Trauma and Stress-Related Disorders Practice Questions

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

Jealousy. **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).

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

Post-traumatic stress disorder. **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 = **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.

Q: Anniversary reaction is associated with which disorder?

Grief reaction. **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).

Q: Which of the following are included in dissociative disorders?

Multiple personality disorder. **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.

Q: What is dissociative fugue?

Sudden flight from an immediate life situation. **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.

Question 1

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

Accepted Answer

Symptoms develop immediately after the traumatic event.

Answer

Intrusion symptoms may include nightmares and flashbacks.

Answer

Characterized by negative alterations in cognitions and mood.

Answer

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 2

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

Accepted Answer

Jealousy

Answer

Paralysis

Answer

Anesthesia

Answer

Abnormal gait

Question 3

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

Accepted Answer

Post-traumatic stress disorder

Answer

Major depression

Answer

Mania

Answer

Schizophrenia

Question 4

Anniversary reaction is associated with which disorder?

Accepted Answer

Grief reaction

Answer

Adjustment disorder

Answer

Acute stress reaction

Answer

Post traumatic stress disorder

Question 5

Which of the following are included in dissociative disorders?

Accepted Answer

Multiple personality disorder

Answer

Fugue

Answer

Hypochondriasis

Answer

Somatization disorder

Question 6

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

Accepted Answer

Dissociative disorder

Answer

Mania

Answer

Personality disorder

Answer

Paranoid schizophrenia

Question 7

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?

Accepted Answer

Grief

Answer

Post traumatic stress disorder

Answer

Depression

Answer

Bipolar disorder

Question 8

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?

Accepted Answer

Post-traumatic stress disorder

Answer

Anxiety disorder

Answer

Phobia

Answer

Conversion disorder

Question 9

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?

Accepted Answer

Recurrent memories of the event and avoidance of stimuli associated with the trauma

Answer

Nightmares about the traumatic event

Answer

Autonomic hyperarousal and anxiety

Answer

Depressed mood

Question 10

What is dissociative fugue?

Accepted Answer

Sudden flight from an immediate life situation

Answer

Sudden onset of paralysis

Answer

Fear of a specified object

Answer

Presence of multiple identities

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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