Chapter 12: Personality Disorders. 1. Be able to explain the key features of each personality disorder, the issues in

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1 Chapter 12: Personality Disorders LEARNING GOALS 1. Be able to explain the key features of each personality disorder, the issues in classifying these disorders, and alternative dimensional approaches to diagnosis. 2. Be able to describe the genetic, neurobiological, social environmental and other risk factors for personality disorders, and be able to discuss problems with the research on etiology. 3. Be able to describe the available medication and psychological treatments of personality disorders. Summary Coded on Axis II in DSM-IV-TR, personality disorders are defined as enduring patterns of behavior and inner experience that disrupt functioning. Personality disorders are grouped into three clusters in DSM-IV-TR: odd/eccentric, dramatic/erratic, and anxious/fearful. Personality disorders are usually comorbid with such Axis I disorders as depression and anxiety disorders and tend to predict poorer outcomes for these disorders. The high comorbidity of personality disorders with each other, the difficulties in reliably determining when a person meets diagnostic criteria, and the fact that personality disorders are seen as the extremes of continuously distributed personality traits, have led to proposals to develop a dimensional rather than a categorical means of classifying these disorders. The Odd/Eccentric Cluster

2 Specific diagnoses in the odd/eccentric cluster include paranoid, schizoid, and schizotypal. The major symptoms of paranoid personality disorder is suspiciousness and mistrust; of schizoid personality disorder, interpersonal detachment; and of schizotypal personality disorder, unusual thought and behavior. Behavior-genetic research supports the idea that schizotypal personality disorder is related to schizophrenia. The Dramatic/Erratic Cluster The dramatic/erratic cluster includes borderline, histrionic, narcissistic, and antisocial personality disorders. The major symptom of borderline personality disorder is unstable, highly changeable emotion and behavior; of histrionic personality disorder, exaggerated emotional displays; and of narcissistic personality disorder, highly inflated selfesteem. Antisocial personality disorder and psychopathy overlap a great deal but are not equivalent. The diagnosis of antisocial personality focuses on behavior, whereas that of psychopathy emphasizes emotional deficits. There is evidence that much of the vulnerability to borderline personality disorder is inherited, and there are also (somewhat inconsistent) findings regarding deficits in frontal lobe functioning and regarding greater amygdala activation. Psychosocial theories of the etiology of borderline, histrionic, and narcissistic disorders focus on early parent-child relationships. It is clear that people with borderline personality disorder report extremely high rates of child abuse and parental separation compared to the general population.

3 The object-relations theorist Kernberg and the self-psychologist Kohut have detailed proposals concerning borderline and narcissistic personality disorders, focusing on the child developing an insecure ego because of inconsistent love and attention from the parents. Linehan s cognitive behavioral theory of borderline personality disorder proposes an interaction between a deficit in emotional regulation and an invalidating family environment. A predisposition to antisocial personality disorder and psychopathy is inherited. Psychopaths tend to have fathers who were antisocial and a childhood that lacked discipline. The core problem of the psychopath, however, might be that impending punishment creates no inhibitions about committing antisocial acts. A lack of empathy might also be a factor in the psychopath s callous treatment of others. The Anxious/Fearful Cluster Disorders The anxious/fearful cluster includes avoidant, dependent, and obsessivecompulsive personality disorders. The major symptom of avoidant personality disorder is fear of rejection or criticism; of dependent personality disorder, low self-confidence; and of obsessive-compulsive personality disorder, a perfectionistic, detail-oriented style. Theories of etiology for the anxious/fearful cluster focus on early experience. Avoidant personality disorder might result from the transmission of fear from parent to child via modeling. Dependent personality might be caused by disruptions of the parent-child relationship (e.g., through separation or loss) that

4 lead the person to fear losing other relationships in adulthood. It is important to note that dependency as a personality trait is at least partially inherited. Treatments Although psychodynamic, behavioral,cognitive, and pharmacological treatments all are used for personality disorders, less research has been conducted for these disorders compared to Axis I disorders. Several medications appear to be helpful for quelling specific symptoms. Early research on day treatment programs is promising. Some promising evidence is emerging for the utility of dialectical behavior therapy for borderline personality disorder. This approach combines clientcentered acceptance with a cognitive behavioral focus on making specific changes in thought, emotion, and behavior. Recent research suggests that even psychopathy, often considered virtually untreatable, might respond to intensive psychological treatment. 1. Personality disorders are defined as a. maladaptive behaviors that consistently violate the rights of others. b. inflexible patterns of behavior which impair social and occupational functioning. c. any psychological disorder having an onset before age 12 and recurring at least three times during adult life. d. a chronic pattern of extreme instability in relationships, mood, and self-image. Answer: B Type: Factual Page: Compared to normal personality styles, personality disorders are more a. bizarre and out of control. b. dangerous and immoral. c. inborn and physiological. d. pervasive and inflexible.

