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Why are so many personality disorders so similar? Does it cause misdiagnosis often?
I've wanted to be a psychiatrist for years but am struggling to find accurate sources I trust and have limited contact with professionals. If you have any tips on accurate sources for psychology and psychiatry they would be incredibly appreciated. Thank you for your time.
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Noah’s Answer
As someone who's both studying to be a psychologist and has been diagnosed with a personality disorder, I think I can give an interesting perspective on this. I personally think there are too many clusters of personality disorders than to be useful. That leads in to what Gena said about questioning diagnosis' efficacy. That said, there are some personality disorders I believe to be incredibly useful for treatment as long as they are interpreted correctly. These are antisocial, borderline, narcissistic and ocpd. In my opinion classifications like schizoid, schizotypal, histrionic, dependent, avoidant and even paranoid personality disorder are much less useful in the context of treatment since they can easily overlap into countless other disorders or variables that could be causing the client's symptoms.
For context, I have borderline personality disorder and have seen the diagnosis to be incredibly useful both in my personal experience and on the lives of others. The diagnosis also has a number of flaws, mostly due to misinterpretation on the professional's side and the stigma it carries in society at large. Those are still external problems which don't invalidate the disorder-type itself. In other words, understanding that someone has BPD can be a big step on the path to helping them whereas avoidant personality disorder, although not overtly harmful as a diagnosis is far more vague and doesn't necessarily give you any novel insights into the person's experiences or any other related symptoms they might have. For instance, I would also fit the classification for avoidant personality disorder but symptoms like fear of rejection, avoidant tendencies, shyness and anxiety could just as easily fit into the BPD diagnosis (which isn't to say that everyone who has avoidant personality disorder has BPD). This is why it's so important as a mental health professional to have a deep understanding of each classification and knowledge of it's "use-cases." At the end of the day, diagnosis is just one of the many tools in our toolbox and it isn't going to fit every situation so you'll have to adjust it and "tailor" each diagnosis you give to fit the client's needs.
For context, I have borderline personality disorder and have seen the diagnosis to be incredibly useful both in my personal experience and on the lives of others. The diagnosis also has a number of flaws, mostly due to misinterpretation on the professional's side and the stigma it carries in society at large. Those are still external problems which don't invalidate the disorder-type itself. In other words, understanding that someone has BPD can be a big step on the path to helping them whereas avoidant personality disorder, although not overtly harmful as a diagnosis is far more vague and doesn't necessarily give you any novel insights into the person's experiences or any other related symptoms they might have. For instance, I would also fit the classification for avoidant personality disorder but symptoms like fear of rejection, avoidant tendencies, shyness and anxiety could just as easily fit into the BPD diagnosis (which isn't to say that everyone who has avoidant personality disorder has BPD). This is why it's so important as a mental health professional to have a deep understanding of each classification and knowledge of it's "use-cases." At the end of the day, diagnosis is just one of the many tools in our toolbox and it isn't going to fit every situation so you'll have to adjust it and "tailor" each diagnosis you give to fit the client's needs.
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Gena’s Answer
Hi Keira,
I can appreciate your struggle. There is so much information out there of varying quality! Like you, many professionals are seriously questioning the current diagnostic system and even questioning the usefulness of diagnosis at all. There is even a group called ‘A Disorder 4 Everyone’ that raises some of the same questions you have here.
I find the work of Professor Peter Kinderman (the head of the British Psychological Society) contemporary, nuanced, practical and compassionate. He critically questions ‘popular’ thinking in psychiatry around diagnosis and treatment and proposes what I think is a more humane and pragmatic approach to thinking about and caring for people in distress.
Jonathan Shedler who is both a researcher and treating clinician, making him one of the most qualified to make comment in my view, questions the current ‘evidence based practice model’. Like Professor Kinderman, he makes a very good case for a more nuanced, more humane and ultimately more effective way of thinking about and caring for people in distress.
