Trauma and Stress-Related Disorders — MCQs

A group of four teenagers were involved in a car accident, resulting in the deaths of three individuals on the spot. The surviving girl was admitted to the ICU for three months. Following her discharge, she frequently wakes up at night in a terrified state, reporting recurring dreams of the event and an ongoing fear of cars. What is the most likely diagnosis?

Q39Medium

A 23-year-old man, following a road traffic accident, presents with anger, disturbed sleep, and avoidance. Which of the following features helps in differentiating post-traumatic stress disorder (PTSD) from other disorders?

Q40Easy

What is dissociative fugue?

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

Question 31: Which of the following is a FALSE statement regarding post-traumatic stress disorder?

A. Symptoms develop immediately after the traumatic event. (Correct Answer)
B. Intrusion symptoms may include nightmares and flashbacks.
C. Characterized by negative alterations in cognitions and mood.
D. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Explanation: ### Explanation **1. Why Option A is the Correct (False) Statement:** According to DSM-5 criteria, the symptoms of Post-Traumatic Stress Disorder (PTSD) typically begin within the first 3 months after the trauma, but there is often a **latency period**. Crucially, a diagnosis of PTSD requires the symptoms to persist for **more than one month**. If symptoms occur and resolve within the first month (3 days to 1 month) following the event, the diagnosis is **Acute Stress Disorder (ASD)**, not PTSD. Therefore, saying they develop "immediately" as a rule for PTSD is clinically inaccurate. **2. Analysis of Other Options:** * **Option B:** Intrusion symptoms are a core pillar of PTSD. These include distressing dreams (nightmares), dissociative reactions (flashbacks) where the individual feels the event is recurring, and intense psychological distress at exposure to cues. * **Option C:** This reflects the "Negative Alterations in Cognition and Mood" cluster, which includes inability to remember aspects of the trauma, persistent negative beliefs about oneself, and a diminished interest in significant activities. * **Option D:** This is a standard functional criterion for most psychiatric disorders in the DSM-5; the symptoms must interfere with the patient's daily life or cause significant distress to qualify as a disorder. **3. NEET-PG High-Yield Pearls:** * **Duration Key:** < 1 month = Acute Stress Disorder; > 1 month = PTSD. * **Delayed Expression:** PTSD can be diagnosed with "delayed expression" if the full diagnostic criteria are not met until at least 6 months after the event. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) like **Sertraline** and **Paroxetine** are FDA-approved. * **Specific Symptom Rx:** **Prazosin** (an alpha-1 blocker) is highly effective for trauma-related nightmares. * **Therapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and EMDR (Eye Movement Desensitization and Reprocessing) are preferred psychotherapies.

Question 32: In conversion disorder, all of the following are seen except?

A. Jealousy (Correct Answer)
B. Paralysis
C. Anesthesia
D. Abnormal gait

Explanation: **Explanation:** **Conversion Disorder (Functional Neurological Symptom Disorder)** is a psychiatric condition where psychological stress is "converted" into physical symptoms that suggest a neurological or medical condition, but cannot be explained by any known organic pathology. **Why "Jealousy" is the correct answer:** Jealousy is an **emotional state** or a symptom often associated with personality disorders (like Paranoid or Borderline) or delusional disorders (Othello syndrome). It is not a physical manifestation of neurological dysfunction. Conversion disorder specifically involves **sensory or motor deficits**, not complex emotional or delusional states. **Analysis of incorrect options:** * **Paralysis:** This is a classic motor symptom of conversion disorder. Patients may present with "pseudoparalysis" of a limb that does not follow anatomical nerve distributions. * **Anesthesia:** Sensory loss (e.g., "glove and stocking" anesthesia) is a hallmark feature. The loss of sensation typically does not correspond to dermatomal patterns. * **Abnormal Gait:** Functional gait disorders (e.g., *astasia-abasia*, where the patient has a wild, staggering gait but rarely falls) are common motor presentations. **High-Yield Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not universal) feature where the patient shows a surprising lack of concern regarding their severe physical disability. * **Primary Gain:** The internal relief achieved by keeping an emotional conflict out of conscious awareness. * **Secondary Gain:** External benefits derived from the symptoms (e.g., attention, avoiding work). * **Identification:** Patients may unconsciously model their symptoms after someone they know. * **Hoover’s Sign:** A clinical test used to differentiate organic from functional leg weakness (extension of the "paralyzed" leg when the patient flexes the contralateral hip against resistance).

