Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders Indian Medical PG Practice Questions and MCQs

Question 21: A 22-year-old female presents with a 2-day history of speech loss after being slapped by her husband. On examination, her cough reflex and laryngeal reflex are normal. What is the most probable diagnosis?

A. Somatization disorder
B. Conversion disorder (Correct Answer)
C. Dissociative fugue
D. Depersonalization

Explanation: ### Explanation **Correct Answer: B. Conversion Disorder** **Why it is correct:** Conversion disorder (Functional Neurological Symptom Disorder) involves the loss of or change in physical function (typically motor or sensory) that suggests a neurological condition but cannot be explained by any known medical or neurological disease. * **The Trigger:** Symptoms often follow a psychological stressor or conflict (in this case, being slapped by her husband). * **The Symptom:** Loss of speech (aphonia/mutism) is a common presentation. * **Clinical Evidence:** The presence of a **normal cough reflex and laryngeal reflex** is a "positive sign" of non-organic pathology. It proves that the physical apparatus for vocalization is intact and that the vocal cords are functioning physiologically, confirming the psychogenic nature of the speech loss. **Why the other options are incorrect:** * **A. Somatization disorder:** Characterized by multiple, chronic physical complaints (pain, GI, sexual) across various organ systems over several years. It is not typically a sudden, single-symptom response to an acute stressor. * **C. Dissociative fugue:** A subtype of dissociative amnesia involving sudden, unexpected travel away from home combined with an inability to recall one's past or identity. * **D. Depersonalization:** A feeling of detachment from oneself, as if one is an outside observer of their own body or mental processes; it does not involve motor or sensory loss. **High-Yield Clinical Pearls for NEET-PG:** * **La Belle Indifférence:** A classic (though not universal) feature where the patient shows a surprising lack of concern regarding their severe disability. * **Primary Gain:** Internal conflict is kept out of awareness (e.g., the speech loss "solves" the conflict of what to say to the husband). * **Secondary Gain:** External benefits derived from the illness (e.g., avoiding chores or gaining sympathy). * **Hoover’s Sign:** A common clinical test for conversion disorder involving leg weakness where involuntary extension occurs when the contralateral leg is flexed against resistance.

Question 22: Which of the following stressors most often leads to psychological impairment that could be diagnosed as an adjustment disorder?

A. Rape
B. Plane accident
C. Loss of job (Correct Answer)
D. All of the above

Explanation: ### Explanation **1. Why "Loss of Job" is Correct:** Adjustment Disorder is defined by the development of emotional or behavioral symptoms in response to an **identifiable stressor** that is within the range of **common human experience**. The stressor is typically non-catastrophic, such as financial difficulties, marital problems, or the **loss of a job**. The symptoms must occur within 3 months of the stressor and cause significant distress or functional impairment, but they do not meet the full criteria for Major Depressive Disorder or PTSD. **2. Why Other Options are Incorrect:** * **Options A (Rape) and B (Plane accident):** These are considered **catastrophic or traumatic stressors**. According to DSM-5 and ICD-11 criteria, exposure to actual or threatened death, serious injury, or sexual violence typically leads to a diagnosis of **Post-Traumatic Stress Disorder (PTSD)** or **Acute Stress Disorder (ASD)**, rather than Adjustment Disorder. While an adjustment disorder *can* follow a trauma, the standard classification distinguishes "common life stressors" (Adjustment Disorder) from "extreme/traumatic stressors" (PTSD/ASD). **3. Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must start within **3 months** of the stressor and must resolve within **6 months** once the stressor (or its consequences) has terminated. * **Subtypes:** DSM-5 specifies subtypes based on predominant symptoms: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, or mixed disturbance of emotions and conduct. * **Treatment of Choice:** **Psychotherapy** (Crisis intervention or Brief Dynamic Psychotherapy) is the gold standard. Pharmacotherapy is only used for symptomatic relief (e.g., insomnia). * **Distinction:** If the symptoms meet the criteria for Major Depressive Disorder (MDD) following a stressor, the diagnosis is MDD, not Adjustment Disorder.

Question 23: A young female presented with hallucinations, abdominal pain, and amnesia. She is likely suffering from which of the following?

