a gloomy outlook on life. They tend to suppress these emotions in social situations due to a fear of rejection or disapproval (social inhibition), leading to significant internal distress. 2. **Analysis of Incorrect Options:** * **Option A (Odd and eccentric behavior):** This describes **Cluster A** personality disorders (Paranoid, Schizoid, and Schizotypal), particularly Schizotypal personality. * **Option C (Reward dependence):** This is one of the dimensions of **Cloninger’s Temperament and Character Inventory**. High reward dependence is seen in individuals who are sensitive to social cues and seek approval, whereas Type D individuals are socially inhibited. * **Option D (Achievement-oriented):** This is a hallmark of **Type A Personality**, which is characterized by competitiveness, time urgency, and hostility. **High-Yield Clinical Pearls for NEET-PG:** * **Cardiovascular Link:** Type D personality is a significant independent predictor of poor prognosis, increased mortality, and reduced quality of life in patients with **Coronary Artery Disease (CAD)**. * **Type A vs. Type D:** While Type A is linked to the *onset* of heart disease (due to hostility), Type D is more strongly linked to *prognosis and mortality* after a cardiac event. * **Type B:** Characterized by a relaxed, patient, and easy-going nature (the opposite of Type A). * **Type C:** Characterized by being cooperative, unassertive, and suppressing emotions; historically linked (though controversially) to **Cancer** proneness.
Question 15: A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?
- A. Hypochondriasis
- B. Somatization disorder
- C. Conversion disorder
- D. Factitious disorder (Correct Answer)
Explanation: ### **Explanation** **Correct Answer: D. Factitious Disorder** The clinical presentation describes a patient who intentionally produces or feigns physical symptoms (vague pains, requesting biopsies) to assume the **"sick role."** Key indicators in this case include the presence of multiple surgical scars (the "gridiron abdomen"), a vague and manipulative history, and a lack of medical records to support past surgeries. Unlike other disorders, the primary motivation in Factitious Disorder (formerly known as Munchausen syndrome) is internal—the psychological need to be a patient—rather than external gain (like money or avoiding work). **Why Incorrect Options are Wrong:** * **A. Hypochondriasis (Illness Anxiety Disorder):** Patients have a genuine, distressing fear of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms or manipulate history. * **B. Somatization Disorder:** Characterized by multiple, chronic physical complaints across different organ systems. However, these symptoms are **not** intentionally produced; the patient truly feels the distress. * **C. Conversion Disorder:** Involves sudden loss of neurological function (e.g., paralysis, blindness) triggered by psychological stress. The symptoms are involuntary and not consciously faked. **NEET-PG High-Yield Pearls:** * **Factitious Disorder vs. Malingering:** In Factitious Disorder, the goal is the **sick role** (internal incentive). In Malingering, the goal is **secondary gain** (external incentive like disability benefits or avoiding jail). * **Gridiron Abdomen:** A classic sign of Factitious Disorder where the patient has multiple crisscrossing surgical scars from unnecessary exploratory surgeries. * **Management:** The best approach is a non-confrontational alliance, focusing on psychiatric management while avoiding unnecessary invasive procedures.
Question 16: Which of the following is characteristic of schizoid personality disorder?
- A. Suspiciousness
- B. Novelty seeking
- C. Odd and eccentric behavior (Correct Answer)
- D. Reward dependence
Explanation: **Explanation:** **Schizoid Personality Disorder (SPD)** belongs to **Cluster A** (the "odd or eccentric" cluster) of personality disorders. The hallmark of SPD is a pervasive pattern of detachment from social relationships and a restricted range of emotional expression. These individuals are often described as "loners" who prefer solitary activities, lack interest in sexual experiences, and appear indifferent to praise or criticism. Because they deviate significantly from social norms regarding interpersonal engagement, their behavior is clinically categorized as **odd and eccentric**. **Analysis of Options:** * **Option A (Suspiciousness):** While also a Cluster A trait, pervasive suspiciousness and mistrust of others are specifically characteristic of **Paranoid Personality Disorder**, not Schizoid. * **Option B (Novelty seeking):** This is a temperamental trait often associated with **Cluster B** disorders, particularly Borderline or Histrionic Personality Disorders, where individuals seek stimulation. Schizoid individuals are typically characterized by low novelty seeking. * **Option C (Correct):** As a member of Cluster A (alongside Paranoid and Schizotypal), the defining descriptive umbrella for Schizoid PD is odd/eccentric behavior. * **Option D (Reward dependence):** Schizoid individuals typically show **low reward dependence**. They do not seek social approval or emotional closeness, which are the primary drivers in high reward-dependent individuals. **High-Yield Clinical Pearls for NEET-PG:** * **The "S" Rule:** **S**chizoid = **S**olitary/Seclusive (prefers being alone); **S**chizotypal = **S**trange (magical thinking/odd beliefs). * **Defense Mechanism:** The primary defense mechanism used by individuals with Schizoid PD is **Fantasy**. * **Differential:** Unlike Avoidant PD (who desire social contact but fear rejection), Schizoid individuals have **no desire** for social intimacy.