5 Answer: D Type: Factual Page: How are personality disorders different from normal personality styles? a. They are more long-lasting. b. They have more of an effect on others. c. They are more extreme. d. They are accompanied by Axis I disorders. Answer: C Type: Factual Page: People diagnosed with a personality disorder a. cannot be diagnosed with an Axis I disorder. b. are rarely diagnosed with an Axis I disorder. c. are frequently diagnosed with an Axis I disorder.. d. must also be diagnosed with an Axis I disorder as well. Answer: C Type: Factual Page: Personality disorders and Axis I disorders are related in that a. they cannot both be diagnosed in the same person. b. if both exist, the Axis I disorder is more serious. c. if both exist, the personality disorder is more serious. d. the personality disorder provides a context for the Axis I disorder. Answer: D Type: Factual Page: The reliability of diagnosing personality disorders has improved by a. strengthening the theoretical basis for each personality disorder. b. showing an interrelationship with Axis I disorders. c. developing clear diagnostic criteria. d. paying closer attention to their possible presence. Answer: C Type: Factual Page: Recent research on diagnosing personality disorders indicates that their reliability is a. totally inadequate. b. improved if specialized, structured interviews are used. c. acceptable for antisocial personality disorder, but inadequate for most others. d. better than most diagnostic categories. Answer: B Type: Factual Page: 388

6 8. Low reliability for a personality disorder suggests a. people with the disorder did not, in fact, have problems functioning normally in daily life. b. clinicians diagnosing patients had difficulty agreeing on whether a patient had the disorder or not. c. people with the disorder at one point in time had recovered by the follow-up assessment. d. people with the disorder often had other personality disorders as well. Answer: B Type: Factual Page: Most people who have been diagnosed as having a personality disorder a. would be better described using one of the Axis I disorders. b. have a pervasive developmental disorder as well. c. have more than one personality disorder. d. have only one personality disorder. Answer: C Type: Factual Page: Compared to normal people, the personalities of people with personality disorders are a. remarkably similar. b. out of touch with reality. c. categorically different but not out of touch with reality. d. more extreme. Answer: D Type: Factual Page: Some people propose replacing DSM's personality disorder labels with a dimensional classification approach because the present labels a. are difficult to distinguish from each other. b. appear to be extremes of continuous traits. c. have few implications for daily functioning. d. are difficult to treat. Answer: B Type: Factual Page: The dimensional approach to personality disorders a. places people into distinct categories of personality style. b. explains personality disorders as extremes of normal personality traits. c. views personality disorders as learned evolutionary behaviors.

7 d. identifies personality disorders according to four key dimensions. Answer: B Type: Factual Page: Which of the following is not one of the factors used in the dimensional approach to personality disorders? a. Agreeableness b. Openness to experience c. Extroversion d. Depressiveness Answer: D Type: Factual Page: The five-factor model of personality disorders is more than DSM. a. comprehensive b. treatment -oriented c. dimensional d. behavioral Answer: C Type: Factual Page: Studies suggest that most personality disorders are characterized by a. depressive symptoms. b. high neuroticism. c. low neuroticism. d. high extraversion. Answer: B Type: Factual Page: The dimensional approach to personality disorders a. clearly distinguishes normal from disordered personality. b. has been shown to be a comprehensive theory for identifying the personalities of the DSM. c. eliminates the problem of comorbidity among personality disorders. d. None of the above choices are correct. Answer: C Type: Factual Page: Problems with accurately diagnosing personality disorders are due to a. personality changes over time. b. spontaneous recovery.

