Personality Disorders — MCQs

Personality Disorders Indian Medical PG Practice Questions and MCQs

Question 61: Systematic desensitization is:

A. Passive avoidance
B. Active avoidance
C. Sudden exposure
D. Graded exposure (Correct Answer)

Explanation: **Explanation:** **Systematic Desensitization** is a type of behavior therapy based on the principle of **Classical Conditioning**, specifically **Reciprocal Inhibition** (developed by Joseph Wolpe). The core concept is that a person cannot be both anxious and relaxed at the same time. 1. **Why D is correct:** Systematic desensitization involves **Graded Exposure**. The process follows three steps: (1) Training in deep muscle relaxation (e.g., Jacobson’s Progressive Muscle Relaxation), (2) Construction of a hierarchy of anxiety-provoking stimuli, and (3) Gradual exposure to these stimuli (starting from the least frightening) while maintaining a relaxed state. This "step-by-step" approach makes it a graded technique. 2. **Why other options are incorrect:** * **Sudden Exposure (C):** This describes **Flooding** or **Implosion therapy**, where the patient is immediately exposed to the most feared stimulus at maximum intensity without a gradual buildup. * **Passive/Active Avoidance (A & B):** These are behavioral responses to anxiety, not therapeutic techniques. In fact, systematic desensitization aims to *eliminate* avoidance behaviors by encouraging controlled confrontation with the phobic stimulus. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** It is the treatment of choice for **Phobias** (Specific phobias, Agoraphobia) and certain cases of OCD. * **Reciprocal Inhibition:** The underlying mechanism where a relaxation response is used to inhibit the anxiety response. * **In-vivo vs. Imaginal:** Exposure can be done in real life (*in-vivo*) or through mental imagery (*imaginal*). * **Founder:** Joseph Wolpe is the key figure associated with this technique.

Question 62: A 20-year-old female presents with a history of frequent breakups, past suicide attempts, and mood swings. What is the most likely diagnosis?

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

Explanation: ### Explanation **Correct Answer: C. Borderline Personality Disorder (BPD)** The clinical presentation of a young female with **instability in interpersonal relationships** (frequent breakups), **affective instability** (mood swings), and **recurrent suicidal behavior** is classic for Borderline Personality Disorder. According to DSM-5 criteria, BPD is characterized by a pervasive pattern of instability in self-image, emotions, and relationships. Key features include: * **Fear of abandonment:** Leading to frantic efforts to avoid real or imagined separation. * **Impulsivity:** Often manifesting as self-harm, substance abuse, or reckless spending. * **Emotional Dysregulation:** Intense "micro-psychotic" episodes or rapid mood shifts. * **Splitting:** A defense mechanism where others are viewed as "all good" or "all bad." --- ### Why the other options are incorrect: * **A. Histrionic Personality Disorder:** While these patients are also emotional and attention-seeking, they typically present with **theatricality**, seductive behavior, and shallow emotions. They lack the self-destructive/suicidal patterns seen in BPD. * **B. Antisocial Personality Disorder:** Characterized by a disregard for the rights of others, lack of remorse, and legal issues. While impulsive, the motivation is personal gain or exploitation rather than emotional instability. * **D. Dependent Personality Disorder:** These individuals have an excessive need to be taken care of, leading to submissive and clinging behavior. They usually avoid conflict to maintain support, unlike the "stormy" relationships of BPD. --- ### High-Yield Clinical Pearls for NEET-PG: * **Gender:** BPD is more commonly diagnosed in **females** (approx. 3:1 ratio). * **Defense Mechanism:** **Splitting** (Primitive Idealization and Devaluation) is the hallmark. * **Treatment of Choice:** **Dialectical Behavior Therapy (DBT)** is the gold standard psychotherapy. * **Pharmacotherapy:** No specific drug treats BPD itself, but SSRIs or Mood Stabilizers are used for symptom management.

