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The Essential Family Guide to Borderline Personality Disorder by Randi Kreger 2008
(Hazelden: Center City, MN)
All rights reserved. [304 pages]
[Answer 25 of 35 questions correctly to receive
11 hours of Continuing Education credit.]


PART 1: The ABCs of BPD
Chapter 1: Welcome to Oz (p. 7-21)
1. The author believes all of the following are true EXCEPT
a. To help your family member who has BPD, you must help yourself first.
b. BPD thoughts, feelings, and behaviors are not different, just exaggerated.
c. In order for your life to improve, you must have cooperation from your BPD family member
d. It takes only one person to fundamentally change a relationship.

Chapter 2: Understanding Borderline Personality Disorder (p. 23-48)

2. Which is NOT true?
a. The word "Borderline" is an old reference to someone who was on the "border" between neurotic and psychotic.
b. BPDs react to real abandonment but not to imagined abandonment.
c. "Splitting" is when the BPD sees someone as their champion (idealization) and also as someone out to get them (devaluation)

d. BPDs feel unworthy, like they are never "good enough."

3. Which is NOT true?
a. Most BPDs attempt suicide.
b. Indications that adolescents might be cutting themselves include wearing long-sleeve shirts, spending too much time in the shower, increasing substance abuse, isolating themselves after a stressful event, and hoarding sharp instruments.
c. BPDs experience intense emotions that are out of proportion to the stressful event.
d. BPDs usually express their anger with intense rage.

4. Which is NOT characteristic of BPD behavior?
a. Equating feelings with facts.
b. Jumping to negative conclusions without any supporting facts.
c. Assuming others are thinking poorly of them.
d. Catastrophizing. Thinking the worst-case scenario will happen no matter what.
e. Blaming others while being held accountable for nothing.
f. Quietly self-critical while repelling compliments.
g. Lying or blowing the truth out of proportion.
h. The inability to complete tasks.

5. Higher-functioning BPDs will
a. disavow having any problems, always blaming their spouse.
b. refuse to go to counseling unless they are threatened to go. Then, they try to convince the therapist they are being victimized.
c. hide their low self-esteem behind a confident pose. They function well at work and only display aggressive behavior toward those close to them.
d. All of the above.

6. Which of the following is the MOST co-occurring disorder with BPD?
a. Depression
b. Substance Abuse
c. Eating Disorders
d. Narcissistic Personality Disorder
e. Bipolar Disorder
f. Histrionic Personality Disorder

Chapter 3: Making Sense of Your Relationship (p. 49-65)

7. A spouse who has BPD will
a. argue like a young child argues.
b. not be aware of their own emotions.
c. overreact to either real or imagined rejection.
d. be aggressively destructive to either self or others.
e. All of the above

8. The non-BPD spouse will
a. always be blamed for any marital problems.
b. often describe a "damned-if-I-do" and "damned-if-I-don't" experience when their BPD spouse reacts negatively to however the non-BPD spouse behaves.
c. be pushed away by their BPD spouse when they get too close, and then accused of abandoning them when they back off.
d. All of the above.

Chapter 4: Risk Factors of BPD (p. 67-81)

9. Which is NOT true?
a. The limbic part of our brain controls our emotions.
b. A person who has too many or too few neurotransmitters could be at risk for BPD.
c. Abuse causes BPD.
d. A fault-finding parent, or one who invalidates their child's feelings, or one who is too overwhelmed to meet their child's needs could put their child at risk for BPD.

Chapter 5: Treating BPD (p. 79-96)
10. Which is NOT true about medications for BPD?
a. Medications cannot cure BPD, but they can reduce BPD symptoms such as depression, mood swings, dissociation, aggression, and impulsivity by normalizing the brain's neurotransmitter levels.
b. The goal with medications is to use the lowest dose which alleviates the symptoms while minimizing the side effects.
c. Drugs that regulate neurotransmitter levels usually take effect right way
d. Clients should know the side effects of stopping a medication before doing so.

11. Which is NOT true about therapies for BPD?
a. Cognitive-behavioral therapy is the thought-feeling-action approach used throughout this book.
b. Dialectical means that BPDs must do two opposite things: accept themselves, and yet not stay the way they are, but acquire new skills.
c. Dialectical Behavior Therapy (DBT) can usually be accomplished in one hour of counseling per week.
d. The primary objective of doing couples therapy where one spouse had BPD is to improve the couple's communication skills.

Chapter 6: Finding Professional Help (p. 97-123)
12. BPDs are one of the most difficult disorders to treat because
a. lower functioning BPDs come to therapy with a defeatist attitude, thinking that they cannot get better.
b. BPD patients are often hostile, verbally attacking their therapists.
c. high-functioning BPD spouses will usually accuse their non-BPD spouses of having BPD and eing abusive, unreasonable, controlling.
d. All of the above.