8 c. a lack of research on personality disorders. d. All of the above choices are correct. Answer: C Type: Factual Page: Which of the following personality disorders falls in the odd/eccentric cluster? a. paranoid b. borderline c. avoidant d. histrionic Answer: A Type: Factual Page: Tom is highly suspicious and believes that others are looking to exploit him. Which of the following personality disorders is the best diagnosis for Tom? a. paranoid b. borderline c. schizoid d. schizotypal Answer: A Type: Applied Page: Compared to a person with paranoid schizophrenia, a person diagnosed as having paranoid personality disorder is a. less likely to experience social and occupational dysfunction. b. more disturbed. c. suffering from a more chronic and severe mental illness. d. more likely to respond to medication. Answer: A Type: Factual Page: Paranoid personality disorder differs from paranoid schizophrenia in that a. paranoid personality is not associated with unreasonable paranoia. b. paranoid personality is more greatly associated with different delusions than schizophrenia. c. paranoid personality is not associated with hallucinations. d. paranoid personality is not likely to be present with depression. Answer: C Type: Factual Page: 391

9 22. Which personality disorder is most appropriate for Joe? He lives alone in a cabin in the woods where he does the minimum to get by. When approached, he responds appropriately but is not interested in conversation or making friends. a. avoidant b. schizoid c. histrionic d. borderline Answer: B Type: Applied Page: Schizoid personality disorder has most in common with a. histrionic personality disorder. b. schizotypal personality disorder. c. dissociative identity disorder. d. bipolar I disorder. Answer: B Type: Factual Page: One of the problems with the diagnosis of schizotypal personality disorder is a. lack of reliability in making the diagnosis. b. difficulty distinguishing it from schizophrenia. c. it is so rare that it is not clear whether the disorder should be listed. d. overlap with other personality disorder diagnoses. Answer: D Type: Applied Page: Schizoid and schizotypal personality disorders may be distinguished only by the presence of which of the following symptoms in schizotypal persons? a. indifference to others. b. visual hallucinations. c. flat affect, little overt emotion. d. overtly odd behaviors. Answer: D Type: Factual Page: Schizotypal, but not schizoid, personality disorder involves a. odd, eccentric beliefs and behaviors. b. interpersonal problems, few friends. c. flat affect, emotional indifference d. social anxiety, fear of others.

10 Answer: A Type: Factual Page: The personality disorders in the odd/eccentric cluster have been genetically linked to a. bipolar disorder. b. major depression. c. schizophrenia. d. dissociative identity disorder. Answer: C Type: Factual Page: The paradigm has been used the most in describing the odd/eccentric personality disorders. a. biological/genetic b. psychoanalytic c. cognitive-behavioral d. labeling theory Answer: A Type: Applied Page: Family studies a. support the role of genetics in the odd/eccentric cluster. b. show a very limited role of genetics in the odd/eccentric cluster. c. have been inconclusive when examining the relationship between schizophrenia and the odd/eccentric cluster. d. have shown there to be a stronger genetic component to schizoid and schizotypal personality disorder than paranoid personality disorder. Answer: A Type: Factual Page: Yolanda vacillates between feeling extremely positive feelings for her friend, to having extreme negative feelings for her, often for no apparent reason. When these changes in her disposition occur, she also experiences deep depression and sometimes engages in self-injurious behavior. On the basis of this information, Yolanda most likely has personality disorder. a. borderline b. schizoid c. obsessive-compulsive d. paranoid Answer: A Type: Applied Page: 394

11 31. Ken may act sad one minute and happy the next. He seems to have no idea what he wants out of life. He says he cannot stand being alone, yet he gets into violent fights with his friends over minor matters. When his marriage broke up due to his drastic mood shifts and impulsive gambling, Ken attempted suicide. Which of the following diagnoses best fits Ken's symptoms? a. bipolar I disorder b. dissociative identity disorder c. schizotypal personality disorder d. borderline personality disorder Answer: D Type: Applied Page: People with borderline personality disorder are often a. unstable and impulsive. b. uninhibited and promiscuous. c. demanding and angry. d. shy and withdrawn. Answer: A Type: Factual Page: A person with which of the following diagnoses is most likely to also have posttraumatic stress disorder or a mood disorder? a. borderline personality b. obsessive-compulsive personality c. paranoid personality d. avoidant personality Answer: A Type: Factual Page: Which neurotransmitter system has been implicated in anger control and has been used for borderline personality? a. norepinephrine b. serotonin c. GABA d. dopamine Answer: B Type: Factual Page: Given that people with borderline personality disorder are impulsive, we would expect them to do poorly on tests that measure functioning of the a. frontal lobe.

