Rosh Psychiatry Board Practice Exam

Which behavior may signal borderline personality disorder in a patient?

1. Intense and unstable relationships

2. Excessive growth around social gatherings

3. Detached and aloof demeanor

4. Chronic feelings of emptiness

The correct answer is: Intense and unstable relationships

Intense and unstable relationships are a hallmark feature of borderline personality disorder (BPD). Individuals with this disorder often experience extreme fluctuations in their interpersonal relationships, swinging from idealization to devaluation in their perception of others. This instability in relationships can stem from an intense fear of abandonment and an inability to maintain a stable sense of self or emotional state. Patients may form very close attachments quickly, leading to high levels of emotional intensity, but these relationships can abruptly shift due to perceived slights or changes in the dynamics. For example, a person may idolize a friend or partner one moment and then feel abandoned or betrayed the next, resulting in conflict, emotional outbursts, or withdrawal. The other choices represent different behaviors or symptoms that may not align as closely with the diagnostic criteria for BPD. Excessive growth around social gatherings does not necessarily indicate BPD but may suggest other social or anxiety disorders. A detached and aloof demeanor can be found in various other conditions like autism spectrum disorders or avoidant personality disorder rather than BPD specifically. Chronic feelings of emptiness can be associated with BPD, but they do not define the relational instability that is critical for the diagnosis. Therefore, intense and unstable relationships effectively encapsulate a key symptom of borderline