As part of the stress response, the HPA axis is stimulated. Which structures make up this system?

Choice A reason: Self-directed violence is a risk in dissociative identity disorder but is a consequence, not the cause, of identity disruption. Trauma-induced changes in amygdala-hippocampal connectivity drive dissociation, not violence, which arises from emotional dysregulation secondary to fragmented identity states.

Choice B reason: Chronic low self-esteem may co-occur in dissociative identity disorder but is not the primary cause. Identity disruption stems from trauma-induced neural changes, particularly in the amygdala and prefrontal cortex, leading to fragmented self-states, not primarily from self-esteem deficits.

Choice C reason: Childhood trauma and abuse are the primary causes of dissociative identity disorder, disrupting neural integration in the prefrontal cortex and hippocampus via chronic cortisol elevation. This fragments identity formation, creating distinct personality states as a coping mechanism for overwhelming stress.

Choice D reason: Poor impulse control is a symptom in some dissociative identity disorder cases but not the cause. Identity disruption results from trauma-induced amygdala hyperactivity and hippocampal dysfunction, leading to dissociated states, not primarily from impulsivity, which is a secondary behavioral outcome.

Choice A reason: Auditory hallucinations are positive symptoms of schizophrenia, driven by mesolimbic dopamine excess, causing sensory perceptions without stimuli. They reflect hyperactive neural signaling, not the diminished motivation or functioning characteristic of negative symptoms, making this incorrect.

Choice B reason: Threatening behavior is a positive symptom, reflecting dopamine-driven impulsivity and agitation in schizophrenia’s mesolimbic pathway. Negative symptoms involve deficits like apathy, not active behaviors, making this choice unrelated to negative symptom criteria.

Choice C reason: Delusions of grandeur are positive symptoms, stemming from excessive dopamine in the mesolimbic system, causing exaggerated beliefs. Negative symptoms involve reduced emotional or behavioral expression, not active psychotic beliefs, making this choice incorrect.

Choice D reason: Poor personal hygiene is a negative symptom of schizophrenia, reflecting reduced motivation and self-care due to prefrontal cortex dopamine hypofunction. This deficit in volition and functioning aligns with negative symptoms, distinguishing it from positive symptoms like hallucinations.