12 b. parietal lobe. c. occipital lobe. d. temporal lobe. Answer: A Type: Factual Page: Which of the following characterizes borderline personality disorder? a. emotional dysregulation b. low extraversion c. bland, dull affect d. panic attacks Answer: A Type: Factual Page: A major feature of object relations theory is a. the manner of self-representation. b. ego-functioning. c. id control. d. introjection of values during childhood. Answer: D Type: Factual Page: In object relations theory, 'splitting' refers to the tendency of people with borderline personality disorders to a. separate themselves from society. b. forget unpleasant events. c. see people as all good or all bad. d. think illogically. Answer: C Type: Factual Page: The research literature that supports the link between borderline personality disorder and troubled childhood has found that a. most studies were conducted only on women. b. patients with BPD are more likely to report a history of parental separation and abuse than other Axis II patients are. c. family conflict is difficult to measure accurately. d. most studies were conducted on families that had concurrent alcohol abuse present in the home. Answer: B Type: Factual Page: 395

13 40. Two primary features of Linehan's diathesis-stress theory of borderline personality disorder are a. ego functioning and transference. b. object representation and cognitive style. c. cognitive bias and attribution error. d. dysregulation and invalidation. Answer: D Type: Factual Page: Which of the following personality disorders is the best diagnosis for Claude? Claude goes to great lengths to be the center of attention. He announces his views and feelings with great drama; however one soon suspects it is only for effect, and he seems willing to say or do almost anything to get others to pay attention to and like him. a. histrionic b. schizotypal c. schizoid d. paranoid Answer: A Type: Applied Page: A primary characteristic of histrionic personality disorder is a. avoidance of others. b. multiple, vague physical complaints. c. inability to make realistic life plans. d. overly dramatic and attention seeking behavior. Answer: D Type: Factual Page: The psychoanalytic theory of histrionic personality disorder focuses on a preoccupation with a. childhood health problems. b. sex. c. cleanliness. d. oneself. Answer: B Type: Applied Page: Veronica imagines that she will one day have great success in business, although she now is working as a waitress. She has difficulty getting along at work because she envies her boss' position of authority (feeling she is more intelligent than him) and expects special favors such as not having to clean the stove like the other waitresses. Which of the following personality disorders best fits Veronica?

14 a. narcissistic b. borderline c. histrionic d. avoidant Answer: A Type: Applied Page: Narcissistic personality is primarily characterized by a. avoidance of others. b. a lack of self-confidence. c. multiple, vague physical complaints. d. self-centeredness with fantasies of success. Answer: D Type: Factual Page: Narcissism, as proposed by Kohut, develops when children are a. abused. b. treated by their parents as if they are special, one-of-a-kind people. c. not getting enough approval from their parents. d. only children or first children. Answer: C Type: Applied Page: Theories of the etiology of narcissistic personality disorder suggest such people actually have a. distorted perceptions. b. no conscience. c. weak egos. d. low self-esteem. Answer: D Type: Factual Page: According to the social cognitive model of narcissistic personality disorder, people with this disorder place a high value on interpersonal interactions because a. they yearn for interpersonal closeness and warmth. b. interpersonal interactions are central for reinforcing their self-esteem. c. they have such high self-esteems. d. they are very concerned about the quality of their friendships. Answer: B Type: Factual Page: 397

15 49. According to the social cognitive model of narcissistic personality disorder, individuals with this disorder a. have vulnerable self-esteems. b. have extremely high self-esteems. c. are socially aloof. d. are afraid to brag or bolster themselves. Answer: A Type: Factual Page: A precursor to antisocial personality disorder is a. conduct disorder. b. oppositional disorder. c. antisocial disorder of childhood or adolescence. d. pervasive developmental disorder. Answer: A Type: Factual Page: According to the DSM-IV diagnosis, adults with antisocial personality disorder must have shown problems such as running away, truancy, and theft prior to age a. 12. b. 15. c. 18. d. 7. Answer: B Type: Factual Page: Convicted felons are most likely to have which of the following disorders? a. borderline personality disorder b. sadistic personality disorder c. psychopathy d. antisocial personality disorder Answer: D Type: Applied Page: A problem with diagnosing antisocial personality is a. many antisocial personality individuals do not exhibit anti-social behavior as children. b. the diagnosis is associated with schizophrenia. c. the validity of the diagnosis varies widely across cultures. d. not all antisocial personality individuals score high on measures that are intended to measure antisocial behavior.

