Personality Disorders — MCQs

Personality Disorders Indian Medical PG Practice Questions and MCQs

Question 71: A child diagnosed with conduct disorder is at higher risk of developing which personality disorder later in life?

A. Antisocial personality disorder (Correct Answer)
B. Avoidant personality disorder
C. Dependent personality disorder
D. Anankastic (Obsessive-Compulsive) personality disorder

Explanation: ### Explanation **Correct Option: A. Antisocial personality disorder** The diagnosis of **Antisocial Personality Disorder (ASPD)** in adulthood is fundamentally linked to a childhood history of **Conduct Disorder (CD)**. According to the DSM-5 and ICD criteria, a diagnosis of ASPD cannot be made unless there is evidence of Conduct Disorder with onset before the age of 15 years. **The Medical Concept:** Conduct disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms are violated (e.g., aggression to people/animals, destruction of property, theft). When these behaviors persist into adulthood (age >18) and are accompanied by a lack of remorse and disregard for social norms, the diagnosis transitions to Antisocial Personality Disorder. **Why Incorrect Options are Wrong:** * **B. Avoidant Personality Disorder:** This is characterized by extreme social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. It is often preceded by **Social Anxiety Disorder** or extreme shyness in childhood, not Conduct Disorder. * **C. Dependent Personality Disorder:** This involves a pervasive need to be taken care of, leading to submissive and clinging behavior. It is not associated with the externalizing, aggressive behaviors seen in Conduct Disorder. * **D. Anankastic (Obsessive-Compulsive) Personality Disorder:** This is defined by a preoccupation with orderliness, perfectionism, and control. There is no clinical correlation between childhood aggression (CD) and the development of OCPD. **High-Yield Clinical Pearls for NEET-PG:** * **Age Criteria:** Conduct Disorder is diagnosed in patients **<18 years**; Antisocial Personality Disorder is diagnosed only in patients **≥18 years**. * **The Progression:** Oppositional Defiant Disorder (ODD) → Conduct Disorder (CD) → Antisocial Personality Disorder (ASPD). * **Key Feature:** The hallmark of ASPD is a **lack of remorse** and failure to conform to social norms/laws. * **Genetic Link:** There is a strong association between ASPD and Substance Use Disorders (Alcoholism).

Question 72: Which of the following is NOT a feature of personality disorder?

A. Ego dystonia (Correct Answer)
B. Stigmas in childhood
C. Behavior is maladaptive
D. Disorder results in personal distress

Explanation: **Explanation:** The correct answer is **A. Ego dystonia**. In psychiatry, personality disorders are characterized by **ego-syntonic** traits. This means the individual perceives their behaviors, thoughts, and impulses as natural, acceptable, and consistent with their self-image. They rarely feel that their personality is the problem; instead, they often perceive the outside world or others as the source of their conflict. **Ego-dystonia**, conversely, refers to symptoms that are perceived as alien, distressing, and inconsistent with one’s self-concept (e.g., Obsessive-Compulsive Disorder or Depression). Since personality disorders are inherently ego-syntonic, ego-dystonia is **not** a feature. **Analysis of other options:** * **B. Stigmas in childhood:** Personality disorders are developmentally rooted. Patterns of behavior typically begin in late childhood or adolescence and crystallize by early adulthood. * **C. Behavior is maladaptive:** By definition, these disorders involve inflexible and pervasive patterns of inner experience and behavior that deviate markedly from cultural expectations, leading to functional impairment. * **D. Disorder results in personal distress:** While the traits are ego-syntonic, the *consequences* of those traits (e.g., failed relationships, job loss, or legal issues) frequently lead to significant personal distress or suffering. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-syntonic:** Personality Disorders, Anorexia Nervosa. * **Ego-dystonic:** OCD (the obsessions are unwanted), Bulimia Nervosa, Mood Disorders. * **Diagnosis Age:** Personality disorders are generally not diagnosed before age 18, as personality is still developing. * **Classification:** Remember the three clusters: **A** (Odd/Eccentric), **B** (Dramatic/Erratic), and **C** (Anxious/Fearful).

Question 73: Abnormal thought possession is found in which of the following conditions?