13. Which is an acceptable question a person should ask of s potential therapist to treat BPD?
a. Do you believe that both medications and therapy are necessary in treating someone with BPD?
b. Do you have experience in treating borderline clients? If yes, how long have you been doing so?
Do you keep informed of the latest BPD research?
d. All of the above

14. Which of the following does Byron Bloemer, Ph.D., advise therapists to do when treating BPD clients?
a. Avoid getting pulled into their BPD clients' misery.
b. Assess how well each BPD client can manage their emotions.
c. Accentuate the client's strengths and successes, like the example of his client who did NOT fall apart six of the last seven days.
d. All of the above.

PART 2: Power Tools
Chapter 7: Power Tool 1 -- Take Good Care of Yourself (p. 129-146)

15. The author gives much practical advice in this chapter. She says, "If you get only one thing out of this chapter, let it be this: ________."

a. Do not let yourself be embarrassed into isolation or pushed into it by threats, implied or outright. Reach out to others.
b. Find a therapist for you.
c. Take things less personally.
d. Learn to control your worry, guilt, anger, and low self-esteem.

16. What does the author mean for the non-BPD to "practice acceptance" of their BPD love one?
a. You acknowledge that you didn't cause your loved one's BPD behavior, you cannot control it, and you cannot cure it.
b. You live in the present, you no longer dwell on the negative past.
c. You accept that the worst may happen. After you do, you start to see what good you actually have.
d. All of the above.

17. For stress-reduction purposes, what physical advice does the author NOT give in this chapter to the non-BPD?
a. To breathe deeply from one's stomach (diaphragm).
b. To eat more fruits and vegetables.
c. To get 1 to 1 1/2 hours more sleep each night.
d. To exercise regularly.

Chapter 8: Power Tool 2 -- Uncover What Keeps You Stuck (p. 147-161)

18. Which is NOT characteristic of the "Stockholm Syndrome"?
a. Giving the BPD abuser small tokens of kindness for NOT being abusive when abusiveness was expected.
b. Making excuses for the BPD abuser's behavior, such as "He was abused as a child."
c. Setting limits for how much damage you will take from the BPD.

d. Becoming preoccupied with the needs, desires, and habits of the BPD abuser in an effort to prevent the BPD from having an outburst.

19. Adult children of BPDs who have low self-esteem often try to relieve their shame by
a. being good.
b. drinking.
c. getting angry.
d. overcompensating.

20. Why doesn't rescuing work?
a. Because it protects people from the consequences of their own behavior, thus enabling them to act irresponsibly.
b. Because it is too exhausting and demanding for the rescuer.
c. Because most people never become grateful enough to change what they need to change.
d. Because it results in neither person developing genuine self-respect.

21. Elizabeth B. Brown, author of Living Successfully with Screwed-Up People
, says there is a way to sincerely help people without rescuing them. She suggests which of the following support messages?
a. I'm here for you, but there are limits and boundaries.
b. I'm here for you, but I know that your choices and their consequences belong to you.
c. I'm here for you, but I'm willing to lose the relationship if we become twisted together.
d. All of the above.

Chapter 9: Power Tool 3 -- Communicate to Be Heard (p. 163-194)
22. The author describes the Splitting-Shame-Fear Spiral this way: The BPD processes information differently than the non-BPD. When the BPD sees a threat, their emotions hijack their brain. They craft insults from general remarks, pull negative intent out of thin air, and twist innocent phrases into daggers. They interpret their own fear as anger. They then can become aggressive, and start an all-out fight over the smallest thing. Which method does the author NOT recommend for the non-BPD to respond to such a difficult cycle of behavior?
a. Instead of trying to show the BPD that her beliefs are wrong, the non-BPD should say to the BPD that they both care for one another, that they can be a team together, and that they both want love and intimacy, and they want at least to be in the same room together without hostility.
b. The non-BPD should remind himself that his BPD spouse is talking aggressively because she is scared, not because her scathing accusations are true.
c. The non-BPD should truly practice deep breathing at the beginning of a BPD's rage.
d. None of the above.

23. What should a non-BPD NOT say when their BPD spouse begins a verbally abusive tirade?
a. "You need to calm down and be reasonable. You're getting out of hand."
b. "I want to hear what you have to say, but it's hard for me when things get too emotional."
c. "We'll talk later when things calm down."
d. "We'll talk later when I can give you my full attention."

24. Which is NOT true about "intentional communication"?
a. Empathy targets what the BPD is thinking.
b. It is possible to empathetically acknowledge a BPD's emotions without agreeing with their thinking.
c. It is good to ask clarifying questions such as, "What can I do to help you right now?"
d. Don't defend yourself when you are criticized.

25. The author says, "People with anorexia don't eat enough, people with depression cry, people with rapid-cycling bipolar disorder are moody, and people with BPD yell." What does the author mean by making this statement?
a. That BPDs cannot help their behavior. They have no choice but to behave this way.
b. That there are some things about BPD behavior that are just always going to be this way.
c. That BPDs will act this way because they have impulsive, excessive, and inappropriate anger. So don't take their anger personally.
d. That non-BPDs should not live with such behavior.

