(Mis)Diagnosing Personality

personality-disorder-misdiagnosisDoes our culture promote the labeling of regular variations in behavior and personality as abnormal and disordered?

It has been announced that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-V, will contain some significant updates. The DSM, published by the American Psychiatric Association (APA), is considered the standard for understanding and classifying mental disorders in the U.S. and around the world.

With recent changes, however, the manual and the 30,000+ psychiatrists who oversee its contents have come under heavy criticism. This is because the new edition to be published later in May contains criteria which would classify such common behavior as tantrums, overeating, and grief as personality disorders. For example, those who grieve over the loss of a loved one or a relationship for more than what is considered necessary would be seen as suffering from Prolonged Grief Disorder (PGD) and kids who are stubbornly broody and have outbursts would be displaying Disruptive Mood Dysregulation Disorder (DMDD).

Critics of the new manual include many psychiatrists, like the head of the National Institute of Mental Health who says the manual, “lacks scientific validity”. Other health professionals and the public alike have put pressure on the APA to revise its changes, believing that the current update would encourage the labeling of normal people as unwell and in need of serious psychiatric help, including medications.

Others, like myself believe that the APA’s updates are a part of a global culture of diagnosing undesirable personality traits as mental illness. Although the average person isn’t aware of how symptoms specifically manifest and how severe they can be, many personality disorders have become common parlance as a way of dismissing people who we don’t get along with or understand. Thus:

  • That odd person who is rather cold, blunt, and a loner has antisocial personality disorder.
  • The grating boss who is concerned with order and conformity has obsessive-compulsive personality disorder.
  • The woman who is emotionally intense and expressive has borderline personality disorder.

The APA claims that their diagnoses are made to better understand people and ensure they receive the best treatment for their mental health. Despite this, it can’t be ignored that these conditions have been popularized and are now used not to understand but to stigmatize and exclude those whose behaviors don’t line up with the society’s –or a specific person’s– ideal and norm of personality. Instead of trying to understand and empathize with others we have learned to simply classify them as “crazy”.

So, is the publicizing of personality disorders and mental illness wrong? I don’t believe so. I agree that it is helpful and necessary to understand the various ways that personality can manifest, I believe it is also necessary to understand that these are not personality disorders but personalities, well within the realm of normal human behavior, response, and outlook.

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33 thoughts on “(Mis)Diagnosing Personality

  1. Pharmaceutical corporations can peddle more drugs if there are more ‘disorders’ to be fixed… Follow the money.

  2. Froggie, what about the general public? What is their motive for trying to diagnose people with personality disorders?

  3. I believe that the majority of the world is high on some sort of drug most of the time. A lot of people are popping pills, left, right and centre….instead of dealing with the root of the problem. The psychiatrists are so quick to diagnosing people (most of the time, misdiagnosing them) but they never uproot the problem and deal with it………..Drugs are a temporary solution to a bigger problem….people are also so naive, they never seek holistic healing, they are looking for a quick fix to make them feel better…….

  4. It will be interesting to see what the implications are from these changes in the years to come. In my former line of work it was imperative to have a resident labeled to be able to seek out appropriate treatment, whether it be medication, counselling or both. However I do agree that medication is doled out way too easily.

    Personality disorders are the most difficult to come to a definitive diagnosis on because as you point out what exactly is normal behaviour or just a personality quirk? We are all at some points in our lives anti-social, or a bit obsessive but for those who are at a level where it is a disorder it interrupts their lives to an extreme point. I’ve worked with people with suspected personality disorders (as a case manager) and actually found reading the DSM-V on their disorder to be helpful for me in trying to support them. I think we always need to be careful in adding more labels but if they have some validity then it should be added.

    People riding off others as crazy will continue to happen regardless of these changes so not sure it has any real implications for the general public and the stigma attached to mental health.

  5. Mkhululie,

    I’m for more natural treatments as well. Before I pop a pill, I look for a less invasive form of treatment.