Question 33: A woman experienced a traumatic event three years ago and subsequently developed nightmares and nighttime terror. What is the most probable diagnosis?

A. Major depression
B. Post-traumatic stress disorder (Correct Answer)
C. Mania
D. Schizophrenia

Explanation: **Explanation:** The correct diagnosis is **Post-traumatic stress disorder (PTSD)**. This condition occurs following exposure to a traumatic event (e.g., physical assault, natural disaster, or combat). The clinical hallmark of PTSD is the presence of **intrusive symptoms**, such as recurrent nightmares, flashbacks, and night terrors, where the patient "re-experiences" the trauma. According to DSM-5/ICD-11 criteria, if these symptoms persist for **more than one month** and cause significant distress or functional impairment, PTSD is diagnosed. In this case, the symptoms have persisted for three years, fitting the chronic profile of the disorder. **Why other options are incorrect:** * **Major Depression:** While depression can be comorbid with PTSD, its primary features are persistent low mood, anhedonia, and sleep disturbances (usually insomnia), rather than trauma-specific nightmares. * **Mania:** Characterized by elevated mood, decreased need for sleep, and pressured speech; it is not triggered by a specific past trauma in this manner. * **Schizophrenia:** A psychotic disorder characterized by delusions, hallucinations, and disorganized thinking, which are absent in this clinical vignette. **High-Yield Clinical Pearls for NEET-PG:** * **Timeframe:** Symptoms <1 month = **Acute Stress Disorder**; Symptoms >1 month = **PTSD**. * **Core Symptom Clusters:** 1. Intrusion (nightmares/flashbacks), 2. Avoidance (of reminders), 3. Negative alterations in cognition/mood, 4. Alterations in arousal (hypervigilance/startle response). * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Specific Symptom Management:** **Prazosin** (an alpha-1 blocker) is highly effective for treating PTSD-associated nightmares.

Question 34: Anniversary reaction is associated with which disorder?

A. Adjustment disorder
B. Acute stress reaction
C. Grief reaction (Correct Answer)
D. Post traumatic stress disorder

Explanation: **Explanation:** **1. Why Grief Reaction is Correct:** An **anniversary reaction** is a specific psychological phenomenon where an individual experiences a recurrence or intensification of distress on the date of a significant loss or traumatic event. It is most characteristically associated with **Grief Reaction (Bereavement)**. On the anniversary of a loved one's death, individuals often experience symptoms like sadness, insomnia, and vivid memories of the deceased. While usually a part of normal grieving, it can sometimes trigger a major depressive episode. **2. Why Other Options are Incorrect:** * **Adjustment Disorder:** This involves an emotional or behavioral response to an identifiable stressor (e.g., divorce, job loss) occurring within 3 months of the stressor. It focuses on the inability to cope with ongoing life changes rather than a specific cyclical anniversary response. * **Acute Stress Reaction:** This is a transient condition that develops in response to exceptional physical or mental stress. Symptoms appear within minutes and typically subside within 2–3 days. It is a reaction to an immediate event, not a delayed anniversary response. * **Post-Traumatic Stress Disorder (PTSD):** While PTSD involves "re-experiencing" (flashbacks/nightmares), the term "anniversary reaction" is classically used in psychiatric literature to describe the cyclical mourning process in grief. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Grief:** Usually lasts 6–12 months; self-esteem remains intact. * **Persistent Complex Bereavement Disorder:** Diagnosed if intense grief continues beyond 12 months (6 months in children). * **Kubler-Ross Stages of Grief:** Denial, Anger, Bargaining, Depression, Acceptance (**DABDA**). * **Anticipatory Grief:** Grief experienced *before* an expected loss (e.g., terminal illness).

Question 35: Which of the following are included in dissociative disorders?