26. If a non-BPD spouse is in a car with their BPD spouse, and the BPD starts yelling, what should the non-BPD NOT say?
a. "I understand you're upset right now. Can we talk about this when we get home so I can give you my full attention?"
b. "I need some time to think about what you have just said. Can we talk about this when we get back home?
c. (If the non-BPD is driving) "I'm going to pull over onto the side of the road until you stop yelling."
d. "I do want to hear what you have to say but I'm distracted by traffic right now. Can we talk about this later?"

27. Which is NOT an example of diffusing the situation by using non-combative statements?
a. "I might not be making myself very clear. What I'm saying is..."
b. "You have a problem with yelling instead of discussing things calmly."
c. "I'd like to stay focused on this one issue right now and not bring other subjects into the discussion."
d. "Maybe we can work together to find a compromise on this subject."

28. Which is NOT an acceptable statement for a non-BPD spouse to make who is trying to set limits?
a. "I won't stand here and listen to you yell at me, so I'm going to leave the room if this continues."
b. "Stop acting like a child by throwing another temper tantrum.
c. "I won't tolerate that kind of language, so I'm going to leave the room if it continues."
d. "Name-calling is not going to get us anywhere. If it continues, we'll have to discuss this another time."

29. The author says, "If you are ever ambushed and forget what to do and say, remember these four key points." Which was NOT one of those four points?
a. Breathe deeply.
b. Stay safe. Leave or call for help if necessary.
c. Tell your BPD spouse, "Stop being so emotional.
d. Keep your eyes soft and steady. Relax your face. Keep your arms uncrossed.
e. Empathize with the BPD's feelings even if you don't agree with her words. Keep your tone of voice neutral.

30. Sharon and her 29-year-old daughter, Amanda, who has BPD, have developed a communication system that compensates for the deficits of the disorder. It includes all of the following responses EXCEPT
a. "Amanda, I need to talk to you about something. It may be upsetting to you, but in the long run things are going to work out okay."
b. "I'm feeling overwhelmed by this conversation. I'm going to take a walk and calm myself down."
c. "I'm trying to be reasonable, but you need to do your part as well."
d. "Let's do something else for a while so that we can let this all settle in. Then we'll talk some more."

Chapter 10: Power Tool 4 -- Set Limits with Love (p. 195-226)

31. In order for you as the non-BPD to set proper limits, you must do all of the following EXCEPT

a. Concentrate on your BPD's personality flaws.

b. Don't make decisions based on your fear of losing the relationship, or out of obligation or guilt.
c. Trust your own perceptions instead of listening to your BPD's negative, angry, and inaccurate judgments about who you are. Don't believe your BPD when, after you have set limits, they call you "selfish", "controlling", or "abusive."
d. Instead of rescuing your BPD from your limits, you let him take responsibility for how he reacts to your limits. He is accountable for his own emotions, actions, and choices.

32. A non-BPD husband has set a limit for his BPD wife not to call him at work more than 2 or 3 times each day. The husband says to his wife,"We can talk when I get home. I won't feel so frustrated because I will be able to work, and you will feel less frustrated because I won't have to tell you I can't talk." This statement represents which part of the DEAR communication technique?
a. Describe the situation as you see it in a factual, unemotional manner.
b. Express your feelings or opinions about the situation clearly.
c. Assert your limits, making them simple.
d. Reinforce the benefits of your limits, if appropriate.

33. When setting limits, you should do all of the following EXCEPT
a. Make sure you obtain your BPD's permission to set a particular limit.
a. Don't get pulled into arguments about your limits. Let go of your compelling need to make your BPD agree with you. Don't over-explain why you are setting limits.
b. Be gentle so as to validate your BPD's feelings, yet be assertive so as to stand firm by your limits.
c. Don't raise your voice. Use a gentle and calming tone.
d. Use positive self-talk to offset negatives from the BPD.

Chapter 11: Power Tool 5 -- Reinforce the Right Behavior (p. 227-240)
34. Tacy told her daughter, Betsy, that she could not call her at her work more than 3 times each day unless it was an emergency. If Betsy does not keep this limit, what is the best way for Tacy to respond to her when Betsy calls a fourth time?
a. Tacy should ask Betsy why she is calling a fourth time.
b. Once she hears Betsy's voice a fourth time, Tacy should immediately say in a neutral tone, "We'll talk when I get home tonight," and then gently terminate the phone call. Or, if Tacy is screening her calls, not pick it up when she hears Betsy's voice.
c. It is OK for Tacy to
occasionally talk to Betsy after she calls three times, but not every time.
d. Tacy should give Betsy the benefit of the doubt, that perhaps a fourth call really is an emergency.

35. Besides setting limits, what are some other practical ways of dealing with BPD behavior?
a. Use the least reinforcing scenario (LRS) when your BPD makes an unpleasant comment. Stand still and remain expressionless.
b. When visiting a family member with BPD, take someone with you, especially if the BPD member does not act out when other people are around.
c. Praise the BPD's good behavior.
d. All of the above