Personality Disorders-Fact or Fiction?

Personality disorders are challenging to diagnose and therefore are difficult to treat; so they shouldn’t be included as a diagnostic category. I will discuss how diagnosis and studying the causation of personality disorders are challenging. Also how treatment of personality disorders is difficult will be discussed to support my argument of not including personality disorders as a diagnostic category. Research information that will support my argument will be discussed also. If personality disorders are to be considered as a diagnostic category, they should have a clear defined criteria of what each personality disorder is.
The Challenges in Diagnosing Personality Disorders Distinct care is in command concerning the identification of personality disorders because more misidentifications possibly happen here than in any other classification of disorder. There are various explanations for this. One issue is that analytic standards for personality disorders are not as distinctly explained as they are for most Axis I analytic classifications, so they are frequently not easy to follow in practice or exact. For example, it might be challenging to identify dependably whether a person sustains a given standard for dependent personality disorder such as “has difficulty making everyday decisions without an excessive amount of advice and reassurance from others“ or “goes to excessive lengths to obtain nurturance and support from others.” Because the standard for personality disorders are described by consistent patterns of behavior or incidental behaviors rather than by more unbiased behavioral criteria (such as having a prolonged and persistent depressed mood or a panic attack), the psychologist needs to use more judgment in making the identification than is the case for most Axis I disorders. With the increase of self-report inventories and semi-coordinated interviews for the identification of personality disorders, particular features of analytic dependability have grown significantly. Then again, since the understanding between the analyses created on the foundation of diverse self-report inventories or organized interviews is frequently low, there are yet considerable issues with the dependability and rationality of these analyses. Meaning, for example, that five diverse researchers utilizing five diverse valuation tools might categorize units of people with considerably diverse features as having a specific diagnosis such as narcissistic or borderline personality disorder. This almost guarantees that limited acquired research outcomes will be repeated by other researchers even though the units observed by the different researchers have the same analytic tag. Assumed issues with the undependability of diagnoses, a huge transaction of labor over the last 20 years has been focused with regard to creating a more dependable and precise way of evaluating personality disorders. Some philosophers have tried to deal with the issues essential in classifying personality disorders by creating shallow methods of evaluation for the traits and symptoms implicated in personality disorders. Not just one hypothetical opinion on the shallow categorization of personality disorders has yet appeared as exceptional, and several researchers are attempting to create an approach that will mix the various diverse in effect approaches (Butcher, n.d.).
The Challenges in Studying the Causation of Personality Disorders Barely anything is known about the causal issues in most personality disorders, because these disorders have obtained constant interest by researchers only since DSM-III was printed and because they aren’t as agreeable to study. One significant issue in learning the sources of personality disorders comes from the elevated rate of comorbidity among them. For example, in an initial evaluation of four reports, Widiger and his colleagues discovered that’ 85 percent of patients tested who eligible for one personality disorder identification also were eligible for at least one more, and numerous were eligible for some more. A report of almost 900 psychiatric outpatients stated that 45 percent were eligible for at least one personality disorder identification, and among those with one, 60 percent had more than one, and 25 percent had two or more.” This considerable comorbidity adds to the struggle of unravelling which causative features are connected with which personality disorder. Another issue in obtaining assumptions about sources happens because researchers have more assurance in potential reports, in which units of individuals are watched before a disorder emerges and are monitored over a period of time to see which people acquire issues and what causative features have been existent. Comparatively little potential research has been done with the personality disorders. The massive main stream of research is done on individuals who already have the disorders; some of it depends on reflective memory of past occurrences, and some of it depends on noticing present cognitive, biological, interpersonal, and emotional performance. Any assumptions about sources that are proposed need to be contemplated very cautious. Potential biological features, has been advised that babies’ personality (a natural character to respond affectively to ecological incentives) might incline them to the progress of specific personality characteristics and disorders. Some of the significant dimensions of personality that have been reported are activity level, social inhibition versus sociability, and negative emotionality. One method of thinking about personality is that it sets the early groundwork for the growth of the adult personality, but it is not the only factor of adult personality. Assumed that mainly personality and temperamental characteristics have been realized to be reasonably genetic, it is not shocking that there is rising proof for hereditary influences to specific personality disorders. Nevertheless, for most disorders, the hereditary influence emerges to be negotiated by the hereditary influences to the main characteristic dimensions most associated in each disorder preferably than to the disorders themselves. Some development is being created in comprehending the psychobiological substrate of some of the characteristics obviously implicated in the personality disorders. Among psychological features, psychodynamic philosophers initially credited great significance in the progress of character disorders to a baby’s getting extreme versus inadequate satisfaction of his or her urges in the first few years of life. Recently, maladaptive cognitive styles and acquiring founded habit repetitions have obtained more focus as potential causative features. Many of these cognitive styles and maladaptive habits that have been imagined to play significant roles for specific disorders might start in troubled parent-child connection relationships, rather than develop from distinctions in temperament. Parental psychopathology and unproductive parenting exercises have also been involved in specific disorders. Numerous reports have also implied that early sexual abuse emotional, and physical may be vital features in a subsection of cases for some dissimilar personality disorders. Numerous types of cultural values, social stressors, and societal changes have also been involved as sociocultural causative features. Ultimately, the objective is to attain a bio-psychosocial viewpoint on the beginnings of each personality disorder, but currently they are far from getting that objective (Butcher, n.d.).
