Trauma and Stress-Related Disorders Practice Questions

Q: La belle indifférence is seen in:

Conversion Reaction. ***Conversion Reaction*** - **La belle indifférence** is a classic sign of **conversion disorder**, where patients show a lack of concern about their dramatic neurological symptoms. - This incongruous emotional state suggests a psychological origin for physical symptoms, such as **paralysis** or **blindness**, that cannot be explained by medical conditions. *Schizophrenia* - Patients with schizophrenia often experience a flattened affect or **anhedonia**, but not typically this specific lack of concern regarding dramatic pseudo-neurological symptoms. - Their emotional responses are usually consistent with their **delusions** or **hallucinations**, which differ from the disinterest of la belle indifférence. *Mania* - Mania is characterized by an elevated, expansive, or irritable mood, increased activity, and **grandiosity**, rather than indifference to significant physical symptoms. - Patients in a manic state may exhibit very high energy levels and be easily distracted, which contrasts with the calm detachment of **la belle indifférence**. *Depression* - Depression is associated with low mood, loss of interest or pleasure, and sometimes **psychomotor retardation**, but not a detached indifference to physical incapacitation. - Patients with depression typically report **anxiety** or distress about their symptoms, rather than an unconcerned attitude.

Q: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?

PTSD. ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.

Q: Ganser syndrome is classified under which of the following disorders?

Dissociative disorder. ***Dissociative disorder*** - Ganser syndrome is characterized by a "passing-off" behavior, where the individual gives **approximate or nonsensical answers** to simple questions, often associated with other dissociative symptoms. - While historically difficult to classify, contemporary understanding places it within the spectrum of dissociative disorders due to its features of an altered state of consciousness and a detachment from reality. *OCD* - **Obsessive-compulsive disorder (OCD)** involves recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). - Ganser syndrome does not typically present with the classic symptom profile of obsessions and compulsions. *Conversion disorder* - **Conversion disorder** involves neurological symptoms (e.g., paralysis, blindness, seizures) that are not consistent with neurological disease and are often preceded by psychological stress. - While both involve psychological factors, Ganser syndrome is distinct in its presentation of "answers" that are close but incorrect, rather than physical symptoms. *Schizoid personality disorder* - **Schizoid personality disorder** is characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - This disorder primarily affects social functioning and emotional expression, which is different from the specific cognitive and behavioral pattern seen in Ganser syndrome.

Q: Astasia-abasia is associated with which of the following conditions?

Functional Neurological Symptom Disorder. ***Functional Neurological Symptom Disorder*** - **Astasia-abasia**, which refers to an inability to stand (astasia) and walk (abasia) despite normal motor function when examined in bed, is a classical presentation of **Functional Neurological Symptom Disorder** (formerly conversion disorder). - This disorder involves neurological symptoms that are incompatible with recognized medical conditions and often linked to **psychological stressors**. - The gait disturbance is bizarre and inconsistent with any known neurological pattern. *Post-Traumatic Stress Disorder* - Characterized by re-experiencing a **traumatic event**, avoidance behaviors, negative alterations in cognitions and mood, and hyperarousal. - While it can manifest with physical symptoms, **astasia-abasia** is not a primary or characteristic feature. *Depressive Disorder* - Primarily involves persistent **sadness**, loss of interest or pleasure, changes in appetite or sleep, and feelings of worthlessness or guilt. - Although physical symptoms like fatigue and psychomotor retardation can occur, **astasia-abasia** is not a typical presentation. *Bipolar Mood Disorder* - Distinguished by episodes of both **mania** (or hypomania) and **depression**. - Symptoms are predominantly mood-related, including extreme shifts in energy, activity levels, and concentration, not specific neurological deficits like astasia-abasia.

Q: Derealization and depersonalization are symptoms of which type of disorder?

Dissociative disorder. ***Dissociative disorder*** - **Derealization** involves experiencing the outside world as unreal or dreamlike - **Depersonalization** is the experience of feeling detached from one's own body or mental processes - These are hallmark symptoms of **dissociative disorders**, specifically depersonalization-derealization disorder in DSM-5 *Personality disorders* - Characterized by enduring, maladaptive patterns of inner experience and behavior - While some personality disorders (e.g., **borderline personality disorder**) may display transient dissociative symptoms under stress, derealization and depersonalization are not core diagnostic features *Mania* - A state of abnormally elevated mood and energy, involving **racing thoughts**, **decreased need for sleep**, and **impulsive behavior** - Does not typically involve consistent derealization or depersonalization as core features *Anxiety disorders* - Depersonalization can occur transiently during **panic attacks** or severe anxiety - However, when derealization and depersonalization are the primary, persistent symptoms, they indicate a **dissociative disorder** rather than an anxiety disorder

Q: Which of the following is NOT considered a phase of child sexual abuse?

