Personality disorders — MCQs

A 33-year-old man with documented antisocial personality disorder and substance use disorder is convicted of assault. The defense attorney requests psychiatric testimony that the defendant's personality disorder diminished his capacity to conform his conduct to the law. His history includes multiple prior convictions, repeated lying, failure to sustain employment, lack of remorse, and disregard for others' safety. However, he understood the wrongfulness of his actions and planned the assault in advance. Evaluate the relationship between antisocial personality disorder and criminal responsibility.

A 26-year-old woman presents requesting cosmetic surgery consultation. She is preoccupied with achieving the 'perfect' appearance, has undergone multiple procedures, and expresses disappointment with each result. She describes herself as special and destined for greatness, becomes enraged when her primary care physician suggested psychiatric evaluation, and states she will report him for 'not understanding her needs.' She expects special treatment in the clinic and becomes irritated when kept waiting. On mental status exam, she shows intact reality testing. Analyze the most likely underlying personality structure.

A 50-year-old man is brought for evaluation by his wife who reports 25 years of strange behavior. He has no close friends, prefers solitary activities, shows little emotion even at family events, and appears indifferent to praise or criticism. He works as a night security guard and has never desired a romantic relationship beyond the marriage his family arranged. He denies hallucinations or paranoia. On exam, he shows restricted affect but is cooperative and logical. What distinguishes this presentation from schizoid personality disorder with comorbid depression?

A 29-year-old woman with borderline personality disorder presents to the emergency department after superficial self-cutting following an argument with her boyfriend. She demands admission, stating 'I'll kill myself if you send me home.' She has had 15 psychiatric hospitalizations in the past 3 years, typically lasting 2-3 days. Her outpatient therapist reports she is engaged in DBT and makes these threats regularly to avoid distress. She denies intent or plan for suicide, vital signs are stable, cuts are superficial. What is the most therapeutic management approach?

A 38-year-old man with antisocial personality disorder is admitted to the medical service for endocarditis from IV drug use. He is charming with nurses but becomes hostile when confronted about treatment non-adherence. He was found attempting to obtain opioids by feigning pain severity. The team is divided: some staff want to discharge him for manipulative behavior, while others advocate for continued treatment. He has violated unit rules multiple times. As the consulting psychiatrist, what is the most appropriate recommendation?