    “FYI, if one misdiagnose a problem or someone, they will surely misunderstand or mistreat the problem/ them.”

    Agreed.

  6. wanderlust,

    “We are all at some points in our lives anti-social, or a bit obsessive but for those who are at a level where it is a disorder it interrupts their lives to an extreme point.”

    Yes, I think people –that is, those without formal training– who diagnose others with personality disorders don’t realize or don’t care that personality disorders are an extreme and extremely disruptive to the person themselves. If someone is normally extremely introverted, rude, and detached, that hardly means they have antisocial personality disorder.

    “People riding off others as crazy will continue to happen regardless of these changes so not sure it has any real implications for the general public and the stigma attached to mental health.”

    I guess what critics are saying is that the DSM-V will widen what is considered “crazy”…because psychiatrists can say what they want but the general perception of people with disorders is that they are nuts.

    It’s enough that we have diagnoses like OCD, BPD, etc, but when you label someone who is intensely grieving over the loss of their relationship for a year as disordered then you’re including a whole lot of people. Also, who doesn’t behave “disordered” in the face of a traumatic event?

  7. At work I have to supervise a graduate who doesn’t have a lot of experience. I care about the way work is done and I also want him to learn how to do things properly as it will really help him as he progresses in his career; So I end up correcting him quite a lot and also explaining how things should be (you can read that as lecturing). It’s never nice to have someone crit your work and point out mistakes, but I don’t rub it in and I let him know they’re mistakes everyone has made.

    My colleague has decided I am an OCD control freak and thinks I don’t like the guy so am being mean. Although I’m quite a detail orientated person, I think my colleague’s judgement is mostly because I work differently and also that I have been given more responsibility.

    It seems wrong that I’m made to feel like paying attention to the detail is a fault (I work as a structural engineer designing buildings). I don’t think people would have thought that in the past. I think it’s good now that other skills are appreciated, but we don’t live in a one size fits all world, so having different people with different skills is a strength.

    (the rest of my comment is totally off topic)

    The extra history to this is that a friendship between me and my colleague soured, which is definitely a factor. It’s one of those situations where you realise someone no longer has a good word to say, but most revealing of their attitude are the conclusions they jump to & the (negative) assumptions they make 😦

    I don’t really know when things started to go wrong, there was a while when I didn’t understand why my colleague seemed to never be around to chat/take lunch and then it developed from there. I don’t wear my heart on my sleeve and I don’t think my colleague realises I’ve been noticing everything. I’ve picked them up a few times when their attitude has crossed the line, and that has made things worse (predictably). It’s difficult because when people say really unreasonable stuff, it’s where the stuff comes from which is the real problem, not the words they said. It would be good to have a chat to clear the air, but I don’t know how we could actually get talking about whatever is underlying it all.

  8. Everyone just wants to be like everyone else. We want to be normal. When one of us is ‘abnormal’ then most everyone misunderstands or are just frightened by these people. Many people don’t want others to be different then how they think people should be because this challenges their world view. If someone else can be different then maybe they could be different too and people are frightened of this thought. It is easier to try to make everyone ‘normal’ like you than to accept that there are many different normals.

  9. Fred,

    Your situation is a perfect example of someone labeling another as having a personality disorder because they don’t like or understand the person’s behavior/quirks.

    The majority of people who are very detail-and structure-oriented do not have OCD. Even if you did have OCD, unless your colleague is a licensed psychiatrist they are hardly equipped to make that diagnosis, even just as a “maybe” thing.

    As far as your friendship goes, I can’t tell which way you should go without knowing more details. But all friendships aren’t built to last; perhaps not even most are. So if the friendship has gone downhill you may just have to accept that and go your own way.

  10. Froggie,

    I’m confused. Are you saying that people wants others to be like them — normal, so they diagnose people who differ from them with disorders so they can keep “normal” the same instead of broadening it?