16 Answer: D Type: Factual Page: Which of the following is a characteristic of psychopathy but NOT of antisocial personality disorder? a. law breaking b. disregard for others c. lack of emotions d. impulsivity Answer: C Type: Factual Page: Behavior-genetics research on antisocial personality disorder a. indicates a significant role of heritability. b. has shown the role of heritability to be negligible. c. indicates no environmental effects. d. has been inconclusive. Answer: A Type: Factual Page: A major family variable that contributes to later psychopathy in children is a. high number of siblings. b. working mothers. c. inconsistent discipline. d. overprotection. Answer: C Type: Applied Page: It has been found that in avoidance learning tasks, the reason psychopaths had difficulty learning to avoid shock was because a. they were unaware that it was a possibility. b. they experience very little anxiety. c. they have a learning disability. d. the experience of the shock was a positive sensation. Answer: B Type: Applied Page: Compared to individuals who are not psychopaths the skin conductance of psychopaths is when they are confronted with an intense or aversive stimulus. a. less reactive b. more reactive

17 c. equally reactive d. more reactive only in those who are criminals Answer: A Type: Applied Page: In research on psychopathy, the startle response is used to measure a. empathy. b. fear. c. attention. d. impulsivity. Answer: B Type: Factual Page: Lykken's (1957) research provided support for the hypothesis that psychopaths experience than controls. a. more anxiety b. less anxiety c. more depression d. less depression Answer: B Type: Applied Page: Studies examining the eye-blink component of the startle response have consistently found psychopaths to be reactive as normal controls when presented with negative stimuli. a. as b. more c. less d. None of the above; findings have been inconsistent. Answer: C Type: Factual Page: When comparing the startle response of psychopaths and nonpsychopaths (both groups were jail inmates), researchers found that psychopaths a. were more easily startled due to hyperarousal. b. were less responsive to the aversive stimuli. c. were more likely to try to frighten their victims. d. did not demonstrate any startle response. Answer: B Type: Applied Page:

18 63. In contrast to research on reduced anxiety and inhibition, recent research on psychopathy has focused upon a. empathy among psychopaths. b. the psychopaths' ability to learn under different conditions. c. distress among psychopaths. d. suicidal ideas among psychopaths. Answer: A Type: Factual Page: The effect of punishment on psychopaths a. is greater, although in the long term they tend to forget the consequences. b. is minimal. c. is associated with lower efforts to commit antisocial acts. d. usually results in greater psychopathic behavior. Answer: B Type: Applied Page: In experimental tasks, if there is a delay between the information presented and an opportunity to respond, psychopaths a. perform poorly. b. showed less impulsivity and improved performance. c. demonstrate frustration and anger. d. usually give up. Answer: B Type: Applied Page: In research on response modulation and psychopathy, psychopaths won or lost money depending on what playing cards appeared. In this research, the impulsivity of psychopaths was studied by a. making them wait before deciding to continue the game. b. having them estimate the amount of money they had won. c. ratings of their verbal statements during the game. d. All of the above are correct. Answer: A Type: Applied Page: In one research study, psychopaths' impulsivity was examined using a card guessing task. Impulsivity was shown by participants responses to having to wait before a. the experiment began. b. the next trial. c. receiving feedback.