A. Conversion disorder
B. Dissociative disorder (Correct Answer)
C. Depersonalization disorder
D. Mania

Explanation: **Explanation:** The clinical presentation of a young female with a combination of **amnesia** (memory loss), **hallucinations**, and **abdominal pain** (pseudoneurological or somatic symptoms) is classic for **Dissociative Disorder**. **1. Why Dissociative Disorder is Correct:** Dissociative disorders involve a disruption in the usually integrated functions of consciousness, memory, identity, or perception. In the context of NEET-PG, "Dissociative Hallucinations" (often visual or complex) and "Dissociative Amnesia" are hallmark features. In ICD-10, what was formerly called "Hysteria" is categorized under Dissociative Disorders, which frequently present with a mix of sensory loss, motor symptoms, and dissociative amnesia, often triggered by psychological stress. **2. Why Other Options are Incorrect:** * **Conversion Disorder (Functional Neurological Symptom Disorder):** While it involves motor or sensory deficits (e.g., paralysis, blindness) without a neurological cause, it does not typically present with amnesia or complex hallucinations as the primary feature. * **Depersonalization Disorder:** This is a specific subtype of dissociative disorder characterized by a persistent feeling of being detached from one’s body or mental processes (feeling like an observer). It does not involve amnesia or abdominal pain. * **Mania:** Characterized by elevated mood, pressured speech, and decreased need for sleep. While psychosis can occur, the combination of amnesia and somatic abdominal pain points strongly toward a dissociative etiology rather than a primary mood disorder. **Clinical Pearls for NEET-PG:** * **Ganser Syndrome:** A rare dissociative disorder characterized by "approximate answers" (paralogia). * **La Belle Indifference:** A classic (though not pathognomonic) sign where the patient shows a surprising lack of concern regarding their severe physical symptoms. * **Primary Gain:** Internal conflict resolution. * **Secondary Gain:** External benefits (e.g., attention, avoiding work).

Question 24: Delayed onset PTSD is diagnosed if symptoms appear after how many months?

A. 1 month
B. 3 months
C. 6 months (Correct Answer)
D. 1 year

Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is characterized by a constellation of symptoms (intrusion, avoidance, negative alterations in cognition/mood, and hyperarousal) following exposure to a traumatic event. According to the **DSM-5**, the specifier **"with delayed expression"** (commonly referred to as delayed-onset PTSD) is used if the full diagnostic criteria are not met until **at least 6 months** after the traumatic event. It is important to note that some symptoms may appear immediately, but the complete syndrome required for diagnosis manifests after this 6-month threshold. **Analysis of Options:** * **A. 1 month:** This is the minimum duration required to diagnose PTSD. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **B. 3 months:** In previous versions (DSM-IV), PTSD was classified as "chronic" if symptoms lasted longer than 3 months, but this is not the criteria for delayed onset. * **C. 6 months (Correct):** This is the standardized timeframe for the "delayed expression" specifier in DSM-5. * **D. 1 year:** While symptoms can certainly appear after a year, the diagnostic threshold for the "delayed" label is established at the 6-month mark. **High-Yield NEET-PG Pearls:** * **Timeframe Rule:** < 1 month = Acute Stress Disorder; > 1 month = PTSD. * **First-line Treatment:** Trauma-focused Cognitive Behavioral Therapy (CBT) and SSRIs (e.g., Sertraline, Paroxetine). * **Prazosin:** A high-yield drug used specifically to treat **PTSD-related nightmares** (alpha-1 blocker). * **Delayed Onset:** Often triggered by a subsequent stressful life event or a "reminder" of the original trauma.

Question 25: Nightmares are seen in which of the following conditions?