Question 17: A 27-year-old female presents with social withdrawal and significant reluctance to socialize with colleagues. She has no friends and declined a date with a male colleague she liked, stating, "Nobody would like me, and I don't want to hurt myself." What is the most likely diagnosis?
- A. Histrionic personality disorder
- B. Schizoid personality disorder
- C. Avoidant personality disorder (Correct Answer)
- D. Anankastic personality disorder
Explanation: ### Explanation The patient’s presentation is classic for **Avoidant Personality Disorder (APD)**. The core feature of APD is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. **1. Why Avoidant Personality Disorder is correct:** Unlike other socially withdrawn individuals, patients with APD **desire social interaction** but avoid it due to an intense **fear of rejection, ridicule, or humiliation**. The patient’s statement, "Nobody would like me" (low self-esteem) and "I don't want to hurt myself" (fear of rejection), despite liking the colleague, confirms that her withdrawal is ego-dystonic and driven by anxiety rather than a lack of interest. **2. Why the other options are incorrect:** * **Schizoid Personality Disorder:** These individuals are socially detached by choice. They have **no desire** for close relationships and are indifferent to praise or criticism. They are "loners" who are happy being alone. * **Histrionic Personality Disorder:** Characterized by excessive emotionality and **attention-seeking** behavior. They are uncomfortable when they are not the center of attention—the polar opposite of this patient. * **Anankastic (Obsessive-Compulsive) Personality Disorder:** Characterized by perfectionism, rigidity, and a preoccupation with rules and control. It does not primarily manifest as social withdrawal due to fear of rejection. **3. High-Yield Clinical Pearls for NEET-PG:** * **APD vs. Social Anxiety Disorder (SAD):** APD is often considered a more severe, chronic, and pervasive form of SAD. * **The "Desire" Factor:** To differentiate in exams, remember: **Schizoid** = No desire for friends; **Avoidant** = Desires friends but is too afraid to try. * **Defense Mechanism:** The primary defense mechanism used in APD is **Fantasy** (retreating into an inner world to gratify needs). * **Treatment:** Cognitive Behavioral Therapy (CBT) and Social Skills Training are first-line; Beta-blockers or SSRIs may be used for associated anxiety.
Question 18: Which is the treatment of choice for Obsessive-Compulsive Disorder (OCD)?
- A. Exposure and response prevention (Correct Answer)
- B. Psychoanalysis
- C. Flooding
- D. Modeling
Explanation: **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The gold-standard psychological treatment is **Exposure and Response Prevention (ERP)**, a specific form of Cognitive Behavioral Therapy (CBT). 1. **Why Option A is correct:** ERP works on the principle of **habituation**. Patients are deliberately exposed to anxiety-provoking stimuli (Exposure) and instructed to refrain from performing the ritualistic behavior (Response Prevention). Over time, the patient learns that the anxiety dissipates naturally without the compulsion, breaking the negative reinforcement cycle. 2. **Why other options are incorrect:** * **Psychoanalysis (B):** Focuses on unconscious conflicts and childhood experiences; it has been found largely ineffective for the core symptoms of OCD. * **Flooding (C):** A form of behavior therapy involving prolonged, intense exposure to a feared stimulus to extinguish the fear response. While related to exposure, it is generally too distressing for OCD patients and lacks the specific "response prevention" component essential for OCD. * **Modeling (D):** Involves observing others interact with the feared object. While helpful in simple phobias, it is not the primary treatment for OCD. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Pharmacotherapy:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the drugs of choice (e.g., Fluoxetine, Fluvoxamine, Sertraline). Note that OCD requires **higher doses** and **longer duration** (10–12 weeks) for a response compared to depression. * **Most Effective Combination:** ERP + SSRIs. * **TCA of Choice:** Clomipramine (most serotonin-specific TCA) is highly effective but usually second-line due to its side-effect profile. * **Neurosurgery (Refractory cases):** Anterior Cingulotomy or Gamma Knife Capsulotomy.
