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|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|SubCategory=General Principles
|Prompt=A 35 year old woman has lived alone most of her adult life. She has no friends and does not like leaving the house much. She has never had an intimate relationship and prefers being alone. She spends her days drawing and collecting random objects which she fashions into dolls. What is the most likely personality disorder present in this patient?
|Prompt=A 42 year old woman has had 7 relationships in the past year all of which she claims were the most intense loves of her life. She has written many songs about her relationships and has sworn she would kill herself if any of her previous lovers tried to leave her. She has also had 2 episodes of major depression in the past year and was arrested for assaulting one of her friends after they had a minor argument. Which of the following types of defenses is most likely to be present in this patient?
|Explanation=Schizoid personality disorder is characterized by voluntary social withdrawal and indifference. Patients with schizoid personality disorder express little emotion and are content with being socially isolated and not having relationships. They usually feel little if any desire for sexual relationships. Patients typically have hobbies and daily work activities that require as little social contact as possible. On the other hand, avoidant personality disorder describes a pattern of hypersensitivity and social inhibition in patients who are usually very shy. These patients desire social relationships but are very timid, often feel inadequate, and are afraid of rejection.
|Explanation=Borderline personality disorder is characterized by a pattern of excessive instability of interpersonal relationships and self-image. Patients are usually impulsive, have a pattern of intense unstable relationships, and recurrent suicidal behavior or threats. Patients can also exhibit mood instability, self-mutilation, and chronic feelings of emptiness. A classical defense mechanism associated with borderline personality disorder is splitting. Splitting is described as intolerance to ambiguity with a belief that people are either completely good or bad at a given time. Patients have alternating extremes of idealization and devaluation towards certain individuals.  
Ex: All waiters are nice and kind, while waitresses are mean and insensitive.


Five features are usually seen in schizoid personality disorder: Social withdrawal, social detachement, intimacy avoidance, restricted affectivity, and anhedonia.
Educational objective: Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people as either completely bad or good with no room for ambiguity.
 
|AnswerA=Rationalization
Educational objective: Schizoid personality disorder is characterized by voluntary social withdrawal with no desire for social contact or relationships.
|AnswerAExp=A defense mechanism characterized by attempts to logically reason out certain behaviors to avoid self-blame. Not characteristic of borderline personality disorder.  
 
|AnswerB=Altruism
References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:American Psychiatric Publishing.
|AnswerBExp=A defense mechanism characterized by kindness and generosity towards other to relieve a guilty conscience. Not usually a feature of borderline personality disorder.
|AnswerA=Schizotypal
|AnswerC=Humor
|AnswerAExp=Schizotypal personality disorder is characterized by weird and eccentric appearance, magical beliefs, bizarre fantasies or preoccupations, and odd thinking and speech. Patients can usually have some form of withdrawal but not as prominent as in schizoid personality.
|AnswerCExp=A defense mechanism characterized by creating an amusing situation out of an awkward or difficult one. Not common borderline personalities.
|AnswerB=Schizoid
|AnswerD=Denial
|AnswerBExp=This patient exhibits the typical features of schizoid personality disorder. The patient neither desires nor enjoys close relationships, and almost always chooses solitary activities. Other features include anhedonia, intimacy avoidance, and restricted affectivity.
|AnswerDExp=A defense mechanism by which one avoids a certain difficult reality by denying it ever happened. Not characteristic of borderline personality disorder.
|AnswerC=Avoidant
|AnswerE=Splitting
|AnswerCExp=Avoidant personality disorder is characterized by avoidance of activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection. The patient usually desires relationships but is afraid of possible consequences.  
|AnswerEExp=Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people and situations as completely black or white due to intolerance towards incertitude.
|AnswerD=Dependent
|AnswerDExp=Dependent personality disorder is characterized by a submissive personality often with very low self esteem. Patients usually have a constant need to be taken care of.
|AnswerE=Borderline
|AnswerEExp=Borderline personality disorder is characterized by a pervasive pattern of instability of interpersonal relationships and self-image. Patients are usually impulsive, have a pattern of intense unstable relationships, and recurrent suicidal behavior or threats.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Schizoid personality disorder, Avoidant personality disorder
|WBRKeyword=Schizoid personality disorder, Avoidant personality disorder
|Approved=No
|Approved=No
}}
}}

Revision as of 18:51, 6 October 2013
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Behavioral Science/Psychiatry
Sub Category SubCategory::General Principles
Prompt [[Prompt::A 42 year old woman has had 7 relationships in the past year all of which she claims were the most intense loves of her life. She has written many songs about her relationships and has sworn she would kill herself if any of her previous lovers tried to leave her. She has also had 2 episodes of major depression in the past year and was arrested for assaulting one of her friends after they had a minor argument. Which of the following types of defenses is most likely to be present in this patient?]]
Answer A AnswerA::Rationalization
Answer A Explanation AnswerAExp::A defense mechanism characterized by attempts to logically reason out certain behaviors to avoid self-blame. Not characteristic of borderline personality disorder.
Answer B AnswerB::Altruism
Answer B Explanation AnswerBExp::A defense mechanism characterized by kindness and generosity towards other to relieve a guilty conscience. Not usually a feature of borderline personality disorder.
Answer C AnswerC::Humor
Answer C Explanation AnswerCExp::A defense mechanism characterized by creating an amusing situation out of an awkward or difficult one. Not common borderline personalities.
Answer D AnswerD::Denial
Answer D Explanation AnswerDExp::A defense mechanism by which one avoids a certain difficult reality by denying it ever happened. Not characteristic of borderline personality disorder.
Answer E AnswerE::Splitting
Answer E Explanation AnswerEExp::Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people and situations as completely black or white due to intolerance towards incertitude.
Right Answer RightAnswer::C
Explanation [[Explanation::Borderline personality disorder is characterized by a pattern of excessive instability of interpersonal relationships and self-image. Patients are usually impulsive, have a pattern of intense unstable relationships, and recurrent suicidal behavior or threats. Patients can also exhibit mood instability, self-mutilation, and chronic feelings of emptiness. A classical defense mechanism associated with borderline personality disorder is splitting. Splitting is described as intolerance to ambiguity with a belief that people are either completely good or bad at a given time. Patients have alternating extremes of idealization and devaluation towards certain individuals.

Ex: All waiters are nice and kind, while waitresses are mean and insensitive.

Educational objective: Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people as either completely bad or good with no room for ambiguity.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Schizoid personality disorder, WBRKeyword::Avoidant personality disorder
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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