A. Multiple personality disorder (Correct Answer)
B. Fugue
C. Hypochondriasis
D. Somatization disorder

Explanation: **Explanation:** Dissociative disorders are characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception. **Why Option A is Correct:** **Multiple Personality Disorder (now known as Dissociative Identity Disorder or DID in DSM-5)** is the hallmark dissociative disorder. It involves the presence of two or more distinct personality states (alters) that recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information. **Why Other Options are Incorrect:** * **Option B (Fugue):** While Dissociative Fugue is a dissociative phenomenon, in modern classification (DSM-5), it is considered a **specifier under Dissociative Amnesia** rather than a standalone disorder. However, in the context of this question, Multiple Personality Disorder is the primary disorder listed. * **Options C & D (Hypochondriasis and Somatization):** These are classified under **Somatic Symptom and Related Disorders** (formerly Somatoform Disorders). They involve physical symptoms or health anxieties that cause significant distress but lack a distinct dissociative component (disruption of identity/memory). **High-Yield Clinical Pearls for NEET-PG:** * **Dissociative Amnesia:** The most common dissociative disorder; usually follows a traumatic event. * **Ganser Syndrome:** Also known as "approximate answers," often seen in prison populations; it is classified as a Dissociative Disorder Not Otherwise Specified (NOS). * **Depersonalization/Derealization Disorder:** Characterized by persistent feelings of detachment from oneself or one's surroundings, with **intact reality testing**. * **Key Association:** Dissociative disorders are strongly linked to a history of severe childhood trauma or abuse.

Question 36: A person with multiple distinct personalities is suffering from which of the following conditions?

A. Mania
B. Personality disorder
C. Paranoid schizophrenia
D. Dissociative disorder (Correct Answer)

Explanation: ### Explanation The presence of multiple distinct personalities (now formally termed **Dissociative Identity Disorder** or DID) is a hallmark of **Dissociative Disorders**. **1. Why Dissociative Disorder is Correct:** Dissociation is a defense mechanism where there is a disruption in the usually integrated functions of consciousness, memory, identity, or perception. In DID (formerly Multiple Personality Disorder), the individual possesses two or more distinct personality states (alters) that recurrently take control of behavior. This is often associated with severe childhood trauma or abuse. **2. Why the Other Options are Incorrect:** * **Mania:** This is a mood state characterized by elation, hyperactivity, and pressured speech. While a manic patient may have inflated self-esteem (grandiosity), they maintain a single, consistent identity. * **Personality Disorder:** These are enduring, inflexible patterns of inner experience and behavior (e.g., Borderline, Antisocial). While they affect how a person relates to the world, they do not involve the "splitting" of the self into multiple distinct identities. * **Paranoid Schizophrenia:** This is a psychotic disorder characterized by delusions and hallucinations. While a patient might believe they are someone else (delusion of identity), they do not physically shift between different personality states with associated amnesia. **3. NEET-PG High-Yield Pearls:** * **Dissociative Identity Disorder (DID):** Most severe form; requires at least two distinct identities and "gaps" in remote or everyday memory (dissociative amnesia). * **Dissociative Fugue:** Sudden, unexpected travel away from home combined with an inability to recall one’s past and the assumption of a new identity. * **Ganser Syndrome:** Also known as "approximate answers"; often seen in prisoners; classified under Dissociative Disorders. * **Treatment:** The primary treatment for DID is long-term, trauma-focused psychotherapy (reintegration of identities). Pharmacotherapy is only used for comorbid symptoms like depression.

Question 37: A girl feels very depressed as her father died one month back. She feels moody, withdraws from others, and expresses a desire to join her father. What is the most likely diagnosis?

