Trauma-Related Disorders; Dissociative Disorders; Personality Disorders; Somatoform Disorders

Question 1

What is pseudocyesis?

Answer 1

“A false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy” (DSM-5)

Question 2

Somatization Disorder is defined as beginning before age ___ ?

Answer 2

Age 30

K&S, p. 634

Question 3

What are the 3 most common Conversion Disorder symptoms?

Answer 3

Paralysis, blindness, and mutism

K&S, p. 639

Question 4

What 4 temperaments and 3 character traits are described in the Cloninger Biosocial Model for understanding personality?

Answer 4

4 Temperaments

• Novelty seeking
• Harm avoidance
• Reward dependence
• Persistence

3 Character traits

• Self-directedness
• Cooperativeness
• Self transcendence

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Question 5

Which of the following is incorrect?

a. heritability of PD parallels heritability of normal personality.
b. heritability of PD is in the range of 0-20%.
c. all types of abuse are implicated in the etiology of BPD.
d. improvement in overall functioning of patients with PD is not as robust as improvement in symptoms.

Answer 5

b is incorrect

• heritability parallels normal personality with 20-60% heritability from twin studies.
• All PD’s: 73% abuse; 82% neglect (Battle 2004, Zanarini 1997).

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Question 6

All the following are true except:

a. PD diagnosis are more strongly negatively related to quality of life than any other variable.
b. people with PD typically live alone
c. OCPD, NPD, and HPD have the least functional impairment of all PD’s.
d. PD diagnosis are stable over time.

Answer 6

d is incorrect.

• McLean Study of Adult Development: 74% of BPD remit by year 6.
• Collaborative Longitudinal PD Study: remission rates at 24 months 50-64%
• Improvement is the norm if DSM diagnosis symptoms/signs (not GAF) are the measure.

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Question 7

What are the defenses involved in Cluster A/B/C Personality Disorders?

Answer 7

Cluster A
- Projection, fantasy, denial
Cluster B
- Splitting, dissociation, denial, acting out, projective identification
Cluster C
- Isolation, passive aggression, hypochondriasis, undoing

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Question 8

Successful treatment of PD’s include all except:

a. development of a stable and positive sense of self.
b. modification of expression of personality traits.
c. due to the advent of new, effective psychotherapies, treatment should be brief (weeks to months)
d. establishment of mutually gratifying and enduring relationships.

Answer 8

c is incorrect

• psychotherapy is the treatment of choice for PD based on 2 meta-analysis (Leichsenring, 2003, Perry 1999).
• Evidence for individual psychodynamic therapy and outpt individual CBT.
• Some evidence for inpatient, day hospital, group psychodynamic.

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Question 9

Regarding Schizoid PD which of the following is incorrect?

a. possible biological etiologies include: familial link to schizophrenia, schizotypal PD, and research that shows that introversion is highly heritable.
b. patients with SPD rarely seek treatment despite adequate insight into associated problems and moderate capacity for relationships.
c. symptoms of SPD are similar to negative symptoms of schizophrenia but SPD patients do not display full blown positive symptoms.
d. patients with SPD take pleasure in few, if any, activities and lack close friends and confidants other than first degree relatives.

Answer 9

b is incorrect

• low insight into associated problems
• low capacity for relationships

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Question 10

Which of the following is correct regarding Schizotypal PD?

a. while patients with schizotypal PD have odd thoughts or ideas they do not typically have odd behaviour or appearance.
b. patients with Schizotypal PD do not have close relationships with first degree relatives.
c. suspiciousness and paranoid ideation is restricted to patients with paranoid personality disorder.
d. patients with schizotypal PD have odd beliefs and magical thinking that influences behaviour and is inconsistent with cultural norms.

Answer 10

d is correct.

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Question 11

Schizotypal PD shares all of the following biological abnormalities with schizophrenia except:

a. loss of frontal lobe volume and striatal dopamine activity.
b. temporal lobe volume reductions.
c. impaired smooth pursuit of eye movements.
d. impaired tests of executive functioning.

Answer 11

a is incorrect

• preservation of frontal lobe volume and striatial DA activity vs. schizophrenia (Siever 2004)

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Question 12

Which of the following is true in paranoid PD?

a. patients with PPD rarely have suspicions about the fidelity of their spouse.
b. PPD responds well to weekly CBT.
c. there is an increased prevalence of PPD in the hearing impaired, new immigrants, minority groups.
d. the delusions seen in PPD are well encapsulated, systematized.

