Personality disorders: Pathology review

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Personality disorders: Pathology review

Psychological disorders

Psychological disorders

Psychological disorders


Personality disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 29-year-old woman comes to the office for a routine check-up at the prompting of her parent. The patient’s parent reports that the patient has endured emotional abuse by her partner. The patient refuses to end the relationship with her partner and feels uneasy when the partner is not around. She adds, “I'm worried that if I leave the relationship, my life will only get worse.” She has not been employed since she started dating and living with her partner, and she is convinced that nobody would hire her. A review of her medical record indicates that she has endured several episodes of verbal abuse from prior relationships, which she suggested “were all her fault.” She has had four prior serious relationships and reports that she has not been single for more than a few weeks in the last 10 years. The patient’s parent states that they manage most of her finances and that the patient is “unable to handle it on her own.” She does not have any friends outside of her romantic relationship. Vitals are within normal limits. Physical examination is unremarkable. Which of the following best describes the underlying cause of this patient’s behavior?  


28 year old Anna is brought to the emergency department by her roommate, who found her in the bathroom about to cut her wrists. Anna tells you that her boyfriend of two weeks broke up with her today. When asked how she feels, she just utters “empty”.

She also discloses that she’s been in several intimate relationships that are always amazing in the beginning, but they all end up being disappointing. Upon physical examination, you notice that Anna has multiple scars over her forearms and wrists.

Next, 35 year old Luis presents to the clinic with his girlfriend, who thinks that he is too shy and he would benefit from getting professional help.

Luis mentions that since childhood, he’s always been the “silent” one. He has very few friends, and he avoids hanging out with new people, since he is afraid they will not like him.

Finally, you see Bella, a 41 year old woman, who comes to the emergency department because she thinks she’s been poisoned by her fiancé. She is certain that he’s been planning to kill her before they get married.

When you ask her why she suspects this or if she has any proof, Bella says that her fiancé has frequently offered to prepare her meals.

She also mentions that she’s afraid she’ll lose her job, because her coworkers have been trying to sabotage her. In addition, Bella doesn’t talk to any of her relatives, because four years ago they forgot her birthday.

Okay, based on the initial presentation, Anna, Luis, and Bella all seem to have a personality disorder.

Now, each of us has a set of personal traits, which are repetitive patterns involving the way we think, feel, act or behave, and perceive ourselves and what surrounds us.

This combined is what makes up a person’s personality. Despite that, we should normally be able to cope with daily circumstances and adapt our personality accordingly.

Now, sometimes these personal traits can interfere with someone’s day-to-day functioning in their personal life, at work, or in social settings. If this were the case, we would say that the individual has a personality disorder.

Generally, personality disorders are characterized by personality traits that can be rigidly pervasive, meaning that they are stable and of long duration, inflexible, meaning that individuals act in a certain way in most situations, and maladaptive, meaning that they have a hard time adjusting to new or different circumstances.

However, what’s high yield is that these traits remain ego-syntonic, meaning that they stay consistent with the individuals’ values, beliefs, and self-image, also known as ego.

And sometimes, this keeps individuals affected by a personality disorder from viewing their behaviors as problematic.


  1. "Histology: A Text and Atlas, International Edition" Wolters Kluwer Law & Business (2019)
  2. "Wheater's Functional Histology" Churchill Livingstone (2013)
  3. "Junqueira's Basic Histology: Text and Atlas, Fourteenth Edition" McGraw-Hill Education / Medical (2015)
  4. "Robbins Basic Pathology" Elsevier (2017)
  5. "Diagnostic Immunohistochemistry" Elsevier (2021)
  6. "Cytology" Saunders (2014)

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