19 d. making a guess. Answer: B Type: Factual Page: What diagnosis would be most appropriate for Tonya? She says she would like to meet people but is too afraid of saying something foolish to speak to them. She describes herself as the ultimate social klutz because she never knows what to say or do. As a result, she keeps to herself except for interacting with a few friends she has known since childhood. a. schizoid personality disorder b. schizotypal personality disorder c. avoidant personality disorder d. dependent personality disorder Answer: C Type: Applied Page: Social phobia is most similar to which personality disorder? a. schizoid b. dependent c. antisocial d. avoidant Answer: D Type: Factual Page: Karl relies on his wife to make every decision, from what kind of suits he should buy to which people at work he should get to know better. He feels that he must rely heavily on his wife because he feels he is not competent to carry out these tasks. Which of the following personality disorders would fit Karl? a. schizoid b. avoidant c. dependent d. borderline Answer: C Type: Applied Page: Peter not only works 70 hours a week, but he spends his off hours planning a schedule for his family. He dictates what time his wife will be home, when dinner will be served, and when they will go to bed. He is such a perfectionist that he actually finds it difficult to get work done efficiently, despite the amount of time he spends trying. Which of the following personality disorders best fits Peter? a. dependent b. narcissistic

20 c. schizoid d. obsessive-compulsive Answer: D Type: Applied Page: Which of the following is characteristic of obsessive-compulsive personality disorder? a. The person is filled with fears that things were not done right. b. The person is bothered by recurring, uncontrollable thoughts. c. The person engages in elaborate, senseless rituals. d. The person is preoccupied with details, rules, and schedules. Answer: D Type: Factual Page: Obsessive-compulsive personality disorder and obsessive-compulsive disorder a. are the terms from DSM-II and DSM-IV for the same basic disorder. b. are genetically linked. c. are actually quite different from one another. d. have similar symptoms but a different etiology. Answer: C Type: Factual Page: Dependent personality disorder has been hypothesized to develop when children a. are sexually abused. b. have parents who have anxiety disorders. c. are made to care for elderly or sick parents at a young age. d. have attachment problems. Answer: D Type: Factual Page: Dependent personality disorder has been hypothesized to develop from parental a. anxiety. b. modeling. c. overprotectiveness. d. abuse. Answer: C Type: Factual Page: Attachment problems in childhood have been suggested as a cause of personality disorder. a. avoidant

21 b. dependent c. obsessive-compulsive d. paranoid Answer: B Type: Factual Page: Which model has been hypothesized to explain avoidant personality disorder? a. cognitive distortions b. modeling c. cognitive dissonance d. oral fixation Answer: B Type: Factual Page: Contemporary psychodynamic theory suggests that obsessive-compulsive personality is a result of a. oral fixation. b. dysfunctional object relations. c. fear of loss of control. d. anal fixation. Answer: C Type: Applied Page: Johanna seeks psychotherapy and has been diagnosed with (Axis I) generalized anxiety disorder and (Axis II) dependent personality disorder. It is reasonable to expect that a. therapy will focus primarily on the personality disorder. b. therapy will take longer, and Johanna will most likely not improve as much as someone with only an Axis I disorder. c. choosing one of the problems and focusing on it will improve both of them. d. biological factors will require drug treatment. Answer: B Type: Applied Page: Which therapy approach seeks to break down personality disorders into sets of separate, concrete problems? a. cognitive-behavioral b. cognitive c. psychodynamic d. interpersonal Answer: A Type: Factual Page: 407

22 81. Avoidant personality disorder would most likely be treated with which type of psychiatric medication? a. anti-anxiety medications b. antidepressants c. neuroleptics d. None of the above choices are correct; medication has not been found effective in treating personality disorders. Answer: A Type: Applied Page: Why might a nondirective approach be most effective with a patient with dependent personality disorder? a. Such patients are difficult to build rapport with, and a nondirective approach works better for that purpose. b. It would reduce the countertransference reaction of the therapist. c. Such patients usually resist active directions from the therapist. d. It would encourage the patient to think independently and take responsibility for decisions. Answer: D Type: Applied Page: Individuals with Borderline Personality Disorder are difficult to treat because a. their intellectual functioning is too low for them to reach true insights. b. they do not feel distressed, despite being so distressing to others. c. they have extreme difficulties trusting others, including a therapist. d. All of the above choices are correct. Answer: C Type: Applied Page: Individuals with borderline personality disorder are especially difficult because they a. require intensive, long-term psychodynamic therapy. b. rarely seek or accept therapy. c. never learn from their experiences. d. act erratically toward the therapist. Answer: D Type: Factual Page: Often, borderline personality disorder naturally engenders which of the following emotional reactions by the therapist? a. empathy

