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.

This statement is true; some measures used to reach a diagnosis cannot be witnessed completely. Personality disorders can be hard to diagnosis with no knowledge of the unseen symptoms. Some of the criteria must be gained by analyzing each individual one by one. The complexity of diagnosing is associated with having accuracy and consistency. Furthermore, without observing these symptoms directly may cause a misdiagnosis. According to Comer (2005), “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 information required for the diagnosis is a person’s behavior, character, and responses to proceedings or state of affairs. Another factor to consider may include environment relations. An individual with this kind of performance can be diagnosed with avoidant personality disorder. However, in the same scenario and adding fear, an individual can be diagnosed with social phobia with other clues of an additional disorder. Combining medications and treatment could have disagreeable results if the individual’s illness is misdiagnosed.

2. Personality disorders can be similar to each other.

In the DSM-IV comparison chart 13-2 of personality disorders on page 399 of Chapter 13, symptoms of different disorders can have common characteristics and therapist interpretations can be directed in a misdiagnosis if the therapist merely trusts on his or her knowledge collected by the evaluation. For instance, the disorders such as personality disorders, anxiety disorders, and obsessive compulsive disorders have a large number of warning signs shared (Abnormal Psychology: Personality Disorders). According to Comer (2005), “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). In addition, according to Comer (2005), Avoidant personality disorder is similar to a social phobia (see Chapter 4), and many people with one of these disorders also experience the other (Markovitz, 2001). The similarities include a fear of humiliation and low confidence. A key difference between the two conditions is that people with a social phobia mainly fear social circumstances, while people with the personality disorder tend to fear close social relationships (Turner et al., 1986).

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

According to Comer (2005), “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). This problem causes the diagnosticians to carry on adjustments and modifications to the reasons employed to determine the personality disorders and the differences. An example stated by Comer (2005) is that the
“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” (Abnormal Psychology: Personality Disorders).

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

Personally, I am in the middle of which way to go on choosing. I do believe that personality disorders are a true mental illness. Individuals do suffers from these disorders and some need medications to help reduce his or her symptoms. However, I also believe that individuals can take control of his or her illness and take responsibility for his or her actions. This is all about mind over matter. If a person in fact wants to change the behaviors, actions, or characteristics of him or herself, the possibilities are endless, but he or she must have the strength and courage to do this and not be afraid.

Cites

Comer, R. J. (2005). Fundamentals of Abnormal Psychology (4th ed.): Personality Disorders. New York, NY: Worth