A. Organic brain syndrome
B. Hysteria
C. Obsessive compulsive disorder (Correct Answer)
D. Neurasthenia

Explanation: **Explanation:** The concept of **Thought Possession** refers to the subjective experience of where a thought originates and who "owns" it. In **Obsessive-Compulsive Disorder (OCD)**, the patient experiences obsessions—recurrent, intrusive thoughts that are perceived as their own (ego-dystonic) but are unwanted and irrational. Because the patient recognizes these thoughts as arising from their own mind (unlike thought insertion in schizophrenia) but feels unable to control or stop them, it is classified as a disorder of **thought possession**. **Analysis of Options:** * **Obsessive-Compulsive Disorder (Correct):** The hallmark is the patient’s recognition that the intrusive thoughts are a product of their own mind, yet they feel "possessed" by them against their will. * **Organic Brain Syndrome:** This typically involves disturbances in consciousness, orientation, and memory (e.g., Delirium or Dementia) rather than specific abnormalities of thought possession. * **Hysteria (Dissociative/Conversion Disorder):** This involves a loss of integration between memories, identity, and immediate sensations or control of body movements, but does not involve the specific phenomenon of thought possession. * **Neurasthenia:** An older term for a condition characterized by physical and mental fatigue and lassitude; it does not involve formal thought disorders. **Clinical Pearls for NEET-PG:** 1. **Thought Possession vs. Thought Alienation:** In OCD, the patient knows the thought is theirs (**Possession**). In Schizophrenia (Schneiderian First Rank Symptoms), the patient believes the thought is put there by an external agency (**Thought Insertion/Alienation**). 2. **Ego-dystonic:** The patient views the symptoms as alien to their self-concept and desires to be rid of them (characteristic of OCD). 3. **Insight:** Insight is generally preserved in OCD, which helps distinguish it from psychotic disorders.

Question 74: In which disorder 'Flooding' is used as a behavior therapy for treatment?

A. Obsessive-Compulsive Disorder (OCD)
B. Schizophrenia
C. Phobia (Correct Answer)
D. Mania

Explanation: **Explanation:** **Flooding** is a form of behavior therapy based on the principle of **classical conditioning (extinction)**. It involves intense, direct, and prolonged exposure to the actual anxiety-provoking stimulus (in vivo) or a vivid imagination of it (implosive therapy) until the patient’s anxiety response eventually subsides. 1. **Why Phobia is Correct:** Phobias are characterized by irrational avoidance of specific stimuli. Flooding works by preventing the patient from using their usual avoidance behaviors. By keeping the patient in the presence of the feared object (e.g., a high place or a spider) for an extended period, the sympathetic nervous system eventually "exhausts" its response, leading to the realization that the feared consequence did not occur. This leads to the extinction of the fear response. 2. **Why Other Options are Incorrect:** * **Obsessive-Compulsive Disorder (OCD):** The treatment of choice is **Exposure and Response Prevention (ERP)**. While similar to flooding, ERP specifically focuses on preventing the ritualistic compulsion following exposure. * **Schizophrenia & Mania:** These are psychotic and mood disorders, respectively, primarily managed with pharmacotherapy (Antipsychotics/Mood Stabilizers). Behavior therapies like flooding are ineffective and potentially harmful in these states due to the risk of exacerbating agitation or psychosis. **High-Yield Clinical Pearls for NEET-PG:** * **Systematic Desensitization:** Unlike flooding, this involves *gradual* exposure paired with relaxation techniques (Reciprocal Inhibition). * **Implosion Therapy:** This is the "imaginal" version of flooding. * **Contraindications for Flooding:** It should be avoided in patients with cardiovascular disease or intense panic disorders due to the high physiological stress induced during the session.

Question 75: Delusion that someone from high socioeconomic status is in love with you is called which of the following?

A. Othello syndrome
B. Capgras syndrome
C. De Clerambault syndrome (Correct Answer)
D. Franklin syndrome

Explanation: ### Explanation **Correct Answer: C. De Clerambault syndrome** **De Clerambault syndrome**, also known as **Erotomania**, is a delusional disorder where the patient (usually female) holds a fixed, false belief that another person is deeply in love with them. This "imagined lover" is typically of a **higher socioeconomic status**, a celebrity, or someone in a position of authority (e.g., a doctor or boss). The patient often believes the person is communicating their love through secret signals or coded messages. #### Analysis of Incorrect Options: * **A. Othello syndrome:** Also known as **Conjugal Paranoia** or morbid jealousy. It is a delusion that one’s spouse or partner is being unfaithful without any proof. * **B. Capgras syndrome:** A "delusional misidentification" syndrome where the patient believes that a close relative or friend has been replaced by an **identical-looking impostor**. * **D. Franklin syndrome:** This is not a recognized psychiatric syndrome. It is likely a distractor. (Note: *Fregoli syndrome* is the belief that different people are actually a single person in disguise). #### NEET-PG High-Yield Pearls: * **Erotomania** is more common in females, but males with the condition are more likely to exhibit stalking behavior or legal issues. * **Primary Erotomania** has a sudden onset and occurs in the absence of other psychotic features. * **Treatment:** The primary approach involves **Antipsychotics** (e.g., Risperidone) and addressing any underlying mood disorders. * **Quick Recall:** * *Othello* = Jealousy * *Capgras* = Impostor * *Fregoli* = Person in disguise * *De Clerambault* = High-status lover

Question 76: A patient presents with unstable interpersonal relationships, a pattern of self-harm or suicidal threats, and intense emotional lability. What is the most likely diagnosis?

