Trauma and Stress-Related Disorders Practice Questions

Q: A 20-year-old man is found in a city far from his hometown, working in a factory. He is unable to recall his past life. What is the most likely diagnosis?

Dissociative fugue. ### Explanation **Correct Option: C. Dissociative Fugue** The clinical presentation describes a classic case of **Dissociative Fugue**. This condition 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. The patient often appears "normal" to others during the fugue state and may take up simple occupations (like working in a factory) in a new location. **Why other options are incorrect:** * **A. Post-traumatic stress disorder (PTSD):** While PTSD involves trauma, it is characterized by intrusive memories (flashbacks), avoidance, and hyperarousal, not a total loss of identity or wandering to a new city. * **B. Body dysmorphic disorder:** This is an obsessive-compulsive related disorder where the patient is preoccupied with perceived flaws in physical appearance that are not observable to others. * **D. Dissociative identity disorder (DID):** Formerly known as Multiple Personality Disorder, DID involves the presence of two or more distinct personality states that take control of behavior. While it involves amnesia, it does not typically present as a single, purposeful journey to a new location with a complete loss of the original identity. **High-Yield Clinical Pearls for NEET-PG:** * **Trigger:** Dissociative fugue is usually precipitated by severe psychosocial stress (e.g., marital conflict, financial ruin, or wartime trauma). * **ICD-10 vs. DSM-5:** In **DSM-5**, Dissociative Fugue is no longer a separate diagnosis; it is now classified as a **specifier under Dissociative Amnesia**. * **Recovery:** Recovery is usually rapid and spontaneous; however, once the fugue ends, the patient may have amnesia for the events that occurred *during* the fugue state. * **Differential:** Always rule out organic causes like Temporal Lobe Epilepsy or substance-induced blackouts.

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: 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 is true regarding depersonalization?

More common after life-threatening trauma.. **Explanation:** **Depersonalization** is a dissociative symptom characterized by a persistent or recurrent feeling of detachment from one’s own mental processes or body (feeling like an outside observer). 1. **Why Option A is Correct:** Depersonalization is a common defense mechanism against overwhelming anxiety. It occurs most frequently following **life-threatening trauma** (e.g., accidents, military combat, or physical abuse). In these scenarios, the psyche "detaches" to protect the individual from the immediate emotional impact of the trauma. Studies suggest that up to 1/3 of individuals exposed to life-threatening danger experience transient depersonalization. 2. **Analysis of Incorrect Options:** * **Option B:** While depersonalization *can* occur in neurological conditions like temporal lobe epilepsy or migraines, Option A is a more fundamental and statistically significant association in psychiatric literature. * **Option C:** Unlike many other dissociative disorders, Depersonalization-Derealization Disorder shows **no significant gender predilection**; it occurs equally in males and females (1:1 ratio). * **Option D:** The mean age of onset is much earlier, typically in **late adolescence or early adulthood** (mean age around **16 years**). It is rare for the disorder to begin after the age of 25. **High-Yield Clinical Pearls for NEET-PG:** * **Reality Testing:** Unlike psychosis, in depersonalization, **reality testing remains intact**. The patient knows the feeling is "not real." * **Derealization:** Often accompanies depersonalization; it is the feeling that the external world is unreal, dreamlike, or distorted. * **Associated Conditions:** Frequently comorbid with Anxiety disorders, Depression, and PTSD. * **Treatment:** No specific FDA-approved drug; SSRIs or Lamotrigine are sometimes used, but Psychotherapy (CBT) is the mainstay.

Question 1

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?

Accepted Answer

Normal grief

Answer

Grief psychosis

Answer

Bereavement reaction

Answer

Supernatural phenomenon

Question 2

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

Accepted Answer

Dissociative fugue

Answer

Dementia

Answer

Dissociative amnesia

Answer

Schizophrenia

Question 3

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 4

A 20-year-old man is found in a city far from his hometown, working in a factory. He is unable to recall his past life. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Post-traumatic stress disorder

Answer

Body dysmorphic disorder

Answer

Dissociative identity disorder

Question 5

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

Accepted Answer

Jealousy

Answer

Paralysis

Answer

Anesthesia

Answer

Abnormal gait

Question 6

Anniversary reaction is associated with which disorder?

Accepted Answer

Grief reaction

Answer

Adjustment disorder

Answer

Acute stress reaction

Answer

Post traumatic stress disorder

Question 7

Reactive depression is similar to which of the following conditions?

Accepted Answer

Adjustment disorder

Answer

Dysthymia

Answer

Double depression

Answer

Post-traumatic stress disorder

Question 8

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 9

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 10

Which of the following is true regarding depersonalization?

Accepted Answer

More common after life-threatening trauma.

Answer

Seen in seizure and migraine patients.

Answer

More common in females.

Answer

Mean age of onset is about 25 years.

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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