Answer 12

c is correct
personal note: it may be worth wondering about the cultural lense through which this finding is made.

• CBT session interval q. 2-3 weeks
• no delusions, more pervasive paranoia

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Question 13

In Dependent PD which of the following is incorrect?

a. difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
b. a recurrent pattern of abuse or dependence on alcohol or other substances.
c. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
d. uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

Answer 13

b is incorrect

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Question 14

In psychodynamic therapy with Dependent PD patients which of the following are true?

a. the therapist explores fears of autonomy, but ignores signs of overly complieant behaviour.
b. while earlier psychodynamic theories stress over gratification in the oral phase, current theories emphasize authoritarian or overprotective parents who prohibit independent activity.
c. “transference longing” the secret longing to attach themselves to the therapist forever is an uncommon form of resistance in therapy with DPD patients.
d. the therapist must avoid the development of dependent transference.

Answer 14

b is true

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Question 15

Which of the following occurs only in Social Phobia

a. shows restraint within intimate relationships because of the fear of being shamed or ridiculed
b. views self as socially inept, personally unappealing, or inferior to others
c. recognizes that the fear of social situations is excessive or unreasonable
d. preoccupied with being criticized or rejected in social situations

Answer 15

c occurs only in Social Phobia

• avoidant PD with co-morbid Social Phobia = 42%
• Social Phobia with co-morbid avoidant PD = 62%
• Large twin study: APD/SP shared genetic, but unique environmental variance.
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Question 16

Which is incorrect regarding Avoidant PD?

a. urgently seeks another relationship as a source of care and support when a close relationship ends
b. maladaptive avoidance develops as a defense against shame, embarrassment and failure
c. normal shyness in children tends to decrease in adolescence and early adulthood but will increase in avoidant PD due to increased role of relationships.
d. patients with avoidant PD are felt to display anxious attachment: they are ambivalent about close relationships and feel very vulnerable to potential punishment and neglect of others.

Answer 16

a is incorrect

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Question 17

Which of the following is correct regarding OCPD?

a. DSM IV requires that the preoccupation with details, lists, rules. order, organization, schedules seen in OCPD occur to the extent that the major point of the activity is lost
b. perfectionism rarely interferes with task completion
c. adolescents with strong OCPD traits rarely grow out of the diagnosis
d. while research is limited one study suggests that CBT may be better than psychodynamic psychotherapy for OCPD

Answer 17

a is correct

• CBT too detail oriented, reluctant to explore emotions.
  note: 30% of OCPD have OCD

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Question 18

What 4 defenses are used in OCPD?

Answer 18

• Reaction formation
• Intellectualizaiton
• Undoing
• Isolation of affect

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Question 19

Otto Kernberg described the defense mechanism of _______________ that occurs in patients with borderline PD. In this primitive defense mechanism, intolerable aspects of the self are projected onto another; the person is induced to play the projected role, and the two persons act in unison.

Answer 19

projective identification

K&S 11th ed.

Question 20

Borderline PD suicide risk?

Answer 20

3-10% (Paris 2004, Zaheer 2008)

uOttawa

Question 21

Which of the following is true when symptoms of borderline PD remit?

a. relapse is the rule
b. affective symptoms improve most, followed by impulsive symptoms, cognitive symptoms improve least
c. overall function does not improve
d. cognitive symptoms, affective symptoms improve least

Answer 21

d is correct (impulsive symptoms improve the most)

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Question 22

In treatment of a patient with Histrionic PD you should:

a. expect that they will have functional impairment similar to patients with BPD
b. watch for idealization with eroticized transference. Use self disclosure liberally but avoid advice giving, maintain clear boundaries
c. limit expectations for response to psychodynamic psychotherapy
d. anticipate symptoms will improve with time

Answer 22

d is correct

• watch for idealization with eroticized transference. Resist self-disclosure, advice giving, maintain clear boundaries.

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Question 23

True or False?
Kohut’s theory suggests that patients with Narcissistic PD have experienced developmental arrest, are thin skinned, sensitive and easily hurt.

Answer 23

True.
Therapists should: take a gentle approach, with emphasis on empathy, avoid criticism and take responsibility when patient is upset.

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Question 24

True or False?
Kernberg’s theory suggests that patients with Narcissistic PD are oblivious, thick skinned, arrogant, crave attention, and disregard others feelings.
Greed, devaluation of others is a defensive operation, requires tactful confrontation and interpretation by the therapist.

Answer 24

True (Kernberg 1975, 1984)

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