Bargaining. ***Bargaining*** - **Bargaining** is typically a phase associated with the Kubler-Ross model of grief (denial, anger, bargaining, depression, acceptance) and is not recognized as a distinct phase in the cycle or process of child sexual abuse. - While a child might attempt to bargain in some contexts for safety or to stop the abuse, it is not a universally accepted or described phase of the abuse process itself. *Engagement* - The **engagement** phase often involves the perpetrator grooming the child, building trust, and isolating them from protective factors. - This phase is crucial for the abuser to gain the child's compliance and reduce the likelihood of disclosure. *Secrecy* - **Secrecy** is a core component of child sexual abuse, where the perpetrator often instills fear or manipulates the child to keep the abuse hidden. - This phase typically involves threats, intimidation, or emotional manipulation to prevent the child from disclosing the abuse to others. *Sexual interaction* - The **sexual interaction** phase refers to the actual abusive acts and physical contact that define child sexual abuse. - This is the explicit act of sexual exploitation or assault that the perpetrator inflicts upon the child.

Q: Post-traumatic stress disorder is characterized by all except:

It doesn't develop after 6 months of stress. ***It doesn't develop after 6 months of stress*** - This statement is **FALSE** and is therefore the correct answer to this "EXCEPT" question. - **PTSD can develop at any time** following a traumatic event, including months or even years later - there is no upper time limit for symptom onset. - The **DSM-5 includes a "delayed expression" specifier** for cases where full diagnostic criteria are not met until at least 6 months after the trauma. - While most cases develop within **3 months of the traumatic event**, delayed onset is well-documented and clinically recognized. - This distinguishes PTSD from **Acute Stress Disorder**, which by definition occurs within 3 days to 4 weeks after trauma exposure. *Flashback and nightmare* - **Flashbacks** (dissociative reactions where the person feels the traumatic event is recurring) and **nightmares** are core symptoms of PTSD. - These belong to the **re-experiencing/intrusion symptom cluster** (Criterion B in DSM-5). - These involuntary recollections cause significant distress and are hallmark features of the disorder. *Re-experiencing stressful events* - **Re-experiencing symptoms** are one of the four main symptom clusters required for PTSD diagnosis. - This includes intrusive memories, traumatic nightmares, flashbacks, and intense psychological/physiological reactions to trauma reminders. - These symptoms reflect the **inability to integrate the traumatic memory** properly, leading to involuntary reactivation. *Exposure to traumatic events* - **Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence** is the essential prerequisite for PTSD diagnosis. - This exposure can be through direct experience, witnessing, learning it happened to a close other, or repeated/extreme exposure to aversive details. - Without documented trauma exposure, PTSD cannot be diagnosed regardless of symptom presentation.

Q: What is the most common form of dissociative disorder?

Dissociative Amnesia. ***Dissociative Amnesia*** - This is the most prevalent dissociative disorder, characterized by an inability to recall important **personal information**, usually of a traumatic or stressful nature. - While other forms involve more complex alterations, **amnesia** for specific events or periods is a foundational and common presentation. *Fugue* - **Dissociative fugue** is a specific, less common subtype of dissociative amnesia where an individual suddenly travels away from their home or workplace and cannot recall past identity or events. - It is often associated with the adoption of a **new identity**, which is not the primary feature of most dissociative disorders. *Somnambulism* - **Somnambulism**, or sleepwalking, is a **sleep disorder** (a parasomnia) and is not classified as a dissociative disorder. - While it involves a dissociative state from full consciousness, its etiology and diagnostic criteria differ significantly from the dissociative disorders listed in the DSM-5. *Multiple personality* - **Multiple personality disorder** is the former name for **Dissociative Identity Disorder (DID)**, which is a relatively rare and severe form of dissociative disorder characterized by the presence of two or more distinct personality states. - While DID is a highly publicized dissociative disorder, it is far less common than dissociative amnesia.