A. Post traumatic stress disorder
B. Grief (Correct Answer)
C. Depression
D. Bipolar disorder

Explanation: ### Explanation **Correct Answer: B. Grief** **1. Why Grief is the correct answer:** Grief is a natural, non-pathological response to the loss of a loved one. In this scenario, the symptoms (depressed mood, social withdrawal, and a desire to "join the deceased") have occurred within **one month** of the father's death. In normal grief, the focus of the distress is specifically on the deceased. The desire to "join the father" is a common feature of bereavement and is distinct from active suicidal ideation seen in clinical depression; it represents a longing for reunion rather than a primary desire to end one's life. **2. Why other options are incorrect:** * **A. Post-Traumatic Stress Disorder (PTSD):** Requires exposure to a traumatic event followed by specific clusters of symptoms: re-experiencing (flashbacks/nightmares), avoidance, and hyperarousal lasting for **>1 month**. The primary feature here is sadness and mourning, not trauma-induced hypervigilance. * **C. Depression (Major Depressive Disorder):** While symptoms overlap, MDD is characterized by pervasive anhedonia, worthlessness, and psychomotor retardation. In grief, "waves" of distress are common, and self-esteem is usually preserved. Per DSM-5, bereavement does not exclude a diagnosis of MDD, but given the short timeframe (1 month) and the specific focus on the father, "Grief" is the most appropriate clinical description. * **D. Bipolar Disorder:** Requires a history of manic or hypomanic episodes, which are absent in this clinical vignette. **3. Clinical Pearls for NEET-PG:** * **Timeline:** Normal grief typically peaks at 2 months and subsides significantly by 6 months. * **Persistent Complex Bereavement Disorder:** Diagnosed if intense grief symptoms persist for **at least 12 months** (6 months in children) and interfere with daily functioning. * **Grief vs. MDD:** In grief, self-esteem is usually intact. If the patient expresses profound **guilt** (unrelated to the death) or **worthlessness**, suspect MDD. * **Stages of Grief (Kübler-Ross):** Denial, Anger, Bargaining, Depression, Acceptance (Mnemonic: **DABDA**).

Question 38: A group of four teenagers were involved in a car accident, resulting in the deaths of three individuals on the spot. The surviving girl was admitted to the ICU for three months. Following her discharge, she frequently wakes up at night in a terrified state, reporting recurring dreams of the event and an ongoing fear of cars. What is the most likely diagnosis?

A. Anxiety disorder
B. Phobia
C. Conversion disorder
D. Post-traumatic stress disorder (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Post-traumatic stress disorder (PTSD)** The diagnosis is based on the presence of a **catastrophic stressor** (a fatal car accident) followed by a specific triad of symptoms lasting for more than one month: 1. **Intrusion Symptoms:** Recurring nightmares and "waking up in a terrified state" (re-experiencing the trauma). 2. **Avoidance:** An ongoing fear of cars (avoiding stimuli associated with the trauma). 3. **Hyperarousal:** Though not explicitly detailed, the night terrors often indicate a state of increased autonomic arousal. In PTSD, the symptoms must persist for **>4 weeks**. Since the patient was in the ICU for three months before these symptoms were noted, the duration criteria for PTSD are clearly met. **Why other options are incorrect:** * **Anxiety Disorder:** This is a broad category. While PTSD involves anxiety, the specific etiology (life-threatening trauma) and symptoms (flashbacks/nightmares) make PTSD the most specific and correct diagnosis. * **Phobia:** While she fears cars, this is a secondary symptom of the trauma. A simple phobia does not account for the recurring nightmares or the history of a catastrophic event. * **Conversion Disorder (Functional Neurological Symptom Disorder):** This involves unexplained motor or sensory deficits (e.g., paralysis, blindness) triggered by psychological stress, which are absent in this case. ### Clinical Pearls for NEET-PG: * **Timeline is Key:** * Symptoms < 4 weeks: **Acute Stress Disorder**. * Symptoms > 4 weeks: **PTSD**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Specific Symptom Management:** **Prazosin** (an alpha-1 blocker) is highly effective for reducing trauma-related nightmares. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (**EMDR**) are gold-standard non-pharmacological treatments.

Question 39: A 23-year-old man, following a road traffic accident, presents with anger, disturbed sleep, and avoidance. Which of the following features helps in differentiating post-traumatic stress disorder (PTSD) from other disorders?