A. Borderline personality disorder (Correct Answer)
B. Depression
C. Avoidant personality disorder
D. Histrionic personality disorder

Explanation: ### Explanation **1. Why Borderline Personality Disorder (BPD) is correct:** The clinical vignette describes the classic triad of BPD: **instability of relationships, self-image, and affect.** According to DSM-5 criteria, BPD is characterized by a pervasive pattern of "emotional dysregulation." The key features mentioned—unstable interpersonal relationships (often alternating between idealization and devaluation, known as "splitting"), recurrent suicidal behavior or self-mutilation, and intense emotional lability—are hallmark diagnostic indicators. Patients often experience chronic feelings of emptiness and an intense fear of abandonment. **2. Why the other options are incorrect:** * **Depression:** While emotional lability and suicidal ideation occur in depression, the core of this question lies in the long-standing, pervasive pattern of *personality* traits and unstable relationships, which points toward a personality disorder rather than a mood episode. * **Avoidant Personality Disorder:** These individuals are characterized by social inhibition and feelings of inadequacy. They avoid relationships due to fear of criticism or rejection, rather than having the "stormy" and intense relationships seen in BPD. * **Histrionic Personality Disorder:** While both involve emotionality, Histrionic PD focuses on attention-seeking behavior and excessive theatricality. It typically lacks the self-harming behavior and profound emptiness characteristic of BPD. **3. NEET-PG High-Yield Pearls:** * **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:** No FDA-approved drug exists for BPD, but Mood Stabilizers or Low-dose Antipsychotics are used for symptom management. * **Cluster:** BPD belongs to **Cluster B** (the "Dramatic, Emotional, or Erratic" cluster).

Question 77: A Head of Department scolds a postgraduate student and the postgraduate student then directs their anger towards a junior resident. This is an example of which defense mechanism?

A. Displacement (Correct Answer)
B. Repression
C. Projection
D. Sublimation

Explanation: ### Explanation **Correct Answer: A. Displacement** **Why it is correct:** Displacement is an **immature defense mechanism** where an individual redirects an emotional impulse (usually aggression or anxiety) from a threatening or unacceptable target to a safer, less threatening substitute. In this scenario, the postgraduate student cannot express anger toward the Head of Department (a figure of authority/threat) and instead "displaces" that anger onto a junior resident (a safer target). **Analysis of Incorrect Options:** * **B. Repression:** This is the unconscious blocking of unacceptable thoughts or impulses from entering the conscious mind. It is "involuntary forgetting." If the student simply forgot the scolding happened, it would be repression. * **C. Projection:** This involves attributing one’s own unacknowledged unacceptable feelings or impulses to others. If the student felt angry but accused the junior resident of being "the angry one," that would be projection. * **D. Sublimation:** This is a **mature defense mechanism** where socially unacceptable impulses are transformed into socially acceptable, productive actions. If the student used their anger as motivation to study harder or exercise, it would be sublimation. **High-Yield Clinical Pearls for NEET-PG:** * **Classification:** Displacement is a Level III (Neurotic) defense mechanism, whereas Sublimation is Level IV (Mature). * **Phobias:** Displacement is the primary defense mechanism involved in the development of **phobias** (e.g., displacing internal anxiety onto an external object like a spider). * **Key Distinction:** Do not confuse **Displacement** (shifting the target) with **Projection** (shifting the ownership of the feeling). * **Reaction Formation:** Transforming an unacceptable impulse into its exact opposite (e.g., being excessively nice to the HOD despite hating them).

Question 78: What is the definitive treatment for phobias?

