A young woman presents with a history of emotional instability, dependent behavior, impulsive aggression, and unstable interpersonal relationships. Which of the following is the most likely diagnosis?

1. A

   Dependent personality disorder

2. B

   Antisocial personality disorder

3. C

   Histrionic personality disorder

4. D

   Borderline personality disorder

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

• The patient's presentation includes a classic quartet of symptoms for Borderline Personality Disorder (BPD): emotional instability (affective lability), unstable interpersonal relationships, impulsivity (manifesting as aggression), and dependent behaviors (stemming from a fear of abandonment).
• BPD is defined by a pervasive pattern of instability in interpersonal relationships, self-image, and affect, along with marked impulsivity.
• The combination of these specific symptoms makes BPD the most fitting diagnosis compared to other personality disorders which may share one or two features but not the entire constellation.
• According to diagnostic criteria, individuals with BPD often experience intense mood swings, have tumultuous relationships, and struggle with anger control and impulsive actions.

Why Other Options Were Wrong

• Option A: Dependent Personality Disorder is primarily characterized by an excessive need to be taken care of, leading to submissive and clinging behaviors. It does not typically involve the intense anger, impulsive aggression, and affective instability seen in BPD.
• Option B: Antisocial Personality Disorder is characterized by a disregard for and violation of the rights of others, deceitfulness, and a lack of remorse. While impulsivity and aggression can be present, the core features of emotional dysregulation and fear of abandonment are absent.
• Option C: Histrionic Personality Disorder is defined by excessive emotionality and attention-seeking behavior. Individuals with this disorder are uncomfortable when they are not the center of attention and may be overly dramatic.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of Cluster B personality disorders based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
• Nurses caring for patients with BPD must maintain strict professional boundaries to manage the patient's tendency for splitting (idealizing and devaluing staff).
• A consistent, unified care plan among all team members is crucial to prevent manipulation and ensure stable treatment.
• Safety is a primary concern. Nurses must be vigilant in assessing for self-harm behaviors or suicidal ideation, which are common in BPD.

How to Approach the Question

• First, identify the key symptoms described in the patient's history: emotional instability, dependent behavior, impulsive aggression, and unstable relationships.
• Recognize that this combination of symptoms points towards a Cluster B personality disorder, known for dramatic and erratic behaviors.
• Systematically compare the patient's symptom cluster with the core features of each option.
• Note that 'emotional instability' and 'unstable relationships' are central to BPD.
• Eliminate Dependent PD because it lacks the aggression and instability.
• Eliminate Antisocial PD because its core is disregard for others, not emotional turmoil.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of Cluster B personality disorders based on clinical presentation.
• Stem keywords: emotional instability, dependent behavior, impulsive aggression, unstable interpersonal relationships
• Lead-in keywords: most likely diagnosis
• Clinical cues: The combination of instability across multiple domains (emotions, relationships, behavior) is a strong pointer towards Borderline Personality Disorder.

Question ID

QlCrEBhU8TdAPFhVTshtEE

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1789-1791, 1801-1803, 1790-1792