The Treatment of Personality Disorders Personality disorders are usually very challenging to treat, in part because they are, by characterization, comparatively pervasive, enduring, and inner experience and inflexible patterns of behavior. Numerous diverse objectives of care can be devised, and several are more challenging to attain than others. Objectives may involve changing whole patterns of behavior or the entire structure of the personality, decreasing personal stress, and changing specific dysfunctional behaviors. In many cases, individuals with personality disorders enroll in treatment only at someone else’s persistence, and they frequently don’t think that they must change. Moreover, those from Cluster A and Cluster B personality disorders have typical challenges in developing and continuing positive relationships, including with a psychologist. For those from the Cluster B, the routine of acting out, usually in their other relationships, is transmitted into the counseling setting, and instead of dealing with their issues at the vocal stage, they might become annoyed with their psychologist and noisily disturb the meetings. Also, individuals who have both an Axis I and an Axis II disorder don’t, do as well in therapy for their Axis I disorders as patients without comorbid personality disorders. This is because individuals with personality disorders have ingrained, rigid personality characteristics that frequently head to inadequate remedial relationships and make them oppose doing the things that would assist to make their Axis I condition better (Butcher, n.d.).
Research Information According to Westen’s research clinician analyses are themselves frequently undependable, returning to formless clinical examination isn’t an answer. A possible answer, might be in the difference between two methods that clinicians utilize in reaching an axis II identification. This hefty dependence of research tools on a process that clinicians realize of regulated use in evaluating personality disorders has started to affect the disorders and standards involved in DSM-IV in ways that must to be cautiously contemplated. For example, passive-aggressive personality disorder was removed from DSM-IV, because of its obvious oddity on the source of present interviews. In their regional sample of doctors, 58.0% stated presently caring for at least one patient who met all the standards for this disorder. This is a larger percentage than that for five of the 10 disorders currently signified on axis II. One option, is that doctors might view passive aggression where it doesn’t exist. Another reason is that passive-aggressive personality disorder, like several other personality disorders, can’t be successfully evaluated through direct questioning because of explaining features of the disorder is lack of insight or considerably self-deception. Study identifies differ from clinical identifies for axis II disorders in a second way: they identify multiple disorders where doctors do not. Three reasons could give explanation for this difference. First, doctors might unsuccessful in recognizing comorbidity, in comparison to controlled tools, which might lean towards more "evenly hovering attention" across possible diagnoses. A second option criticizes the tools rather than doctors: either the criteria they assess or the questions they ask (or both) might not permit for judgment among disorders. Although comorbidity is certainly common on both axis I and axis II, and some axis 1 disorders might not be as distinct as customarily thought (e.g., bipolar disorder or mood and anxiety disorders, and to be more reliable than the other). The first method involves paying attention to their stories about their existences, and getting conclusions about their affective propensities, characteristic behavior, unconscious affect-regulatory procedures (defenses), conscious coping strategies, cognitive patterns, values, fears, and wishes. Research suggests that through utilization of psychometrically sound tools, doctors can, make such conclusions dependably, specifically if reports that they are ranking or rating are composed in plain language with little jargon. The second method in constructing an axis II diagnosis is to add an algorithm to unite those dozens of studies into a diagnosis. DSM-IV compels a specific type of algorithm: whether the patient meets five of eight of the standards, and so forth. Doctors possibly use the same combination of algorithms utilized by individuals in all classification tasks. Most of the time they match their design of studies in contrast to an example of a group, and if the match is good, they determine that the specific insistence is a member of the group. Other times, especially if some piece of information seems irregular, they refer to a list of detailing characteristics, as in DSM-IV. Use of these algorithms is possibly much less dependable than the studies that underlie them, especially when the identification groups themselves do not lie on strong experimental ground. A possible answer is to utilize events established by personality researchers for determining complicated personality courses, which statistically compete the viewed design of personality qualities of an assumed patient with the designs discovered among specific units. If a group of patients empirically lives who split an ordinary group of features similar to the antisocial diagnosis, the synopses of a sizable amount of patients are combined to form an example of that diagnosis by utilizing an tool that evaluates an extensive collection of personality features. To test whether an assumed patient meets standards for that diagnosis for study functions, a researcher or doctor interviews the patient, paying close attention to the patient's descriptions of noticeable social