  11. As weird as that may sound, normal and “crazy” are cultural constructs. So I am not surprised that certain human behaviors are labeled as illnesses. This is culture-specific. I mean, not that long time ago, homosexuality was considered a mental illness. In certain cultures (like medieval Europe), epilepsy was seen as a sign of being possessed (or something). While I’m not one of those people who believe there’s no such a thing as a mental illness (only various degrees of socially acceptable and unacceptable behavior), I also think the way mental conditions and potential illnesses are seen is a cultural construct.

  12. Alee,

    If people accept other personalities as normal as opposed to disordered then there would be nothing wrong with them living in a similar manner as ‘disordered’ people. This would challenge people world views, which is frightening for many people. So instead of accepting other people as normal they would rather mark them as the other so they can keep their view of the world intact.

    An example of this would be how some people view homosexuality as abnormal or disordered. If they were to accept homosexuality as a normal part of human life then maybe they might find that they themselves may have homosexual tendencies. It is much easier for people to deny normalcy to others then to accept that their world views could be flawed in any way.

  13. I saw this (Mis)diagnosing of colleagues especially where I worked, in the financial industry. Oftentimes one was made to feel abnormal because one didn’t behave/perform similar to most of one’s colleagues. A very restricting industry on one’s personality.

    I agree with Froggie’s brief summation: It’s the pharmaceutical industry’s tight hold on our pockets. Fuckers are like bankers in many respects.

  14. Mira,

    “I am not surprised that certain human behaviors are labeled as illnesses. This is culture-specific”

    Agreed. Even within a large culture (say, the US) there are different ideas about what is considered “normal”. In certain communities no one blinks an eye at certain behaviors, while in other communities it’s considered cause for serious alarm.

    “I’m not one of those people who believe there’s no such a thing as a mental illness”

    I’m not either, but I do think some of what is considered mental illness isn’t very legit.

  15. Froggie,

    Thanks for your thorough response. 😉

    “Seems as if crazy is becoming the new normal.”

    This is why I can’t take these things seriously…

    foosrock,

    “I agree with Froggie’s brief summation: It’s the pharmaceutical industry’s tight hold on our pockets. Fuckers are like bankers in many respects.”

    Oh, but they are much easier to avoid. Just don’t take their drugs. 🙂

  16. You can avoid bankers by hiding your money under your mattress! Of course the two situations don’t compare in every respect.

  17. You can avoid bankers by hiding your money under your mattress!

    LOL!. But then you lose out on the interest and worse case someone breaks into your home and steal it. Oh, wait, the banks……

    One of my ex work colleagues takes medication for any little ache. She’s annoying as fuck. (Alee, delete my “French” if you find it offensive. I just love expletives and think they’re so apt). It’s chronic sicklies like her who’re responsible for the horrendous cost of medical insurance. Since I’ve known her, she’s been in “therapy”. I don’t see it helping much. Instead, her pill popping has increased. I suggested once that perhaps she should try marijuana and she nearly had a conniption, strongly telling me off that it’s an illegal drug and not good for one. By the way, the Swiss system tolerates a small amount of marijuana for personal use. Caught with over a certain amount, you’re fined.

  18. foosrock,

    “I suggested once that perhaps she should try marijuana”

    Lol, that sounds like something you’d say.

    Swears are okay as long as they’re not every other word.

  19. Part of the reaction to the DSM, and psychiatry/psychology in general, is that root causes of mental illnesses aren’t known because we don’t understand the brain well enough. So diseases are defined by putting together constellations of symptoms, which is a subjective process. That’s not the most desirable way to approach the problem, but given a lack of alternatives, it’s the best that can be done at this point. Surely something is better than nothing?

    I think you’re right though that this process is susceptible to societal bias. On some level, characteristics that society considers undesirable are prone to being considered illnesses. The mental health professions explicitly grappled with this question in the 1960s when they decided whether to remove homosexuality from their list of psychiatric diseases. The question really comes down to whether society should change to accommodate variations among individuals, or whether the individuals should be forced to change (or to attempt to change, anyway) to accommodate society’s demands.

