How Psychological Disorders Should Be Diagnosed

              Personality disorders have long been assumed to be purely psychological and could only be diagnosed with behavior. This is evidenced by how the Diagnostic and Statistical Manual of Mental Disorders is arranged; it lists out a set of behaviors that is exhaustive and inclusive to help practitioners identify a psychological issue. Behaviors can be altered easily; People change their behavior when they are in different social circles, situations, and even as a job. If the only method of diagnosis is based on easily manipulated variables, then the validity of the diagnosis is variable. In addition to the DSM, mental disorders should be diagnosed by physical characteristics in the brain.

The article, Mind, Brain, and Personality Disorders describes mentalization as the ability to perceive others emotion. “A caregiver who ascribes mental states to the child, treats the child as a mental agent, and helps the child to create internal working models” (pg. 651). It explains that some children who have suffered from abuse cannot perceive others’ emotions as well because mentalization is a skill we learn through socialization. It implies that we learned how to smile when we are happy and frown when we feel anger but that is inaccurate because facial expressions are the same in all cultures. An article titled Universal Facial Expression of Emotion, concluded that facial expression is universal but the reaction to the stimuli to evoke certain facial expressions differs between cultures. Since the behavior is indistinguishable across cultures, it is a natural phenomenon and genetic. If a child needs to be taught how to process facial expressions, there is a defective gene which caused a defective brain.

              In 2007 a study on the frontal lobe of patients with borderline personality disorder showed that there was a physical difference in their brains. The size of the left orbitofrontal cortex and right anterior cingulate cortex was reduced. The right anterior cingulate cortex is associated with empathy, emotions, impulse control, and decision making and the left orbitofrontal cortex is associated with decision making and reward systems. The symptoms of borderline personality disorder include extreme emotional mood swings, impulsiveness, and poor decision making which are linked with the observable decrease in brain size in the areas mentioned above. Lower fractional anisotropy, a word to describe when osmosis is less restricted in all directions in the brain, which is associated with impulsiveness in schizophrenics is also observed in those with BPD (Jon E. Grant, 2007).

              Autism, a disorder with similar symptoms to BPD is explained as being “characterized by complete absence of mentalization on a neurological basis” also has the same physical representation such as a decrease in volume of the right anterior cingulate cortex (M. Mehmet Haznedar, 1997). Unlike autism, “a patient with borderline personality disorder often retains partial ability to mentalize under some circumstances” (Gabbard, 2005, p. 652). When looking at the physical manifestation of the psychological disorders, they appear to be the same disorder. However, they are assumed to be different because the severity of the symptoms are different.

              Autism is often undiagnosed in females. Because diagnoses of psychological issues are not performed with MRI machines, but determined by how people act, it is up to the sufferers to communicate there is something wrong by diverging from appropriate behavior. The problem arises when the disorder is present, but the symptoms are not. Autistic females do not deviate from acceptable behavior in ways other than communication impairment (Frazier, 2014). Studies have suggested that it is because there is more of a pressure on females to conform. Girls are motivated to have friends and they are subjected to bullying if they are not sociable. Gender roles may also be a factor as girls are raised to be nurturing and anti-social behavior contradicts those roles. Autistic symptoms do not conflict with the role of dominance for boys so autistic males do not have as much pressure on them to conform. Girls tend to mask their symptoms so they can receive less negative feedback, also called the camouflage hypothesis. Girls are less likely to show autistic behaviors and, therefore, less likely to diagnosed (Anna Cook, 2018).

               Coincidentally, borderline personality disorder is diagnosed in girls more than boys. It has been suggested that clinicians hold a female bias when diagnosing because the most known symptoms are more likely to be expressed in women. Another reason is differential justice, certain groups receive different consequences for the same behavior. For example, a woman self-destructive behavior may take drugs and end up in a mental hospital but a man with the same behavior will end up in prison and not get the treatment he needs(Randy A. Sansone, 2011).

              Not only are the brains of those diagnosed with autism and borderline personality disorder similar, the symptoms are as well. A study showed that 42 out of 62 women with autism could be diagnosed with a personality disorder based on the criteria in the DSM-IV. With that much overlap it is reasonable to assume that many autistic women are misdiagnosed with BPD and many men with BPD are misdiagnosed with autism. There are limitations to diagnosing psychological disorders through behavior only because how people react to illness and how they perceive their disorders differ, so the symptoms differ. It is imperative that psychologist recognize autism and BPD as a brain defect and make a standard model for a brain with those disorders. BPD and autism cannot effectively be diagnosed by how the patients act, it needs to be identified by what the brain looks like (Robert B. Dudas, 2017).

References

Anna Cook, J. O. (2018). Friendship motivations, challenges and the role of Masking for Girls. European Journal of Special Needs Education, 302-315.

Ekman, P. (1970). Universal Facial Expressions of Emotion. California Mental Health Research Digest, 151-158.

Frazier, D. T. (2014). Behavioral and Cognitive Characteristics of Females and Males. J Am Acad Child Adolesc Psychiatry, 329-340.

Gabbard, G. O. (2005). Mind, Brain, and Personality Disorders. Am J Psychiatry, 648-655.

Jon E. Grant, J. M. (2007). Frontal White Matter. The Journal of Neuropsychiatry and Clinical, 383–390.

M. Mehmet Haznedar, M. M. (1997). ANTERIOR CINGULATE GYRUS VOLUME. Am J Psychiatry, 1047-1050.

Randy A. Sansone, E. a. (2011). Gender Patterns in Borderline Personality Disorder. Innovations in CLINICAL NEUROSCIENCE, 16-20.

Robert B. Dudas, E. A. (2017). The overlap between autistic spectrum conditions and borderline personality disorder. PLoS ONE, 1-13.