A. Nightmares about the traumatic event
B. Recurrent memories of the event and avoidance of stimuli associated with the trauma (Correct Answer)
C. Autonomic hyperarousal and anxiety
D. Depressed mood

Explanation: ### Explanation The core clinical feature that distinguishes **Post-Traumatic Stress Disorder (PTSD)** from other anxiety or mood disorders is the combination of **re-experiencing** the trauma and **active avoidance** of triggers. **1. Why Option B is Correct:** According to DSM-5 and ICD-11 criteria, PTSD is characterized by a specific triad: **Intrusion** (recurrent memories/flashbacks), **Avoidance** (staying away from reminders), and **Hyperarousal**. While many disorders feature anxiety, the specific "re-living" of a traumatic event through intrusive memories, coupled with behavioral avoidance of stimuli associated with that specific trauma, is the hallmark of PTSD. **2. Analysis of Incorrect Options:** * **Option A (Nightmares):** While common in PTSD, nightmares are non-specific and occur in REM sleep behavior disorders, nightmare disorder, and generalized anxiety. * **Option C (Autonomic hyperarousal):** This is a core feature of PTSD but is also the defining characteristic of **Panic Disorder** and **Generalized Anxiety Disorder (GAD)**. It lacks the diagnostic specificity of trauma-related avoidance. * **Option D (Depressed mood):** This is a common comorbidity in PTSD but is the primary feature of **Major Depressive Disorder (MDD)**. It does not help differentiate PTSD; rather, it often complicates the diagnosis. **Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must last **>1 month** for a diagnosis of PTSD. If symptoms last **<1 month**, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Prazosin:** A high-yield drug used specifically to treat **trauma-related nightmares** in PTSD patients. * **Eye Movement Desensitization and Reprocessing (EMDR):** A specialized psychotherapy highly effective for PTSD.

Question 40: What is dissociative fugue?

A. Sudden onset of paralysis
B. Fear of a specified object
C. Presence of multiple identities
D. Sudden flight from an immediate life situation (Correct Answer)

Explanation: **Explanation:** **Dissociative Fugue** (now classified under Dissociative Amnesia in DSM-5) is characterized by a sudden, unexpected travel away from one’s home or place of work, accompanied by an inability to recall one’s past and confusion about personal identity. The "sudden flight" is usually a defense mechanism triggered by severe psychosocial stress or trauma. **Analysis of Options:** * **Option D (Correct):** The hallmark of fugue is the physical act of wandering or "flight" combined with amnesia. Patients often adopt a new identity during the episode and have no memory of the fugue once it ends. * **Option A (Incorrect):** Sudden onset of paralysis without an organic cause is characteristic of **Conversion Disorder** (Functional Neurological Symptom Disorder), where psychological distress is "converted" into physical symptoms. * **Option B (Incorrect):** Fear of a specific object defines a **Specific Phobia**, which is an anxiety disorder, not a dissociative one. * **Option C (Incorrect):** The presence of two or more distinct personality states is the defining feature of **Dissociative Identity Disorder (DID)**, formerly known as Multiple Personality Disorder. **Clinical Pearls for NEET-PG:** * **ICD-10 vs. DSM-5:** In ICD-10, Dissociative Fugue is a separate diagnosis (F44.1). In DSM-5, it is a **specifier** for Dissociative Amnesia. * **Key Feature:** The travel is usually purposeful, but the patient appears bewildered. * **Recovery:** Recovery is typically rapid and spontaneous, but the patient remains amnestic for the events that occurred *during* the fugue state. * **Differential:** Always rule out organic causes like Temporal Lobe Epilepsy (TLE) or substance abuse.

Practice by Chapter

Post-Traumatic Stress Disorder

Practice Questions

Acute Stress Disorder

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Adjustment Disorders

Practice Questions

Reactive Attachment Disorder

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Disinhibited Social Engagement Disorder

Practice Questions

Complex Trauma

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Trauma-Focused Cognitive-Behavioral Therapy

Practice Questions

Eye Movement Desensitization and Reprocessing

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Psychopharmacology for Trauma-Related Disorders

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Trauma in Special Populations

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Resilience and Post-Traumatic Growth

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Dissociative Disorders Related to Trauma

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