meetings, and then explains the patient by utilizing the personality descriptors that include the objects in the tool. Rather than instinctively joining these opinions into a diagnosis, or adding up standards founded on direct questions, as in research diagnosis, the researcher and doctor statistically relates the patient's profile across these subjects with the empirically monitored example to evaluate the levels matched between the patient and the example. An asset of this process is that it can produce dimensional diagnoses controlled by categorical diagnoses, relation coefficient, or a combination of the two based on a combination of dimensional scores and cutoffs. Another asset is that the subjects in the tool and the example profiles need not be restricted to strict personality disorders and can evaluate the range of personality methods, varying from moderately fit to moderately troubled. Initial research utilizing techniques of this sort has produced assuring outcomes and proposes that research observation and clinical observation need not be so different with regard to the diagnosis of personality disorders. The evaluation and classification of personality disorders are liable to be improved considerably if tools prove both empirical and clinical rationality (Westen, 1997). Caplan states there are various hazards included in the diagnosis of a particular personality disorder called self-defeating personality disorder. One of them is the term, self-defeating personality disorder, has done an enormous amount of harm by causing both patients and their doctors to presume that the incentive of the patient is to suffer or to be self-defeating. As a positive, therapy can open new possibilities and as a negative, it closes them down. The planned classification manages strongly to end question about the make-up of the patient's issues, and the tag provides doctor and patient nowhere promising or productive to go. The actual causes for behavior that appears to be self-defeating incorporate, low self-esteem and efforts to match the old-fashioned, female, self-denying role in order to obtain love and acceptance. To comprehend those actual causes proposes a constructive pathway for the counseling work. To presume that the actual reason is to beat one's own intentions, and that that reason is frequently unaware, makes the patient feel even more depressed than before and more helpless to transform. As Kass et al. pointed out, individuals assumed the tag of masochistic personality disorder, the tag which was changed to self-defeating, tends to have harmful counseling reaction and low treatment outcome. If one uses an inappropriate diagnosis, one is liable to utilize an inappropriate or misguided treatment approach, thus leading to needlessly challenging treatment course. Thus, for the planned classification, but use of the tag has been shown to have damaging effects; as Draguns and Blashfield note, "A diagnostic label then can serve as an instrument of behavior change and the direction of this change may be anti-therapeutic and may lead to the crystallization of the chronic patient syndrome.” Second, much of the behavior involved in the standards for this classification is a combination of an obedient execution of the traditional female role and an adaptation to the misogyny in society, carried out in efforts to prevent elimination. It is destructive and bizarre for their community to train women to be self-denying and for the community to deny women and mothers appreciation and respect, and then to call self-denying, unappreciated women pathological. The third exclusionary section ruling out abuse victims is not useful and is harmful, because it assumes the idea that abuse victims are not included; but it is well documented that few doctors ever ask for histories of abuse, and even when they ask, abuse victims are very unwilling to admit abuse. The orderly persistence in their civilization of the need for females to be limitlessly self- denying does itself establish long-lasting mental abuse, but the danger is that, it will not be recognized as abuse. The fourth exclusionary clause according to which this tag isn’t given when the patient is depressed establishes either a rendering useless or a danger of the classification. It is also documented that there is a greater occurrence of learned helplessness and depression in women than in men. The planned classification involves the stern risk that depression would be missed because of the new tag being misused instead. The fifth has no proof and no systematic study has even been brought out to imply that the existence of self-defeating behavior represents a personality disorder rather than some other mental disorder. Many individuals, especially women, are self-denying in several main parts of life but not in most or all ways, yet they are not formally diagnosed often as self-defeating or masochistic. Doctors look at common, self-denying females who are carrying out their community's commands, and they see their pervasive, severe new planned identifications has been the approximate total lack of practical disputes in approval of them. The only disputes put out in favor of the offers have been of the "we think we see it, so it must exist" sort, a theme. The not large APA Work Group planned this classification, and it was up to the APA Board of Trustees to authorize it. As the group sets its thoughts, it will create its own jargon of new classificatory ideas (Caplan, 1987).
Conclusion
Personality disorders shouldn’t be included as a diagnostic category, because the causation, diagnosis, and treatment for personality disorders aren’t clearly defined. In order to diagnose a disorder it has to be able to meet certain criteria to clearly diagnose a patient. When the causation, diagnosis, and treatment aren’t clearly defined, it can cause people to be misdiagnosed and therefore they will receive the wrong treatment.

References

Butcher. (n.d.). Abnormal Psychology, 14th Edition. Argosy University. Retrieved November 12, 2013, from http://digitalbookshelf.argosy.edu/books/0558241484/id/ch10lev1sec1

Caplan, P. (1987). The psychiatric association's failure to meet its own standards: The dangers of self-defeating personality disorder as a category. Journal of Personality Disorders, 1(2), 178-182. doi: Retrieved November 12, 2013, from http://dx.doi.org/10.1521/pedi.1987.1.2.178

Westen, D. (1997). Divergences between clinical and research methods for assessing personality disorders: Implications for research and the evolution of axis II. The American Journal of Psychiatry, 154(7), 895-903. Retrieved November 12, 2013, from http://search.proquest.com/docview/220470670?accountid=34899