648 Personality Disorders
sonality disorder, which cannot be diagnosed in individuals younger than 18 years. Al-
though, by definition, a personality disorder requires an onset no later than early
adulthood, individuals may not come to clinical attention until relatively late in life. A per-
sonality disorder may be exacer bated following the loss of significant supporting persons
(e.g., a spouse) or previously stabilizing social situations (e.g ., a job). However, the devel-
opment of a change in person ality in middle adulthood or later life warrants a thorough
evaluation to determine the possible presence of a personality change due to another med-
ical condition or an unrecogn ized substance use disorder.
Culture-Related Diagnostic Issues
Judgments about personality functioning must take into account the in dividual’s ethnic, cul-
tural, and social background. Personality disord ers should not be confused with problems as-
sociated with acculturation following immigratio n or with the expressi on of habits, customs,
or religious and political values professed by the individual’s culture of origin. It is useful for
the clinician, especially when evaluating some one from a different background, to obtain ad-
ditional information from informants who are fa miliar with the person’s cultural background.
Gender-Related Diagnostic Issues
Certain personality disorders (e.g., antisocial personality disorder) are diagnosed more
frequently in males. Others (e.g., borderline, histrionic, and dependent personality disor-
ders) are diagnosed more freque ntly in females. Although these differences in prevalence
probably reflect real gender differences in the presence of such patterns, clinicians must be
cautious not to overdiagnose or underdiagnos e certain personality disorders in females or
in males because of social stereotypes about typical gender roles and behaviors.
Differential Diagnosis