Diagnosis

A number of issues have created debate related to the difficulty in and reliability
of the diagnosis of personality disorders. The distinction between
“normal” personality characteristics and a personality disorder is not necessarily
clear in the clinical definition of a personality disorder. The DSM-IVTR
notes that when personality traits are inflexible and create distress or impairment
in functioning, they constitute a personality disorder. Some argue
that there is considerable room for debate about the point at which a trait is
considered to create impairment.

The personality disorders have been the subject of criticism by researchers
because of the difficulty in diagnosing them reliably. Individuals with a
personality disorder often display symptoms of other personality disorders.
For example, researchers have debated about the distinction between schizoid
personality disorder and avoidant personality disorder, as both disorders
are characterized by an extreme in social isolation. Individuals with personality
disorders are more likely than the general population to suffer from
other psychological disorders, such as depression, bulimia, or substance
abuse. This overlap of symptoms may lead to difficulty with diagnostic reliability.
The personality disorders occur so frequently with other types of psychological
disorders that it is challenging to sort through symptoms to determine
what is evidence of each disorder. It is difficult to estimate the
prevalence of personality disorders in the United States, as individuals with
these disorders do not recognize that they are dysfunctional and are therefore
less likely to seek treatment.

Researchers have explored the problem of gender bias in the diagnosis of
personality disorders. It is believed that some of the symptoms of certain
personality disorders are more characteristic of one gender than the other.
For example, the aggression and hostility associated with antisocial personality
disorder may be traits associated more frequently with the average male
population, thus affecting the diagnosis among men compared to women.

This supposed gender bias is theorized to be related to the greater prevalence
of borderline personality disorder and histrionic personality disorder
among women compared to men. Perhaps some of the diagnostic symptoms
of this disorder, such as emotionality or fears of abandonment, have been
behaviors more often associated with the female population than the male
population.