Rosh Psychiatry Board Practice Exam

In a patient with suspected borderline personality disorder, which behavior is often exhibited?

1. Stable long-term relationships

2. Intense fear of abandonment

3. Consistent mood regulation

4. Avoidance of social interactions

The correct answer is: Intense fear of abandonment

In individuals with borderline personality disorder (BPD), one of the hallmark features is an intense fear of abandonment. This fear can lead to significant distress and can drive many of the behaviors associated with the disorder. Patients may react with extreme emotional responses to perceived or actual separation or rejection, which often manifests in their relationships. This intense fear can result in frantic efforts to avoid real or imagined abandonment, leading to unstable and tumultuous relationships, where individuals may oscillate between idealizing and devaluing others. Emotionally, this fear can contribute to impulsivity, self-harm behaviors, and other crises that reflect underlying anxiety and distress regarding attachment and security. The context of the other choices highlights that stable long-term relationships and consistent mood regulation are generally not characteristics of individuals with BPD. Additionally, while some individuals may exhibit avoidance of social interactions due to sensitivity to interpersonal dynamics, it is the fear of abandonment that fundamentally drives the unstable relational patterns typical of the disorder.