A. Behavioral therapy (Correct Answer)
B. Social therapy
C. Avoidance
D. Drug therapy

Explanation: **Explanation:** The definitive treatment for phobias is **Behavioral Therapy**. Phobias are characterized by an irrational, persistent fear of a specific object or situation. The core mechanism of behavioral therapy is **deconditioning** the fear response. 1. **Why Behavioral Therapy is Correct:** It addresses the root of the phobic avoidance. The most effective technique is **Systematic Desensitization** (developed by Joseph Wolpe), which involves gradual exposure to the phobic stimulus while practicing relaxation techniques. Another highly effective method is **Flooding** (implosion therapy), where the patient is exposed to the most feared stimulus immediately until the anxiety response extinguishes. 2. **Why Other Options are Incorrect:** * **Social Therapy:** While helpful for social integration in chronic conditions like schizophrenia, it does not address the specific psychological mechanism of a phobia. * **Avoidance:** This is a symptom of the disorder, not a treatment. Avoidance acts as a negative reinforcer, actually strengthening the phobia over time. * **Drug Therapy:** While Benzodiazepines or SSRIs can manage acute anxiety symptoms or comorbid depression, they do not "cure" the phobia. They are considered adjuncts rather than definitive treatment. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Phobia:** Treatment of choice (TOC) is Exposure Therapy (Behavioral). * **Social Phobia (Social Anxiety Disorder):** TOC is Cognitive Behavioral Therapy (CBT); SSRIs (e.g., Paroxetine) are the first-line pharmacological choice. * **Performance Anxiety:** Beta-blockers (Propranolol) are used 30–60 minutes before the event. * **Agoraphobia:** Most commonly associated with Panic Disorder; treated with SSRIs and CBT.

Question 79: A 35-year-old man with an obsessive-compulsive personality disorder is likely to exhibit all of the following features, except?

A. Perfectionism interfering with performance
B. Ego-syntonic thoughts
C. Preoccupation with rules
D. Indecisiveness (Correct Answer)

Explanation: **Explanation:** Obsessive-Compulsive Personality Disorder (OCPD), also known as Anankastic Personality Disorder, is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility and efficiency. **Why "Indecisiveness" is the correct answer (the exception):** While OCPD patients are often slow to complete tasks due to perfectionism, **Indecisiveness** is classically associated with **Dependent Personality Disorder** or the "doubting" nature of Obsessive-Compulsive Disorder (OCD). In OCPD, the individual is typically rigid and stubborn; they have a very clear (albeit inflexible) idea of how things "should" be done. They are often decisive to the point of being authoritarian, unlike the paralyzing doubt seen in OCD. **Analysis of Incorrect Options:** * **A. Perfectionism interfering with performance:** This is a hallmark of OCPD. Their standards are so high that projects often remain unfinished because they cannot meet their own impossible criteria. * **B. Ego-syntonic thoughts:** This is the primary differentiator from OCD. In OCPD, the patient views their behavior as rational, purposeful, and "the right way to do things." In contrast, OCD is **ego-dystonic** (the patient finds their obsessions distressing and irrational). * **C. Preoccupation with rules:** OCPD patients are obsessed with lists, schedules, and hierarchies, often losing the "point" of the activity in the process. **Clinical Pearls for NEET-PG:** * **Mnemonic (SCRIMP):** **S**tubborn, **C**onscientious, **R**igid, **I**nflexible, **M**iserly, **P**erfectionist. * **OCD vs. OCPD:** OCD involves true obsessions/compulsions; OCPD involves a lifelong personality style without discrete obsessions. * **Treatment:** Psychotherapy (CBT) is the mainstay; SSRIs may be used to reduce associated rigidity.

Question 80: Repetition of movements, actions, words, and phrases is known as?

A. Fusion
B. Mannerism
C. Perseveration (Correct Answer)
D. Stereotyping

Explanation: **Explanation:** **Correct Answer: C. Perseveration** Perseveration is the persistent repetition of a specific response (such as a word, phrase, or gesture) despite the absence or cessation of the original stimulus. In clinical psychiatry, it is a sign of **executive dysfunction** and is most commonly associated with **Organic Brain Disorders** (like Dementia or Delirium) and **Schizophrenia**. The patient is unable to "shift sets," meaning they remain stuck on a previous idea or movement even when a new topic is introduced. **Why other options are incorrect:** * **A. Fusion:** This is a formal thought disorder seen in Schizophrenia where heterogeneous ideas are joined together to form a new, often nonsensical, concept. * **B. Mannerism:** These are abnormal, repetitive, and **goal-directed** movements (e.g., a frequent salute or a specific way of adjusting glasses) that are carried out in a stylized or exaggerated fashion. * **D. Stereotypy:** These are repetitive, non-goal-directed, and **purposeless** movements or speech (e.g., body rocking or repetitive tapping) that are often seen in Catatonic Schizophrenia and Autism. Unlike perseveration, they are not triggered by a specific prior stimulus or question. **NEET-PG High-Yield Pearls:** * **Perseveration** is a hallmark of **Frontal Lobe lesions**. * **Palilalia** is a specific type of perseveration involving the repetition of one's own words with increasing frequency. * **Logoclonia** is the repetition of the last syllable of a word (common in Alzheimer’s). * **Verbigeration** (Word Salad) is often confused with stereotypy but refers specifically to the senseless repetition of words/sentences without a stimulus.

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

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Pharmacological Approaches

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Outcome and Prognosis

Practice Questions

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