Question 19: Which of the following personality disorders is characterized by a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation?
- A. Avoidant personality disorder (Correct Answer)
- B. Histrionic personality disorder
- C. Paranoid personality disorder
- D. Narcissistic personality disorder
Explanation: ### Explanation **Correct Answer: A. Avoidant personality disorder** Avoidant Personality Disorder (APD) is a **Cluster C** ("Anxious/Fearful") disorder. The core psychopathology involves a pervasive pattern of **social inhibition**, intense **feelings of inadequacy**, and extreme **hypersensitivity to criticism** or rejection. Unlike schizoid individuals who prefer solitude, patients with APD actually desire social relationships but avoid them due to a paralyzing fear of being shamed, ridiculed, or rejected. **Analysis of Incorrect Options:** * **B. Histrionic personality disorder (Cluster B):** Characterized by excessive emotionality and **attention-seeking** behavior. These individuals are uncomfortable when they are not the center of attention, which is the opposite of the social withdrawal seen in APD. * **C. Paranoid personality disorder (Cluster A):** Defined by pervasive **distrust and suspiciousness** of others. While they may avoid others, it is due to the belief that others have malevolent motives, not due to feelings of personal inadequacy. * **D. Narcissistic personality disorder (Cluster B):** Characterized by **grandiosity**, a need for admiration, and a lack of empathy. While they are sensitive to "narcissistic injury" (criticism), their baseline is an inflated sense of self-importance, not inadequacy. **High-Yield Clinical Pearls for NEET-PG:** * **The "Social Desire" Rule:** Differentiate APD from Schizoid PD—Schizoid patients have **no desire** for relationships (loners by choice), whereas Avoidant patients **desire** relationships but are too afraid to pursue them (loners by fear). * **Defense Mechanism:** The primary defense mechanism used in APD is **Fantasy** (imagining idealized relationships to compensate for real-world isolation). * **Treatment:** Social skills training and Cognitive Behavioral Therapy (CBT) are first-line; Beta-blockers or SSRIs may be used to manage associated anxiety.
Question 20: Which of the following statements is false with respect to Borderline personality disorder?
- A. It is also called emotionally unstable personality disorder.
- B. Parasuicide risk is high.
- C. Suicide risk is high.
- D. Individuals remain in a stable relationship for a long time. (Correct Answer)
Explanation: **Explanation:** Borderline Personality Disorder (BPD) is characterized by a pervasive pattern of **instability** in interpersonal relationships, self-image, and affects, along with marked impulsivity. **Why Option D is the correct (False) statement:** Individuals with BPD typically experience **unstable and intense interpersonal relationships**. This is characterized by a pattern of "splitting"—alternating between extremes of idealization (seeing someone as perfect) and devaluation (seeing them as entirely bad). Their fear of real or imagined abandonment often leads to frantic efforts to avoid being alone, making long-term stable relationships highly difficult to maintain. **Analysis of other options:** * **Option A:** In the ICD-10 classification, BPD is officially termed **Emotionally Unstable Personality Disorder (EUPD)**. It is further divided into two types: Impulsive type and Borderline type. * **Option B & C:** Self-harm and suicidal behaviors are hallmarks of BPD. **Parasuicide** (deliberate self-harm without intent to die, such as cutting) is very common as a means of emotional regulation. However, the risk of completed **suicide** is also significantly high (approximately 8-10%), making both statements true. **High-Yield Clinical Pearls for NEET-PG:** * **Defense Mechanism:** The most characteristic defense mechanism is **Splitting**. * **Micropsychotic Episodes:** Under severe stress, patients may experience transient, stress-related paranoid ideation or dissociative symptoms. * **Treatment of Choice:** **Dialectical Behavior Therapy (DBT)**, a form of CBT developed by Marsha Linehan, is the gold standard. * **Pharmacotherapy:** Primarily used for symptom control (e.g., SSRIs for mood/impulsivity, low-dose antipsychotics for cognitive-perceptual symptoms).
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
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Mentalization-Based Therapy
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Pharmacological Approaches
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Outcome and Prognosis
Practice Questions
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