    I don’t know if you’re aware of the following book, but I thought I’d mention it:

    “Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self”

    This book came out shortly after the introduction of SSRIs, the latest generation of antidepressants, which happened in the late 1980s. Before that point, antidepressants carried so many side effects that they tended to be only prescribed to the most severely depressed patients, but the new drugs carried much fewer side effects, making their use much more prevalent.

    The author, psychiatrist Peter Kramer, observed that SSRIs were having the effect of making patients more extroverted. He postulated that our society prefers extroverts in many, many ways, and so these drugs could be viewed as a way to “fix” introverts or help them fit into a society that really didn’t want them. He put it more elegantly than I have, I’m sure. Anyway, I remember the book attempting to grapple with the ethics of this.

  20. smartacus,

    “Surely something is better than nothing?”

    Not necessarily. Too much subjectivity and lack of actual facts can make for a true disaster when it comes to personality issues because everyone will be applying their own bias and methods to their “diagnoses”.

    “I don’t know if you’re aware of the following book”

    I wasn’t. Thanks for the info. The way people used to view homosexuality and introversion (actually, I think a lot of people still view it that way…) is a perfect example of what I mean.

  21. Alee, I don’t mean something is better than nothing in every possible situation.

    I just mean that I don’t have any doubt that real mental illnesses exist. The lines may be somewhat blurry, but I wouldn’t buy the argument that someone diagnosed with schizophrenia only has an extreme personality. Hearing voices that tell you to do self-destructive things would be an undesirable trait in any society. Brains, like any other human organ, can fail or be defective. And many people are better off with the treatments that exist, both pharmacological and non-pharmacological.

    So, I don’t really think there’s much of an option to NOT have a science of psychiatry, even if we acknowledge that it’s in its infancy, and it’s crude, and it still gets important things wrong.

  22. smartacus,

    “I just mean that I don’t have any doubt that real mental illnesses exist.”

    I’m not saying that at all.

    What I’m saying (in the post and in the comments) is that the way things currently are people are haphazardly being diagnosed with mental illness, by professionals and laypeople (the latter may be the greatest issue). I read the current estimate for mental illness is 1 out of every 5 persons…I think not.

    “The lines may be somewhat blurry, but I wouldn’t buy the argument that someone diagnosed with schizophrenia only has an extreme personality.”

    Mental disorders an extreme in the sense that they are not in the range of normal.

  23. I absolutely agree. We are like normal people. In fact, very normal people! To quote: It is very, very importantly necessary to understand that these are not personality disorders but personalities, well within the realm of normal human behavior, response, and outlook.

  24. If everyone was was suffering from schizophrenia then they would not be suffering from it. If a mental disorder wasn’t actually a disorder, but was in fact the normal then it wouldn’t be a disorder. If it was common place our society would be centered around such a person and how they think and act. It would be understood by all because it wouldn’t be seen as odd or scary. If schizophrenia was the norm it would probably not even have a name. It would just be a natural and normal part of life.

  25. @ Alee
    Okay, if I take your meaning, you feel that mental illnesses are being defined too expansively. It’s hard to say, but it’s a valid point of view. Ultimately, I don’t think we’ll ever have a fully satisfying definition of mental illness, at the very least until we understand the brain better and can attach cause and effect to various dysfunctions.

    Even then, I don’t think the debate about what is a dysfunction will entirely go away. There will always be value judgments that are made. For example, you could extend the analogy I made to physical illnesses, not just mental ones: Is a paraplegic a person with a disease, or does society just discriminate against people with legs that don’t work?

  26. @ Froggie
    I don’t know about that one. I don’t think the situation could even theoretically exist in which schizophrenia became the accepted norm.

    Untreated schizophrenia is a pretty serious impairment. Frankly, if everybody was schizophrenic and didn’t have medication to treat it, I think the entire human race might go extinct.

  27. Unless it only impairs people living in the world we live in which schizophrenia is abnormal. While you are probably correct about extinction being probable it is impossible to know without experimentation which would be impossible to do.

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