A. Adjustment disorder
B. Post-Traumatic Stress Disorder (Correct Answer)
C. Dissociative disorder
D. Obsessive-Compulsive Disorder

Explanation: **Explanation:** **Post-Traumatic Stress Disorder (PTSD)** is the correct answer because nightmares are a hallmark symptom of the **"Intrusion"** cluster. According to DSM-5 criteria, PTSD is characterized by four symptom clusters following exposure to a traumatic event: Intrusion (flashbacks, distressing dreams), Avoidance, Negative alterations in cognition/mood, and Alterations in arousal/reactivity. The nightmares in PTSD typically involve themes related to the specific traumatic event and are a form of involuntary re-experiencing. **Why other options are incorrect:** * **Adjustment Disorder:** While it involves emotional or behavioral symptoms in response to a stressor, the stressor is usually non-catastrophic (e.g., divorce, job loss). It lacks the specific intrusive symptoms like vivid nightmares or flashbacks seen in PTSD. * **Dissociative Disorder:** These disorders involve a breakdown of memory, identity, or perception (e.g., Dissociative Amnesia or Fugue). While they can be comorbid with trauma, nightmares are not a primary diagnostic feature. * **Obsessive-Compulsive Disorder (OCD):** OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). It does not typically present with trauma-themed nightmares as a core symptom. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must persist for **>1 month** for a diagnosis of PTSD. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **Treatment of Choice:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine are first-line. * **Specific Symptom Management:** **Prazosin** (an alpha-1 blocker) is highly effective and frequently tested for the specific treatment of **PTSD-associated nightmares**. * **Therapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are the preferred psychotherapeutic interventions.

Question 26: A 65-year-old woman whose husband died one week ago reports that she cries much of the time and has difficulty sleeping. She also states that she briefly saw her husband walking down the street yesterday. What is the most appropriate first action by her physician?

A. Recommend a vacation
B. Provide support and reassurance (Correct Answer)
C. Prescribe antipsychotic medication
D. Prescribe antidepressant medication

Explanation: ### Explanation **1. Why "Provide support and reassurance" is correct:** The patient is experiencing **Normal Grief (Bereavement)**. Her symptoms—crying, insomnia, and a brief visual hallucination of the deceased—are considered normal physiological and psychological responses within the first few weeks of losing a spouse. In normal grief, the individual typically maintains the "insight" that the deceased is actually gone, and the hallucinations (often called **pseudohallucinations**) are fleeting and common. The management of normal grief is supportive; the physician should validate the patient's feelings, monitor for progression to clinical depression, and provide reassurance that these experiences are part of the natural healing process. **2. Why the other options are incorrect:** * **A. Recommend a vacation:** While seemingly helpful, a vacation can be a form of "avoidance" and may disrupt the necessary grieving process. It does not address the patient's immediate emotional needs. * **C. Prescribe antipsychotic medication:** Antipsychotics are not indicated for bereavement-related hallucinations. These are not signs of a primary psychotic disorder (like Schizophrenia) but are transient phenomena of grief. * **D. Prescribe antidepressant medication:** Pharmacotherapy is not indicated for normal grief. Antidepressants are only considered if the patient meets the criteria for **Major Depressive Disorder (MDD)** (e.g., persistent suicidal ideation, profound worthlessness, or symptoms lasting beyond a reasonable timeframe with functional impairment). **3. NEET-PG High-Yield Clinical Pearls:** * **Normal Grief vs. MDD:** In grief, the focus is on the deceased (waves of grief); in MDD, the focus is on self-loathing and pervasive hopelessness. * **Hallucinations in Grief:** Seeing or hearing the deceased is a common, non-pathological finding in the immediate post-bereavement period. * **Persistent Complex Bereavement Disorder:** Diagnosed only if the intense symptoms of grief persist for at least **12 months** (6 months in children) after the loss. * **Initial Management:** Always prioritize **active listening and empathy** over pharmacotherapy in uncomplicated bereavement.

Question 27: Which of the following is NOT true for Post-Traumatic Stress Disorder (PTSD)?

A. A past history of psychiatric illness is a risk factor.
B. Women are more predisposed to developing PTSD.
C. PTSD can occur in individuals with high intellectual capacity. (Correct Answer)
D. Emotional numbing is a common symptom.

