Axia College Material
Appendix G

The DSM-IV

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.

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

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).

2. Personality disorders can be similar to each other.

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).

3. People with different personalities can be given the same diagnosis
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.

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

I do not personally believe that personality disorders are true mental illnesses because I believe everyone has different personalities. Some of us know how and understand how to control our different personalities. It takes our different personalities to help us discover which personality actually fit us to make us into who we are.