23 b. anger and frustration c. pride d. suicidal feelings Answer: B Type: Applied Page: Drug treatment for borderline personality disorder a. has been shown to be ineffective for treating the symptoms of the disorder. b. must be conducted with weekly consultations from a neurologist. c. must be done with care as people with the disorder often abuse drugs. d. has been researched too little to make any general statements. Answer: C Type: Factual Page: One goal of Kernberg's object relations psychotherapy for borderline personalities is to overcome the patient's defense of a. seeing others as all powerful and all good. b. splitting the world into black and white terms. c. marginalizing their involvement with others. d. denying impulses toward self-actualization. Answer: B Type: Applied Page: The primary outcome (or goal) in Kernberg's therapy for Borderline Personality Disorder is a. achieving insight by probing childhood conflicts. b. helping clients learn to solve problems more effectively. c. strengthening their weak ego so the client will stop splitting. d. correcting dysfunctional ways of thinking. Answer: C Type: Applied Page: A primary focus of object-relations therapy for borderline personality disorders is to a. strengthen patient's ability to tolerate intensive psychoanalysis. b. improve patients support network by teaching social skills. c. minimize patient's tendency to see others in black-or-white terms. d. provide direct advice to minimize potential legal problems. Answer: C Type: Factual Page: Dialectical behavior therapy for patients with borderline personality disorder combines

24 a. social skills training and free-association. b. ego analysis and more directive behavioral techniques. c. cognitive-behavioral problem-solving, social skills training and client-centered empathy. d. Gestalt techniques and relaxation training. Answer: C Type: Applied Page: One of the primary goals in Dialectical Behavior Therapy for Borderline Personality Disorder is a. achieving effective ego-boundaries. b. learning contingencies associated with reward and punishment. c. effective modulations of extreme emotional states. d. avoidance of distress. Answer: C Type: Applied Page: Which of the following is emphasized in Linehan's Dialectical Behavior Therapy for borderline personality disorder? a. systematic assessment before therapy begins b. calm acceptance of contradictions and acting out c. focusing on fears of vulnerability in a dangerous, unpredictable world d. setting appropriate limits clearly from the beginning Answer: B Type: Applied Page: Studies comparing Linehan s dialectical behavior therapy and treatment as usual for people with borderline personality disorder have found a. superiority of dialectical behavior therapy across all targeted areas. b. superiority of dialectical behavior therapy in decreasing intentional self-injurious behavior and suicide attempts. c. superiority of dialectical behavior therapy in decreasing feelings of hopelessness. d. None of the above; no differences were found. Answer: B Type: Factual Page: In working with patients with borderline personality disorder, Linehan advocates acceptance a. as a way of helping patients see the world in more black and white terms. b. as a primary means of preventing suicide attempts. c. as a way to help patients gradually change.

25 d. regardless of whether or not the patient changes. Answer: C Type: Factual Page: 410: Focus on Discovery 95. In working with borderline personalities, Beck, Kernberg, and Linehan all agree that these patients a. need to develop and work through transference and counter transference reactions for therapy to be successful. b. have great difficulty establishing trust in their therapist. c. need paradoxical interventions because of their oppositional style. d. have problems based on dysfunctional cognitions. Answer: B Type: Applied Page: According to a recent meta-analysis, psychological treatment of psychopaths can be successful if a. conducted in a controlled setting. b. the patient is older. c. family members are involved. d. it is intensive and long-term. Answer: D Type: Factual Page: Psychotherapy for psychopaths a. must be intensive to be effective. b. is more beneficial for younger psychopaths than older psychopaths. c. must be examined for faking good by those treated. d. All of the above choices are correct. Answer: C Type: Factual Page: 411 Essay Questions: 1. Discuss the rationale for including personality disorders in the DSM-IV. 2. Describe the advantages and disadvantages of a dimensional approach to assessing personality disorders. What problems does it solve? What problems does it create? 3. How are the clusters of personality disorders distinguished? 4. Describe therapy for borderline personality disorder according to cognitive behavioral therapy and object relations therapy. 5. Contrast the theories of Kernberg and Linehan with respect to the etiology of borderline personality disorder. How are their different ideas reflected in the way they would provide psychotherapy for a person with borderline personality disorder?

26 6. Discuss the difference between individuals with antisocial personality from nonantisocials with regard to their reaction to emotional material.

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