Explanation: ### Explanation **1. Why Option C is the Correct Answer (The "Not True" Statement)** In the context of PTSD risk factors, **high intellectual capacity** is considered a **protective factor**, not a predisposing one. Research indicates that individuals with higher IQs or greater cognitive reserve are generally less likely to develop PTSD after a traumatic event. They often possess more effective coping mechanisms and better cognitive processing abilities to integrate the trauma. Therefore, while PTSD *can* occur in anyone, high intelligence is traditionally listed as a factor that decreases vulnerability, making this the "incorrect" statement regarding risk. **2. Analysis of Incorrect Options (True Statements about PTSD)** * **Option A:** A **past history of psychiatric illness** (such as anxiety or depression) is a well-established predisposing risk factor. Pre-existing vulnerabilities lower the threshold for developing PTSD following a stressor. * **Option B:** **Gender** is a significant factor; women are approximately twice as likely to develop PTSD compared to men, often due to the nature of the trauma (e.g., sexual assault) and different biological stress responses. * **Option D:** **Emotional numbing** (anhedonia, feeling detached from others, or restricted affect) is a core symptom cluster in the DSM-5 criteria for PTSD, falling under "Negative alterations in cognitions and mood." **3. NEET-PG Clinical Pearls** * **Timeline:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **Core Symptom Triad:** 1. Intrusion (flashbacks/nightmares), 2. Avoidance, 3. Hyperarousal (startle response). * **First-line Treatment:** **SSRIs** (Sertraline, Paroxetine) are the drugs of choice. * **Therapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective. * **Prognosis:** Good prognosis is associated with rapid onset of symptoms, short duration (<6 months), and strong social support.

Question 28: A man, whose wife died 6 months prior, reports that his wife appeared to him and asked him to join her. What is the most likely diagnosis?

A. Normal grief (Correct Answer)
B. Grief psychosis
C. Bereavement reaction
D. Supernatural phenomenon

Explanation: In psychiatry, distinguishing between normal grief and clinical pathology is a high-yield concept for NEET-PG. **Explanation of the Correct Answer:** The scenario describes a **pseudohallucination** (specifically, a visual or auditory perception of the deceased), which is a common and **normal feature of grief**. In normal grief, the individual typically retains insight—they recognize that the experience is not "real" in a physical sense, even if it feels vivid. The timeline of 6 months is also consistent with the typical grieving process. Seeing or hearing the deceased is considered a culturally and clinically normal phenomenon during bereavement and does not signify a psychotic disorder. **Analysis of Incorrect Options:** * **B. Grief psychosis:** This is not a standard clinical diagnosis. While "Brief Psychotic Disorder" can be triggered by a stressor, it requires a loss of reality testing and other symptoms (delusions, disorganized speech) which are absent here. * **C. Bereavement reaction:** While technically related, "Normal Grief" is the more specific clinical term used in exams to describe the non-pathological psychological response to loss. * **D. Supernatural phenomenon:** This is a non-medical, non-scientific explanation and is never the correct answer in a clinical examination. **Clinical Pearls for NEET-PG:** * **Timeline:** Normal grief usually peaks within 6 months and begins to subside. If symptoms are severe and persist beyond 12 months (in adults), consider **Prolonged Grief Disorder** (ICD-11/DSM-5-TR). * **Grief vs. Depression:** In grief, self-esteem is usually preserved. If the patient expresses pervasive feelings of worthlessness, guilt (not related to the deceased), or suicidal ideation to "end the pain" (rather than just "joining" the deceased), suspect **Major Depressive Disorder (MDD)**. * **Management:** Normal grief requires support and empathy, not pharmacotherapy. Antidepressants are only indicated if the patient meets the full criteria for MDD.

Question 29: A person missing from home is found wandering purposefully. He is well-groomed and denies having any amnesia. What is the most likely diagnosis?