Q: A woman with bilateral headaches that worsen with emotional stress, who has two children both doing poorly in school, is diagnosed with:

Tension headache. ***Tension headache*** - **Tension headaches** are often described as a bilateral dull, constant ache, frequently associated with **stress** and muscle tension, as suggested by the patient's emotional stress with her children's schooling. - The lack of typical migraine features like **pulsating pain**, **photophobia**, **phonophobia**, or aura, and the bilateral nature, favor tension headache over migraine. *Migraine* - **Migraines** typically present as unilateral, pulsating pain, often accompanied by **nausea**, vomiting, photophobia, or phonophobia. - While stress can be a trigger, the **bilateral presentation** and absence of other hallmark migraine features make it less likely. *Cluster headache* - **Cluster headaches** are characterized by severe, unilateral pain, frequently around the eye (periorbital), and are associated with **autonomic symptoms** like lacrimation, rhinorrhea, or ptosis. - They occur in "clusters" over days or weeks and are not typically bilateral or primarily triggered by emotional stress in this manner. *Trigeminal neuralgia* - **Trigeminal neuralgia** causes sudden, severe, shock-like pain in the distribution of the trigeminal nerve, often triggered by light touch, chewing, or speaking. - It is not typically described as a continuous bilateral headache worsened by emotional stress.

Q: A person who was previously a software engineer experienced financial losses, relocated to a new place, changed their name, and began working as a taxi driver without any knowledge of their past life. What is the most likely diagnosis?

Dissociative amnesia. ***Dissociative amnesia (with dissociative fugue)*** - This is the **correct diagnosis according to DSM-5**, where dissociative fugue is now classified as a **subtype of dissociative amnesia**. - The classic features present include: **sudden, unexpected travel** away from home, **amnesia for one's past identity**, and assumption of a **new identity** (new name, new occupation, new location). - The individual has **inability to recall important autobiographical information** about their previous life as a software engineer, which is the core feature of dissociative amnesia. - The **"fugue" specifier** is added when there is purposeful travel or bewildered wandering associated with amnesia for identity. *Dissociative fugue (as standalone diagnosis)* - This was a **separate diagnosis in DSM-IV** but has been **reclassified in DSM-5** as a subtype of dissociative amnesia. - While this term describes the clinical picture accurately, it is **no longer used as an independent diagnostic entity** in current classification systems. *Ganser syndrome* - Characterized by **"giving approximate answers"** (vorbeireden) to questions and other bizarre behaviors, often seen in forensic settings. - While it involves dissociative features, it typically doesn't include the **extensive traveling and sustained new identity formation** as seen in this case. - The hallmark is **nonsensical or approximate responses** to simple questions, which is not described here. *Dissociative identity disorder* - Involves the presence of **two or more distinct personality states** with recurrent gaps in recall of everyday events. - This disorder is characterized by **"switching" between multiple identities**, not a single sustained altered identity. - The key difference is **multiple alternating identities** versus the **single new identity with amnesia** for the old one seen in this case.

Question 1

La belle indifférence is seen in:

Accepted Answer

Conversion Reaction

Answer

Depression

Answer

Schizophrenia

Answer

Mania

Question 2

A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?

Accepted Answer

PTSD

Answer

Anxiety disorder

Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Adjustment disorder

Question 3

Ganser syndrome is classified under which of the following disorders?

Accepted Answer

Dissociative disorder

Answer

OCD

Answer

Conversion disorder

Answer

Schizoid personality disorder

Question 4

Astasia-abasia is associated with which of the following conditions?

Accepted Answer

Functional Neurological Symptom Disorder

Answer

Post-Traumatic Stress Disorder

Answer

Depressive Disorder

Answer

Bipolar Mood Disorder

Question 5

Derealization and depersonalization are symptoms of which type of disorder?

Accepted Answer

Dissociative disorder

Answer

Personality disorders

Answer

Mania

Answer

Anxiety disorders

Question 6

Which of the following is NOT considered a phase of child sexual abuse?

Accepted Answer

Bargaining

Answer

Engagement

Answer

Secrecy

Answer

Sexual interaction

Question 7

Post-traumatic stress disorder is characterized by all except:

Accepted Answer

It doesn't develop after 6 months of stress

Answer

Flashback and nightmare

Answer

Re-experiencing stressful events

Answer

Exposure to traumatic events

Question 8

What is the most common form of dissociative disorder?

Accepted Answer

Dissociative Amnesia

Answer

Fugue

Answer

Somnambulism

Answer

Multiple personality

Question 9

A woman with bilateral headaches that worsen with emotional stress, who has two children both doing poorly in school, is diagnosed with:

Accepted Answer

Tension headache

Answer

Migraine

Answer

Cluster headache

Answer

Trigeminal neuralgia

Question 10

A person who was previously a software engineer experienced financial losses, relocated to a new place, changed their name, and began working as a taxi driver without any knowledge of their past life. What is the most likely diagnosis?

Accepted Answer

Dissociative amnesia

Answer

Ganser syndrome

Answer

Dissociative fugue

Answer

Dissociative identity disorder

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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