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Chapter 12 Practice Exam Questions

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University of Toronto Scarborough
Konstantine Zakzanis

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 onAxis 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 suchAxis 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  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 self- esteem. 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.  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.  Apredisposition 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.Alack of empathy might also be a factor in the psychopath’s callous treatment of others. TheAnxious/Fearful Cluster Disorders  The anxious/fearful cluster includes avoidant, dependent, and obsessive- compulsive 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 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 toAxis 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 client- centered 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: 387 2. 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. Answer: D Type: Factual Page: 387 3. 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: 387 4. People diagnosed with a personality disorder a. cannot be diagnosed with anAxis I disorder. b. are rarely diagnosed with anAxis 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: 387 5. Personality disorders and Axis I disorders are related in that a. they cannot both be diagnosed in the same person. b. if both exist, theAxis I disorder is more serious. c. if both exist, the personality disorder is more serious. d. the personality disorder provides a context for theAxis I disorder. Answer: D Type: Factual Page: 387 6. The reliability of diagnosing personality disorders has improved by a. strengthening the theoretical basis for each personality disorder. b. showing an interrelationship withAxis I disorders. c. developing clear diagnostic criteria. d. paying closer attention to their possible presence. Answer: C Type: Factual Page: 388 7. 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 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: 388 9. 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: 390 10. 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: 387 11. 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: 390 12. 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. d. identifies personality disorders according to four key dimensions. Answer: B Type: Factual Page: 390 13. 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: 390 14. 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: 390 15. 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: 390 16. 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: 390 17. Problems with accurately diagnosing personality disorders are due to a. personality changes over time. b. spontaneous recovery. c. a lack of research on personality disorders. d. All of the above choices are correct. Answer: C Type: Factual Page: 391 18. Which of the following personality disorders falls in the odd/eccentric cluster? a. paranoid b. borderline c. avoidant d. histrionic Answer:AType: Factual Page: 391 19. 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:AType:Applied Page: 391 20. 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:AType: Factual Page: 391 21. 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 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: 392 23. 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: 392 24. 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: 392 25. 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: 392 26. 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. Answer:AType: Factual Page: 392 27. 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: 393 28. 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:AType:Applied Page: 393 29. 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:AType: Factual Page: 393 30. 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:AType:Applied Page: 394 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: 394 32. People with borderline personality disorder are often a. unstable and impulsive. b. uninhibited and promiscuous. c. demanding and angry. d. shy and withdrawn. Answer:AType: Factual Page: 394 33. Aperson with which of the following diagnoses is most likely to also have post- traumatic stress disorder or a mood disorder? a. borderline personality b. obsessive-compulsive personality c. paranoid personality d. avoidant personality Answer:AType: Factual Page: 395 34. 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: 395 35. 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. b. parietal lobe. c. occipital lobe. d. temporal lobe. Answer:AType: Factual Page: 395 36. Which of the following characterizes borderline personality disorder? a. emotional dysregulation b. low extraversion c. bland, dull affect d. panic attacks Answer:AType: Factual Page: 396 37. 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: 396 38. 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: 396 39. 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 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: 396 41. 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:AType:Applied Page: 396 42. Aprimary characteristic of histrionic personality disorder is a. avoidance of others. b. multiple, vague physical complaint
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