Question 63: All of the following are cluster B personality disorders except:

A. Borderline
B. Histrionic
C. Narcissistic
D. Paranoid (Correct Answer)

Explanation: **Explanation:** Personality disorders in the DSM-5 are categorized into three clusters (A, B, and C) based on shared descriptive characteristics. **1. Why Paranoid is the correct answer:** **Paranoid Personality Disorder** belongs to **Cluster A**. Cluster A disorders are characterized by **odd or eccentric** behaviors. This cluster includes: * **Paranoid:** Pervasive distrust and suspiciousness. * **Schizoid:** Social isolation and detached emotional expression. * **Schizotypal:** Odd beliefs, magical thinking, and eccentric appearance. **2. Why the other options are incorrect:** Options A, B, and C all belong to **Cluster B**, which is characterized by **dramatic, emotional, or erratic** behaviors. * **Borderline (A):** Marked by instability in relationships, self-image, and affect, along with significant impulsivity. * **Histrionic (B):** Characterized by excessive emotionality and attention-seeking behavior. * **Narcissistic (C):** Defined by grandiosity, a need for admiration, and a lack of empathy. *(Note: Antisocial Personality Disorder is the fourth member of Cluster B).* **High-Yield Clinical Pearls for NEET-PG:** * **Cluster A (Odd/Eccentric):** "Weird" (Paranoid, Schizoid, Schizotypal). * **Cluster B (Dramatic/Erratic):** "Wild" (Antisocial, Borderline, Histrionic, Narcissistic). * **Cluster C (Anxious/Fearful):** "Worried" (Avoidant, Dependent, Obsessive-Compulsive). * **Defense Mechanisms:** Paranoid PD primarily uses **Projection** (attributing one's own unacceptable feelings to others). * **Genetic Link:** Cluster A disorders have a higher prevalence in biological relatives of patients with Schizophrenia.

Question 64: A child who is reluctant to go to the shop for sugar, spills half of it on the way. This is an example of:

A. Hysteria
B. Passive aggression (Correct Answer)
C. Disobedience
D. Active aggression

Explanation: **Explanation:** The scenario described is a classic clinical presentation of **Passive-Aggressive behavior**. This defense mechanism involves the indirect expression of hostility through acts of omission, procrastination, stubbornness, or intentional inefficiency. **1. Why Passive Aggression is Correct:** In this case, the child is "reluctant" (underlying hostility/resistance) but cannot openly defy the authority figure. Instead of refusing directly (active aggression), the child complies but performs the task poorly by "spilling half of it." This allows the individual to express resentment while maintaining a facade of compliance. In psychiatry, this is often associated with **Passive-Aggressive Personality Disorder** (now categorized under "Other Specified Personality Disorders" in DSM-5, but still high-yield for exams). **2. Why Other Options are Incorrect:** * **Hysteria (Dissociative/Conversion Disorder):** This involves the unconscious conversion of psychological distress into physical symptoms (e.g., sudden blindness or paralysis) without a physiological cause. It does not involve intentional inefficiency. * **Disobedience:** This implies an overt, direct refusal to follow rules. The child in the question actually went to the shop, meaning they were "obedient" on the surface but sabotaged the result. * **Active Aggression:** This would involve direct confrontation, such as shouting, throwing the money away, or flatly refusing to go. **Clinical Pearls for NEET-PG:** * **Defense Mechanism:** Passive aggression is considered an **immature defense mechanism**. * **Key Features:** Look for keywords like *procrastination, "forgetfulness," stubbornness,* and *intentional inefficiency* in vignettes. * **Management:** In a clinical setting, the best approach is to encourage the patient to express their feelings directly and assertively rather than through indirect sabotage.

Question 65: Which of the following is the best predictor of attempting suicide in the future?

A. Alcohol abuse
B. Unemployment
C. Prior suicide attempt (Correct Answer)
D. Divorce

Explanation: **Explanation:** The single best predictor of a future suicide attempt or completed suicide is a **prior history of suicide attempts**. Statistically, individuals who have attempted suicide once are at a significantly higher risk (up to 40–100 times higher than the general population) of trying again, especially within the first 6 to 12 months following the initial attempt. This is a critical high-yield fact for psychiatric risk assessment. **Analysis of Options:** * **Prior suicide attempt (Correct):** It is the most potent clinical indicator. While many factors contribute to risk, a past history demonstrates both the intent and the "acquired capability" to enact self-harm. * **Alcohol abuse (Incorrect):** Substance abuse is a major **risk factor** and often acts as a disinhibitor, but it is statistically secondary to a previous attempt in terms of predictive power. * **Unemployment & Divorce (Incorrect):** These are **psychosocial stressors** (sociodemographic factors). While they increase vulnerability and are common in suicidal patients, they are non-specific and less predictive than a patient’s own behavioral history. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** Prior suicide attempt. * **Most Common Method (India):** Poisoning (pesticides) and Hanging. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to the use of more lethal methods). * **Protective Factor:** Strong social support and family ties (especially having young children) are the strongest protective factors. * **Highest Risk Comorbidity:** Depression (most common), followed by Bipolar Disorder and Schizophrenia.

