Trauma and Stress-Related Disorders Practice Questions

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: 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 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.

Q: What is the most common presenting symptom in conversion disorder (historically termed hysteria)?

Motor or sensory symptoms. ***Motor or sensory symptoms*** - Historically, **hysteria** (now largely replaced by terms like **conversion disorder** or functional neurological symptom disorder) frequently presented with **unexplained motor or sensory deficits** such as paralysis, tremor, blindness, or aphonia. - These symptoms are neurological in nature but are not attributable to a known neurological or medical condition, often appearing in response to psychological stress. *Excessive health concerns* - This symptom is more characteristic of **illness anxiety disorder** (formerly hypochondriasis), where individuals are preoccupied with having or acquiring a serious illness. - While there is a psychological component, it does not typically involve the dramatic functional neurological symptoms seen in hysteria. *Disorganized speech* - **Disorganized speech** is a hallmark symptom of **psychotic disorders**, particularly **schizophrenia**, reflecting a disturbance in thought processes. - It is not a common presentation of conversion disorder or what was historically termed hysteria. *Dissociative fugue* - **Dissociative fugue** involves sudden, unexpected travel away from home or one's customary workplace, with **amnesia for identity** or other important autobiographical information. - While a dissociative symptom, it is distinct from the motor and sensory symptoms that were classically associated with hysteria and conversion disorder.

Q: Which of the following is not a clinical feature of post-traumatic stress disorder?

Grandiosity. ***Grandiosity*** - **Grandiosity** refers to an inflated sense of self-importance, superiority, or special abilities, which is characteristic of manic or hypomanic episodes in bipolar disorder, not PTSD. - PTSD typically involves negative alterations in cognition and mood, including persistent negative beliefs about oneself (e.g., "I am bad," "I can't trust anyone"), which is opposite to grandiose thinking. - The core symptoms of PTSD do not include elevated mood, inflated self-esteem, or grandiose delusions. *Flashbacks* - **Flashbacks** are a hallmark feature of PTSD, involving vivid, intrusive re-experiences of the traumatic event where the individual feels as if the trauma is happening again. - They are a key symptom in the **intrusion cluster (Criterion B)** of DSM-5 PTSD diagnostic criteria. - Flashbacks can involve sensory, emotional, or physical re-experiencing with dissociative qualities. *Nightmares* - **Nightmares** related to the traumatic event are a common and distressing feature of PTSD, falling under the **intrusion symptom cluster (Criterion B)**. - They often involve re-enacting the trauma or experiencing themes related to its content, leading to sleep disturbance and significant emotional distress. - Trauma-related nightmares occur in the majority of PTSD patients and contribute to sleep avoidance. *Emotional distress* - **Emotional distress** is a pervasive symptom in PTSD, including intense anxiety, fear, sadness, anger, or irritability. - This distress appears across multiple symptom clusters: **intrusion (Criterion B)**, **negative alterations in cognition and mood (Criterion D)**, and **alterations in arousal and reactivity (Criterion E)**. - Emotional distress can be triggered by trauma reminders (internal or external cues) and is a core feature of the disorder.

Q: Which of the following dissociative disorders involves the presence of two or more distinct identities?

Dissociative Identity Disorder. ***Dissociative Identity Disorder*** - This disorder is characterized by the presence of **two or more distinct personality states** or an experience of **possession**. - These distinct identities recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. - This is the **defining feature** that distinguishes DID from other dissociative disorders. *Depersonalization/Derealization Disorder* - This involves **persistent or recurrent experiences of depersonalization** (feeling detached from one's mental processes or body) or **derealization** (feeling that the world is unreal or dreamlike). - While consciousness is maintained, there is no presence of multiple distinct identities. - The person retains awareness that these are subjective experiences. *Dissociative Amnesia* - This is characterized by an inability to recall important **autobiographical information**, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. - May include dissociative fugue as a specifier (sudden travel with amnesia for identity). - It does not involve the presence of multiple distinct identities. *Major Depressive Disorder* - This is a mood disorder characterized by a persistently **depressed mood or loss of interest** in activities, causing significant impairment in daily life. - It is not a dissociative disorder and does not involve the presence of multiple identities.

Question 1

Which of the following is a key feature that differentiates Post Traumatic Stress Disorder (PTSD) from other mental health disorders?

Accepted Answer

Avoidance of reminders and intrusive memories of a traumatic event

Answer

Nightmares about traumatic events

Answer

Depression

Answer

Autonomic arousal and anxiety

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

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 6

What is the most common form of dissociative disorder?

Accepted Answer

Dissociative Amnesia

Answer

Fugue

Answer

Somnambulism

Answer

Multiple personality

Question 7

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

Question 8

What is the most common presenting symptom in conversion disorder (historically termed hysteria)?

Accepted Answer

Motor or sensory symptoms

Answer

Excessive health concerns

Answer

Disorganized speech

Answer

Dissociative fugue

Question 9

Which of the following is not a clinical feature of post-traumatic stress disorder?

Accepted Answer

Grandiosity

Answer

Emotional distress

Answer

Flashbacks

Answer

Nightmares

Question 10

Which of the following dissociative disorders involves the presence of two or more distinct identities?

Accepted Answer

Dissociative Identity Disorder

Answer

Dissociative Amnesia

Answer

Depersonalization/Derealization Disorder

Answer

Major Depressive Disorder

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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