Rosh Psychiatry Board Practice Exam

What best describes a barrier to treatment for a patient with paranoid personality disorder?

1. Aggression

2. Agoraphobia

3. Delusions of persecution

4. Fragile self-concept

The correct answer is: Fragile self-concept

In the context of paranoid personality disorder, a fragile self-concept significantly contributes to barriers to treatment. Individuals with this disorder often exhibit a heightened sensitivity to perceived criticism and an intense fear of being judged or misunderstood. This fragile self-concept can lead to difficulties in engaging with healthcare providers, as patients may interpret therapeutic interactions as threatening or invasive. The reluctance to disclose personal feelings or experiences in therapy can further hinder the establishment of a trusting therapeutic relationship. Patients may view treatment as an adversarial process rather than a supportive one, making it challenging to work towards resolution and healing. Thus, the fragile self-concept directly affects their willingness and ability to seek help and adhere to treatment plans. While other factors such as aggression, agoraphobia, and delusions of persecution may be noted in the context of paranoid personality disorder, they are not as central to the challenges faced in the therapeutic relationship. Aggression may be a symptom, but not necessarily a barrier to treatment in the same way that a fragile self-concept can inhibit openness and trust. Similarly, agoraphobia relates more to anxiety about being in situations where escape might be difficult rather than a direct impediment resulting from the personality disorder. Delusions of persecution can certainly complicate treatment,