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Personality disorders are some of the hardest psychological disorders to diagnose. In this lesson, we’ll look at diagnostic challenges regarding personality disorders, including bias and overlap with other psychological disorders.

Personality Disorders

Imagine that you are a psychologist, and Becky comes to see you. She’s charming and funny and seems to have no problems at all. But, there’s a darker side to Becky. She’s seeing you as part of court-ordered therapy because she assaulted a man who took a parking spot that Becky wanted. She beat the man until he was unable to move and then went on her way as though nothing had happened.

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Becky might be suffering from a personality disorder, a psychological disorder that involves behaviors that make it difficult for a person to succeed in interpersonal relationships.There are many different types of personality disorders, all with slightly different symptoms. Some people with personality disorders, like Becky, might have a complete disregard for the rights and safety of others. Others might be so submissive that they can’t assert themselves to protect their own rights.Still others might feel very little emotion and have perceptual distortions, like hearing voices.

The one thing that they all have in common, though, is that the disorder affects the patient’s personality and that it causes interpersonal difficulties.Let’s look closer at some of the challenges that face psychologists when diagnosing people with personality disorders.

Biases

So, you’re a psychologist, and Becky comes to see you.

She’s charming and funny on the surface, but she has a mean streak. If anyone gets in her way, she does whatever she has to in order to get what she wants, even if that means physical violence. She doesn’t feel any remorse for what she’s done.Becky has many symptoms that are similar to antisocial personality disorder, which involves a consistent disregard for the rights and safety of others. Like many other antisocial personality disorder patients, Becky appears to be charming and sweet, but she is selfish and feels no empathy for others.

Because Becky has the symptoms, we should just diagnose her with antisocial personality disorder, right? Well, in a perfect world that is what we would do. But, diagnosing a mental illness is not like diagnosing a physical one. We can’t take a person’s temperature or draw blood or do X-rays in order to find proof of a disorder.Instead, psychological disorders are diagnosed by talking to a patient and gathering evidence from what they say and do. And, because people with antisocial personality disorder are usually very good at faking emotions and being charming, it is difficult to diagnose them in any circumstance.

Imagine this: what if, after beating up that man, Becky started crying and told the police officers that the man had threatened her? Maybe she even says that he tried to sexually assault Becky? ‘It was just self-defense,’ she tells the officers.Now imagine that the genders in that scenario are reversed: a man beats a woman brutally and then tries to tell the cops it was because the woman tried to sexually assault him. Which person is more likely to be arrested and charged?Here’s another key issue with diagnosing antisocial and other personality disorders: gender bias. Many people believe that men are naturally more aggressive and violent than women, so they are more likely to be diagnosed with antisocial personality disorder.Likewise, there are other personality disorders that involve being submissive or overly emotional. Because these traits are seen as stereotypically female, women are more likely to be diagnosed with those disorders.

There are other biases in diagnosis of personality disorder, as well. In particular, people from lower socioeconomic classes are more likely to be diagnosed with a personality disorder than people from the upper classes.

Overlap

Antisocial personality disorder is only one of many personality disorders. Becky’s cousin Nate has a disorder called schizotypal personality disorder.

This involves odd or eccentric behaviors that get in the way of interpersonal relationships.For example, Nate talks to people who aren’t there. He believes that he can change people’s thoughts and put thoughts into other people’s heads. Nate also responds to serious situations with laughter.

He doesn’t feel very much emotion, but when he does, it’s usually inappropriate.Diagnosing Nate with schizotypal personality disorder should be easy. He has the symptoms, so we should just say, ‘OK, yeah, let’s diagnose him.

‘But, there’s another problem psychologists face with diagnosing personality disorders. Many personality disorders overlap with other psychological disorders. For example, does Nate have schizotypal personality disorder, or does he have schizophrenia? It’s hard to tell, because the symptoms are very similar: in both cases, the patient may hear voices, display little or inappropriate emotions and have delusions.The overlap between personality disorders and other psychological disorders can make it difficult to diagnose or lead to an inaccurate diagnosis. In addition, some of the personality disorders, like schizotypal and schizoid, overlap with each other, making diagnosis even more difficult.

Lesson Summary

Personality disorders are psychological disorders that involve behaviors that cause interpersonal difficulties. There are many types of personality disorders and some distinct challenges when it comes to diagnosing them. Gender and socioeconomic biases in diagnosis are a serious problem, as is the large overlap of symptoms between personality disorders and other psychological disorders.

Learning Outcomes

After you have finished with this lesson, you’ll be able to:

  • Explain what personality disorders are
  • Understand that there is overlap between some personality disorders
  • Discuss gender and socioeconomic biases concerning diagnoses of personality disorders

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