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The DSM-IV is an important tool for clinicians. It provides a standard for diagnoses to be standardized across psychology; however, the DSM-IV is not as precise for diagnosing personality disorders as some psychologists would like.

Give an example of each of the following problems identified in your readings and explain how these problems could negatively affect a diagnosis.

Some criteria used for reaching a diagnosis cannot be observed directly.

Personality disorders can be similar to each other.

People with different personalities can be given the same diagnosis

Do you think that personality disorders are true mental illnesses? Why or why not?

What Problems Are Posed by the DSM Categories?



Most of today’s clinicians believe that personality disorders are important and
troubling patterns, yet these disorders are particularly hard to diagnose and easy
to misdiagnose. These difficulties indicate serious problems with the validity (accuracy)
and reliability (consistency) of the DSM categories (Jablensky, 2002).
One problem is that some of the criteria used to diagnose personality disorders
cannot be observed directly. To separate paranoid from schizoid personality
disorder, for example, clinicians must ask not only whether people avoid forming
close relationships but also why. In other words, the diagnoses often rely heavily
on the impressions of the individual clinician. A related problem is that clinicians
differ widely in their judgments about when a normal personality style crosses the
line and deserves to be called a disorder (Clark, 2002). Some even believe that it
is wrong ever to think of personality styles as mental disorders, however troublesome
they may be (Kendell, 2002).
The similarity of personality disorders within a cluster, or even between
clusters, poses yet another problem (Grilo et al., 2002). Within the “anxious” cluster,
for example, there is considerable overlap between the symptoms of avoidant
personality disorder and those of dependent personality disorder. When clinicians
see similar feelings of inadequacy, fear of disapproval, and the like, is it reasonable
to consider them separate disorders (Bornstein, 1998; Livesley et al., 1994)?
Also, the many borderline traits (“dramatic” cluster) found among some people
with dependent personality disorder (“anxious” cluster) may indicate that these
two disorders are but different versions of one basic pattern (Dolan et al., 1995;
Flick et al., 1993).
Another problem is that people with quite different personalities may be given
the same personality disorder diagnosis. Individuals must meet a certain number
of criteria from DSM-IV to receive a given diagnosis, but no single feature is necessary
for any diagnosis (Millon, 2002, 1999; Costello, 1996).
Partly because of these problems, diagnosticians keep changing the criteria
used to assess each of the personality disorders. In fact, the diagnostic categories
themselves have changed more than once, and they will no doubt change again.
For example, DSM-IV dropped a past category, passive-aggressive personality
disorder, a pattern of negative attitudes and resistance to the demands of others,
because research failed to show that this was more than a single trait. The pattern
is now being studied more carefully and may be included once again in future editions
of the DSM.

  • psychology -

    Some criteria used for reaching a diagnosis cannot be observed directly.

    Some diagnoses depend upon WHY a particular behavior is exhibited. A person who avoids others may be introverted and enjoy his own company -- or may be paranoid or schizoid.

    Personality disorders can be similar to each other.

    "Within the “anxious” cluster,
    for example, there is considerable overlap between the symptoms of avoidant personality disorder and those of dependent personality disorder."


    People with different personalities can be given the same diagnosis

    "no single feature is necessary
    for any diagnosis."


    Do you think that personality disorders are true mental illnesses? Why or why not?

    For me -- the difference is how the individual functions in his own life and in society. A person with a personality disorder may function reasonably well -- and therefore not have a true mental illness. This is a matter of degree of malfunctioning.

    What Problems Are Posed by the DSM Categories?

    Rose -- what do you think these problems are?

  • psychology -

    Ms. Sue,


    I think these problems are due to the unreliability of poor clinician training and unclear causes

  • psychology -

    I disagree, Rose. Most medicine is more art that science because each person is unique. This is certainly true with mental health workers. They have to come up with a diagnosis based only on observable behaviors. They don't have blood tests, MRIs, etc., to help them make diagnoses. No test can get into a person's head to measure or determine the WHY of a person's behavior.

    My 14-year-old honorary grandson spun so far out of control at home that his mother (a psychologist) called the police, and he spent a night in the county juvenile home. His behavior in school is exemplary, yet his academic work is usually mediocre. He spends several days and nights with me a month and -- he's the perfect guest and person. Why is he such problem at home? Is it related to his mother? Is it related to an inherent neurological problem (which has been medically diagonsed). Is it related to his adoption as an infant from another country? Is it related to the brain injury he suffered a couple years ago?

    The human brain and human behavior is so complex that trying to pin labels on behavior is nearly impossible.

  • psychology -

    Thank you so much ms. Sue

    Have a great evening.

  • psychology -

    You're very welcome, Rose.

  • psychology -

    These categories are related to the clinical judgment of the professional, which varies from clinician to clinician. Much of the information about the client relies on the observations of relatives and friends of the client, which also vary in their validity. To add to this, the client's behavior will vary considerably over time and situations.

    The DSM is the attempt to make the decisions more empirical. However, criteria are related to social norms which also vary with time.

    Distinguishing variations in "normal" behavior from the pathological has always been a problem. At one extreme, for the psychiatrist, Thomas Szasz, mental illness is a myth. <(Broken Link Removed)

    I don't know if my response will clarify the situation or add to the confusion. That is your decision to make. Thanks for asking.

  • Hum/130 -

    I need help in this corse I'm willing to pay anything.

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