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A second reason for this diagnostic failure is that if a patient carries a diagnosis of personality disorder (DSM-IV, Axis II ), the odds that insurers will cover the treatment are greatly reduced. There are several reasons for this default: (1) The belief that personality problems are willful, while DSM-IV Axis I clinical syndromes are not; (2) serious definitional problems for personality disorders, including poor reliability and rampant comorbidity among them (Kupfer, First, & Regier, 2002; Widiger & Costa, 1995); and (3) relatively few recognized effective treatments for personality disorder (Chambless & Ollendick, 2001). Clinician reluctance to file for reimbursement for treatment of personality disorder has absurd as well as negative consequences for personality-disordered patients. About 10 years ago, before dialectical behavior therapy (DBT; Linehan, 1993) had been articulated and so effectively brought to a higher level of clinician and administrator acceptance for treatment of borderline personality disorder, I heard from an administrator for the Public Employees Health Plan for the state of Utah that their database of cases treated shows, There are essentially no personality disorders in our state. Despite the success of DBT, even today, insurers are likely simply to declare: We do not cover treatment for personality disorders. Although nearly invisible in the administrative world of practice, research studies have made it clear that if Axis I disorders are comorbid with personality disorder, the Axis I problems are likely to be more severe and longer lasting (Shea, 1993). Over and above the obvious need to help people mitigate their self- and other-defeating problem personality patterns, there is a clear need to better understand the impact of personality on Axis I problems and to use that understanding in developing more effective treatments for both Axis I and Axis II.

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number, age, gender, or grade in school, occupation, ethnicity, marital status, and living arrangements. Information about current and past medical and psychiatric problems and treatments are also usually requested. The chief complaint or a list of symptoms experienced by the patient is discussed as well as the patient s hypotheses regarding the contributing factors associated with the development and maintenance of the problem(s). The interviewer often wants to know how the person has tried to cope with the problem(s) and why he or she wishes to obtain professional services now. Interviewing is used for a wide variety of purposes. For example, an interview is typically conducted whenever a psychologist begins psychotherapy with a new patient. Interviews are also conducted to determine

but does not have that primary key in the other schema, or when a concept is mapped to an attribute type in one schema but it is mapped to an entity type in the other schema Constraint con icts where the same construct has different, incompatible requirements: for example, this occurs when the same attribute is optional (nullable) in one schema but is mandatory (not null) in the other schema

There is something of a paradox in this marriage of trust and prosperity Those who have misread Adam Smith s principles of reciprocal capitalism often clamor for truly unregulated, laissez-faire markets They work under the illusion that, free of regulation, they could achieve anything they put their minds to This is simply another form of rulesbound thinking: de ning your ability to achieve in relation to regulatory constructs But in fact, the certainty and predictability created by strong legal systems and regulatory apparatuses support achievement Consider traf c signals as a metaphor Traf c signals allow us to get around as speedily, ef ciently, and safely as we can They help to create a reasonable level of certainty that other drivers and pedestrians will behave in a predictable fashion.

Select the instance on the Stage and choose Window > Properties. Click the Swap button in the Property inspector. In the Swap Symbol dialog box, select a symbol that will replace the one currently assigned to the instance. To duplicate a selected symbol, click the Duplicate Symbol button at the bottom of the dialog box.