Here is a link to an interview with Jonathan:
https://www.google.com/search?q=jonathan+shedler+the+empiricals+new+clothe+s&rlz=1CDGOYI_enAU618AU618&hl=en-GB&sxsrf=APwXEdctamb450H9G-vLceQcpAWNhYfN5w%3A1686866301345&ei=fYmLZLXcFMDy4-EP3LysqAQ&oq=jonathan+shedler+the+empiricals+new+clothe+s&gs_lcp=ChNtb2JpbGUtZ3dzLXdpei1zZXJwEAMyBwghEKABEAoyBwghEKABEAoyBwghEKABEAoyBAghEBUyBAghEBU6CggAEEcQ1gQQsAM6BwgAEIoFEEM6CggAEIAEEBQQhwI6BQgAEIAEOgcILhCKBRBDOgYIABAWEB46CAgAEIoFEIYDOgUIIRCgAUoECEEYAFCmCVjON2CFOmgBcAF4AIABkQKIAZcnkgEGMC4yNy4xmAEAoAEBwAEByAEI&sclient=mobile-gws-wiz-serp#fpstate=ive&vld=cid:951674f2,vid:lBVezwSi2BU
You can find more about Peter Kinderman’s thinking here:
https://adisorder4everyone.com/bio/peter-kinderman/
https://www.abc.net.au/radionational/programs/allinthemind/does-mental-illness-exist/9130774
https://www.google.com/search?rlz=1CDGOYI_enAU618AU618&hl=en-GB&sxsrf=APwXEdcLE_7ezD8jGrrkSCJaYP9A-bPHYw:1686866061558&q=we.need.a.whole.new.approach+to.mental.health&tbm=vid&sa=X&ved=2ahUKEwjI2ofjocb_AhVITmwGHQ_cDJ8Q0pQJegQIBhAB&biw=375&bih=640&dpr=3#fpstate=ive&vld=cid:25a0a75c,vid:zO2-b8PzG3A
I find it so inspiring and hopeful when people who are starting out in their career question the status quo. I hope you keep your questioning, open mind throughout your career.
Gena
I can appreciate your struggle. There is so much information out there of varying quality! Like you, many professionals are seriously questioning the current diagnostic system and even questioning the usefulness of diagnosis at all. There is even a group called ‘A Disorder 4 Everyone’ that raises some of the same questions you have here.
I find the work of Professor Peter Kinderman (the head of the British Psychological Society) contemporary, nuanced, practical and compassionate. He critically questions ‘popular’ thinking in psychiatry around diagnosis and treatment and proposes what I think is a more humane and pragmatic approach to thinking about and caring for people in distress.
Jonathan Shedler who is both a researcher and treating clinician, making him one of the most qualified to make comment in my view, questions the current ‘evidence based practice model’. Like Professor Kinderman, he makes a very good case for a more nuanced, more humane and ultimately more effective way of thinking about and caring for people in distress.
Here is a link to an interview with Jonathan:
https://www.google.com/search?q=jonathan+shedler+the+empiricals+new+clothe+s&rlz=1CDGOYI_enAU618AU618&hl=en-GB&sxsrf=APwXEdctamb450H9G-vLceQcpAWNhYfN5w%3A1686866301345&ei=fYmLZLXcFMDy4-EP3LysqAQ&oq=jonathan+shedler+the+empiricals+new+clothe+s&gs_lcp=ChNtb2JpbGUtZ3dzLXdpei1zZXJwEAMyBwghEKABEAoyBwghEKABEAoyBwghEKABEAoyBAghEBUyBAghEBU6CggAEEcQ1gQQsAM6BwgAEIoFEEM6CggAEIAEEBQQhwI6BQgAEIAEOgcILhCKBRBDOgYIABAWEB46CAgAEIoFEIYDOgUIIRCgAUoECEEYAFCmCVjON2CFOmgBcAF4AIABkQKIAZcnkgEGMC4yNy4xmAEAoAEBwAEByAEI&sclient=mobile-gws-wiz-serp#fpstate=ive&vld=cid:951674f2,vid:lBVezwSi2BU
You can find more about Peter Kinderman’s thinking here:
https://adisorder4everyone.com/bio/peter-kinderman/
https://www.abc.net.au/radionational/programs/allinthemind/does-mental-illness-exist/9130774
https://www.google.com/search?rlz=1CDGOYI_enAU618AU618&hl=en-GB&sxsrf=APwXEdcLE_7ezD8jGrrkSCJaYP9A-bPHYw:1686866061558&q=we.need.a.whole.new.approach+to.mental.health&tbm=vid&sa=X&ved=2ahUKEwjI2ofjocb_AhVITmwGHQ_cDJ8Q0pQJegQIBhAB&biw=375&bih=640&dpr=3#fpstate=ive&vld=cid:25a0a75c,vid:zO2-b8PzG3A
I find it so inspiring and hopeful when people who are starting out in their career question the status quo. I hope you keep your questioning, open mind throughout your career.
Gena