Question 91: What is the most common presenting symptom in conversion disorder (historically termed hysteria)?
- A. Excessive health concerns
- B. Disorganized speech
- C. Dissociative fugue
- D. Motor or sensory symptoms (Correct Answer)
Explanation: ***Motor or sensory symptoms***
- Historically, **hysteria** (now largely replaced by terms like **conversion disorder** or functional neurological symptom disorder) frequently presented with **unexplained motor or sensory deficits** such as paralysis, tremor, blindness, or aphonia.
- These symptoms are neurological in nature but are not attributable to a known neurological or medical condition, often appearing in response to psychological stress.
*Excessive health concerns*
- This symptom is more characteristic of **illness anxiety disorder** (formerly hypochondriasis), where individuals are preoccupied with having or acquiring a serious illness.
- While there is a psychological component, it does not typically involve the dramatic functional neurological symptoms seen in hysteria.
*Disorganized speech*
- **Disorganized speech** is a hallmark symptom of **psychotic disorders**, particularly **schizophrenia**, reflecting a disturbance in thought processes.
- It is not a common presentation of conversion disorder or what was historically termed hysteria.
*Dissociative fugue*
- **Dissociative fugue** involves sudden, unexpected travel away from home or one's customary workplace, with **amnesia for identity** or other important autobiographical information.
- While a dissociative symptom, it is distinct from the motor and sensory symptoms that were classically associated with hysteria and conversion disorder.
Question 92: Which of the following is not a clinical feature of post-traumatic stress disorder?
- A. Grandiosity (Correct Answer)
- B. Emotional distress
- C. Flashbacks
- D. Nightmares
Explanation: ***Grandiosity***
- **Grandiosity** refers to an inflated sense of self-importance, superiority, or special abilities, which is characteristic of manic or hypomanic episodes in bipolar disorder, not PTSD.
- PTSD typically involves negative alterations in cognition and mood, including persistent negative beliefs about oneself (e.g., "I am bad," "I can't trust anyone"), which is opposite to grandiose thinking.
- The core symptoms of PTSD do not include elevated mood, inflated self-esteem, or grandiose delusions.
*Flashbacks*
- **Flashbacks** are a hallmark feature of PTSD, involving vivid, intrusive re-experiences of the traumatic event where the individual feels as if the trauma is happening again.
- They are a key symptom in the **intrusion cluster (Criterion B)** of DSM-5 PTSD diagnostic criteria.
- Flashbacks can involve sensory, emotional, or physical re-experiencing with dissociative qualities.
*Nightmares*
- **Nightmares** related to the traumatic event are a common and distressing feature of PTSD, falling under the **intrusion symptom cluster (Criterion B)**.
- They often involve re-enacting the trauma or experiencing themes related to its content, leading to sleep disturbance and significant emotional distress.
- Trauma-related nightmares occur in the majority of PTSD patients and contribute to sleep avoidance.
*Emotional distress*
- **Emotional distress** is a pervasive symptom in PTSD, including intense anxiety, fear, sadness, anger, or irritability.
- This distress appears across multiple symptom clusters: **intrusion (Criterion B)**, **negative alterations in cognition and mood (Criterion D)**, and **alterations in arousal and reactivity (Criterion E)**.
- Emotional distress can be triggered by trauma reminders (internal or external cues) and is a core feature of the disorder.
Question 93: Which of the following dissociative disorders involves the presence of two or more distinct identities?
- A. Dissociative Amnesia
- B. Depersonalization/Derealization Disorder
- C. Dissociative Identity Disorder (Correct Answer)
- D. Major Depressive Disorder
Explanation: ***Dissociative Identity Disorder***
- This disorder is characterized by the presence of **two or more distinct personality states** or an experience of **possession**.
- These distinct identities recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- This is the **defining feature** that distinguishes DID from other dissociative disorders.
*Depersonalization/Derealization Disorder*
- This involves **persistent or recurrent experiences of depersonalization** (feeling detached from one's mental processes or body) or **derealization** (feeling that the world is unreal or dreamlike).
- While consciousness is maintained, there is no presence of multiple distinct identities.
- The person retains awareness that these are subjective experiences.
*Dissociative Amnesia*
- This is characterized by an inability to recall important **autobiographical information**, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
- May include dissociative fugue as a specifier (sudden travel with amnesia for identity).
- It does not involve the presence of multiple distinct identities.
*Major Depressive Disorder*
- This is a mood disorder characterized by a persistently **depressed mood or loss of interest** in activities, causing significant impairment in daily life.
- It is not a dissociative disorder and does not involve the presence of multiple identities.