Question 66: A young lady was admitted after an overdose of diazepam following a broken affair. She has a history of slitting her wrist previously. 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 correct diagnosis is **Borderline Personality Disorder (BPD)**. This case highlights the classic triad of BPD: **emotional instability**, **impulsive self-harm**, and **intense, unstable relationships**. **Why Borderline Personality Disorder is correct:** BPD is characterized by a pervasive pattern of instability in interpersonal relationships and self-image. Key features present in this vignette include: * **Parasuicide/Self-harm:** Recurrent suicidal behavior, gestures, or threats (overdose, wrist slitting) are hallmark features, often triggered by perceived abandonment. * **Relationship Instability:** The "broken affair" acts as a common stressor that triggers impulsive, self-destructive actions. * **Impulsivity:** Engaging in potentially self-damaging activities (drug overdose). **Why the 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 do not typically present with recurrent self-mutilation. * **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 respond with passivity rather than impulsive self-harm. * **Histrionic PD:** Features include attention-seeking behavior and excessive emotionality. While they may use "suicidal threats" to gain attention, the history of actual wrist slitting and overdose is more characteristic of the profound emotional dysregulation seen in BPD. **Clinical Pearls for NEET-PG:** * **Defense Mechanism:** BPD characteristically uses **"Splitting"** (viewing people as all good or all bad). * **Treatment of Choice:** **Dialectical Behavior Therapy (DBT)** is the gold standard. * **ICD-10:** BPD is classified under **Emotionally Unstable Personality Disorder (Borderline type)**. * **Micro-psychotic episodes:** Under extreme stress, BPD patients may experience transient paranoid ideation or dissociative symptoms.

Question 67: What is the cardinal feature of antisocial personality disorder?

A. Violation of rules of society (Correct Answer)
B. Attention-seeking behavior
C. Unstable interpersonal relationships
D. Grandiose behavior

Explanation: **Explanation:** **Antisocial Personality Disorder (ASPD)** is a Cluster B personality disorder characterized by a pervasive pattern of disregard for, and violation of, the rights of others. 1. **Why Option A is correct:** The cardinal feature of ASPD is a chronic failure to conform to social norms and legal codes. Individuals with ASPD lack a "moral compass" or conscience, leading to repeated acts that are grounds for arrest, deceitfulness (repeated lying/conning), impulsivity, and a profound **lack of remorse** for their actions. 2. **Why the other options are incorrect:** * **Option B (Attention-seeking behavior):** This is the hallmark of **Histrionic Personality Disorder**. These individuals feel uncomfortable when they are not the center of attention and often use physical appearance or provocative behavior to draw focus. * **Option C (Unstable interpersonal relationships):** This is the defining feature of **Borderline Personality Disorder (BPD)**. BPD is characterized by a "stable instability" in relationships, self-image, and affect, often involving frantic efforts to avoid abandonment. * **Option D (Grandiose behavior):** This is characteristic of **Narcissistic Personality Disorder**. While both ASPD and Narcissism involve a lack of empathy, Narcissists primarily seek admiration and feel entitled, whereas those with ASPD are more focused on exploitation and rule-breaking. **High-Yield Clinical Pearls for NEET-PG:** * **Age Criteria:** A diagnosis of ASPD cannot be made before age **18**. * **Precursor:** There must be evidence of **Conduct Disorder** with onset before age 15. * **Gender:** It is significantly more common in **males**. * **Key Association:** High correlation with substance abuse and "psychopathy" (though psychopathy is a more severe subset).

Question 68: A characteristic feature of schizoid personality is:

A. Conversion reaction
B. Not concerned with disease
C. Checks details of all things
D. Emotional coldness (Correct Answer)

Explanation: **Explanation:** **Schizoid Personality Disorder (SPD)** is characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. **Why "Emotional Coldness" is Correct:** The hallmark of SPD is **emotional coldness, detachment, or flattened affectivity**. These individuals are often described as "loners" who neither desire nor enjoy close relationships, including being part of a family. They show little interest in sexual experiences, take pleasure in few (if any) activities, and appear indifferent to the praise or criticism of others. This lack of emotional reactivity is the core diagnostic feature. **Analysis of Incorrect Options:** * **A. Conversion reaction:** This is a feature of **Dissociative (Conversion) Disorder**, where psychological stress manifests as physical neurological symptoms. It is not a personality trait. * **B. Not concerned with disease:** This is often referred to as *la belle indifférence*, classically associated with **Conversion Disorder**, not schizoid personality. * **C. Checks details of all things:** This is a characteristic of **Obsessive-Compulsive Personality Disorder (OCPD)**, where there is a preoccupation with orderliness, perfectionism, and mental/interpersonal control. **High-Yield Clinical Pearls for NEET-PG:** * **The "S" Rule:** Distinguish between **Schizoid** (Socially distant/Solitary) and **Schizotypal** (Socially awkward + Strange/Magical thinking). * **Defense Mechanism:** The primary defense mechanism used in Schizoid Personality Disorder is **Fantasy**. * **Differential:** Unlike Avoidant Personality Disorder (who desire social contact but fear rejection), Schizoid individuals have **no desire** for social interaction. * **ICD-10/DSM-5 Criteria:** Look for keywords like "Anhedonia," "Introspection," and "Indifference to social norms."