A. Dementia
B. Dissociative amnesia
C. Dissociative fugue (Correct Answer)
D. Schizophrenia

Explanation: **Explanation:** The correct diagnosis is **Dissociative Fugue** (now classified under Dissociative Amnesia in DSM-5, but frequently tested as a distinct entity in NEET-PG). **Why it is correct:** Dissociative fugue is characterized by sudden, unexpected travel away from home or one's customary place of work, accompanied by an inability to recall one's past and confusion about personal identity or the assumption of a new identity. Key features in this vignette include: 1. **Purposeful wandering:** Unlike the aimless wandering of organic conditions, fugue states often involve organized travel. 2. **Well-groomed appearance:** This indicates preserved self-care and social functioning, which distinguishes it from psychosis or advanced dementia. 3. **Denial of amnesia:** Patients in a fugue state are often unaware they have forgotten their past and may have adopted a new persona, making them appear "normal" to a casual observer. **Why incorrect options are wrong:** * **Dementia:** While wandering occurs, it is usually aimless (getting lost). Patients show cognitive decline, poor grooming, and global memory deficits, not a specific loss of identity. * **Dissociative Amnesia:** This involves an inability to recall important personal information (usually traumatic). While fugue is a subtype, "Dissociative Fugue" is the more specific and better fit for a patient found wandering far from home. * **Schizophrenia:** Patients typically exhibit "disorganized" behavior, poor self-care, and positive symptoms like hallucinations or delusions. Their wandering is rarely "purposeful" or "well-groomed." **High-Yield Clinical Pearls for NEET-PG:** * **Trigger:** Usually follows a severe psychosocial stressor (e.g., marital distress, financial ruin, or war). * **Recovery:** Recovery is typically spontaneous and rapid. However, once the fugue ends, the patient may have amnesia for the events that occurred *during* the fugue state. * **Management:** The primary treatment is psychotherapy; hypnosis or amobarbital interviews may be used to recover lost memories.

Question 30: What is the diagnostic feature that differentiates PTSD from other disorders that occur following a stressful incident?

A. Episodic occurrence of symptoms
B. Severe anxiety and autonomic arousal
C. Re-experiencing and avoidance of trauma (Correct Answer)
D. Nightmares about the event

Explanation: ### Explanation Post-Traumatic Stress Disorder (PTSD) is characterized by a specific constellation of symptoms following exposure to a life-threatening event. While many psychiatric conditions involve anxiety, the **pathognomonic hallmark** of PTSD is the combination of **re-experiencing** (intrusive memories, flashbacks) and **persistent avoidance** of trauma-related stimuli. #### Why the Correct Answer is Right: According to DSM-5 and ICD-11, PTSD is defined by four symptom clusters: **Intrusion** (re-experiencing), **Avoidance**, **Negative alterations in cognition/mood**, and **Hyperarousal**. While anxiety is common to many disorders, the specific psychological "reliving" of the event coupled with active efforts to avoid reminders is what differentiates PTSD from Generalized Anxiety Disorder or simple Phobias. #### Why Other Options are Wrong: * **A. Episodic occurrence:** PTSD symptoms are generally persistent (lasting >1 month) rather than episodic. Episodic symptoms are more characteristic of Panic Disorder or Bipolar Disorder. * **B. Severe anxiety and autonomic arousal:** These are non-specific features found in Panic Disorder, Phobias, and Acute Stress Disorder. They do not uniquely identify PTSD. * **D. Nightmares:** While a common symptom of PTSD, nightmares occur in various conditions (REM sleep behavior disorder, nightmare disorder) and are only one subset of the "re-experiencing" cluster. #### NEET-PG High-Yield Pearls: * **Timeline:** If symptoms last **<1 month**, the diagnosis is **Acute Stress Disorder**. If **>1 month**, it is **PTSD**. * **First-line Treatment:** Trauma-focused Psychotherapy (CBT/EMDR) and **SSRIs** (Sertraline, Paroxetine). * **Prazosin:** An alpha-1 blocker specifically used to reduce trauma-related nightmares. * **Complex PTSD:** A newer ICD-11 category involving disturbances in self-organization, often following prolonged/repeated trauma (e.g., childhood abuse).

Practice by Chapter

Post-Traumatic Stress Disorder

Practice Questions

Acute Stress Disorder

Practice Questions

Adjustment Disorders

Practice Questions

Reactive Attachment Disorder

Practice Questions

Disinhibited Social Engagement Disorder

Practice Questions

Complex Trauma

Practice Questions

Trauma-Focused Cognitive-Behavioral Therapy

Practice Questions

Eye Movement Desensitization and Reprocessing

Practice Questions

Psychopharmacology for Trauma-Related Disorders

Practice Questions

Trauma in Special Populations

Practice Questions

Resilience and Post-Traumatic Growth

Practice Questions

Dissociative Disorders Related to Trauma

Practice Questions

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