Professional Avoidance of Diagnosing or Treating Individuals who suffer from Personality Disorders
There exists a common reluctance among mental health providers to diagnose or treat individuals whom they suspect may suffer from a personality disorder.
Even when mental health professionals suspect a personality disorder may be the root cause of a family situation, there is often a reluctance to apply the label of personality disorder to an individual.
This can happen for a number of reasons:
Lack of knowledge about PD's - Even among mental health professionals, there is often a lack of understanding about how people who suffer from personality disorders function and how that affects the dynamics of a relationship. Some even doubt if personality disorders are "real" mental illnesses.
Stigma - most people don't like being labeled as "personality-disordered" or having a mental health diagnosis assigned to them for fear of what people will think. This creates reluctance among certain mental health professionals to label someone as "personality-disordered".
Avoidance of conflict - sometimes people who suffer from personality disorders can become angry, vindictive or even violent - and many mental health professionals who want to create a positive environment for themselves and their clients will skirt around the issue without applying the label "personality disorder" in the hope that they can avoid conflict.
Sense of Hopelessness - there is a belief among some mental health professionals that personality disorders are incurable and therefore not treatable effectively.
Lack of Qualification - Many therapists who are the first line of care for people who suffer from personality disorders do not have the requisite psychiatric or psychological qualifications to perform a full-blown clinical diagnosis or to prescribe medications.
Fear of losing a client - Many therapists fear that if they confront a client with a label or diagnosis of a personality disorder, the client will leave them.
Fear of dependency - Some people who suffer from personality disorders can become very emotionally attached to a therapist and begin to feel increasingly dependent on them. Some therapists will avoid people who suffer from certain types of personality disorders - especially DPD, BPD, ASPD & HPD for fear of stalking, harassment, after-hours calls, inappropriate or unprofessional sexual advances etc.
When diagnosis does happen
Full blown diagnosis of personality disorders often has to be completed by a clinical psychologist or psychiatrist, and often involves the use of written exercises, interview exercises and observation over several visits. This makes diagnosis expensive and rare and few people volunteer themselves to be tested for such a diagnosis.
For this reason, diagnosis of personality disordered individuals is typically only performed on those who are hospitalized, those who are subjected to diagnosis through the criminal justice system or those who are involved in a civil dispute - most commonly in a custody dispute over parental access to children.
Where diagnosis is administered in this way, people are often incentivized by the stakes or institutions involved to pursue treatment, therapy or work on their behavior. Therefore the prognosis for diagnosed people is better than that for those who are not diagnosed. A number of studies done on treatment programs such as CBT or DBT have had high success rates.