Question 69: Type D personality has been found to be a risk factor for which of the following conditions?

A. Coronary artery disease (Correct Answer)
B. Depression
C. Personality disorder
D. Schizophrenia

Explanation: **Explanation:** **Type D personality** (the "D" stands for **Distressed**) is a psychological construct characterized by two stable personality traits: **Negative Affectivity** (a tendency to experience negative emotions like anxiety, irritability, and gloom) and **Social Inhibition** (a tendency to inhibit self-expression in social interactions due to fear of rejection or disapproval). **1. Why Coronary Artery Disease (CAD) is correct:** Extensive psychosomatic research has established Type D personality as a significant independent risk factor for adverse cardiovascular outcomes. Patients with Type D personality have a higher prevalence of **Coronary Artery Disease** and experience worse prognoses following myocardial infarction. The underlying mechanism involves chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis and increased levels of pro-inflammatory cytokines, leading to endothelial dysfunction and accelerated atherosclerosis. **2. Why other options are incorrect:** * **Depression:** While Type D individuals are prone to depressive symptoms due to negative affectivity, Type D is a *personality construct*, not a clinical mood disorder. * **Personality Disorder:** Type D is a personality *type* or trait cluster used in health psychology; it is not classified as a formal Personality Disorder (like Borderline or Antisocial) in the DSM-5 or ICD-11. * **Schizophrenia:** There is no established clinical correlation between Type D personality and the pathogenesis of psychotic disorders like schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Type A Personality:** Characterized by time urgency, competitiveness, and **hostility**. It is also linked to CAD (specifically the hostility component). * **Type B Personality:** Relaxed, easy-going, and less stressed; considered "cardio-protective." * **Type C Personality:** Characterized by suppressing emotions and difficulty expressing needs; traditionally associated with a higher risk of **Cancer** (though evidence is less robust than Type D/CAD). * **Type D Summary:** Negative Affectivity + Social Inhibition = High Risk for **CAD and Poor Cardiac Prognosis.**

Question 70: Which of the following is a Cluster C personality disorder?

A. Obsessive compulsive (Correct Answer)
B. Paranoid
C. Schizoid
D. Borderline

Explanation: **Explanation:** Personality disorders are categorized into three clusters (A, B, and C) based on shared descriptive characteristics. **Cluster C** is known as the **"Anxious or Fearful"** cluster. It includes: 1. **Obsessive-Compulsive Personality Disorder (OCPD):** Characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and control. 2. **Avoidant Personality Disorder:** Characterized by social inhibition and feelings of inadequacy. 3. **Dependent Personality Disorder:** Characterized by an excessive need to be taken care of. **Analysis of Options:** * **Option A (Correct):** OCPD is a classic Cluster C disorder. Unlike OCD (an anxiety disorder), OCPD is **ego-syntonic** (the individual believes their way is correct and feels no distress about their traits). * **Option B (Incorrect):** **Paranoid** personality disorder belongs to **Cluster A** (the "Odd or Eccentric" cluster), along with Schizoid and Schizotypal disorders. * **Option C (Incorrect):** **Schizoid** personality disorder belongs to **Cluster A**. It is characterized by social detachment and a restricted range of emotional expression. * **Option D (Incorrect):** **Borderline** personality disorder belongs to **Cluster B** (the "Dramatic, Emotional, or Erratic" cluster), along with Antisocial, Histrionic, and Narcissistic disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Clusters:** * **A:** Weird (Odd/Eccentric) * **B:** Wild (Dramatic/Erratic) * **C:** Worried (Anxious/Fearful) * **OCPD vs. OCD:** OCPD is about a lifestyle of perfectionism (ego-syntonic), while OCD involves specific intrusive thoughts and rituals (ego-dystonic). * **Most Common Personality Disorder:** Generally cited as Obsessive-Compulsive Personality Disorder in the general population.

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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