Talk:Personality disorder: Difference between revisions
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:"Personality disorders are represented on Axis II of the DSM-IV, and are particularly controversial because they often seem sexist, " |
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Which ones are regarded as being sexist? -- [[User:The Anome|The Anome]] 10:04, 23 Jun 2004 (UTC) |
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== [[Bipolar disorder]] == |
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: (this sentence has since been removed from the article) [[User:Sietse Snel|Sietse]] 13:41, 16 Oct 2004 (UTC) |
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Bipolar disorder is NOT a PERSONALITY disorder. They might exist together, but are seperate Axis I, and Axis II disorders. |
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== Criticisms == |
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Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior. |
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I think the criticisms as they currently stand are an excellent academic critique but a little abstruse. Terms like "diagnostic heterogeneity", "construct validity", and "temporal stability" could be simplified or explained like the "diagnostic heterogeneity" one is. What about replacing "temporal stability" with "consistency of symptoms over time"? I think the overall impression is fine but I suspect many a reader will not understand the basic thrust of the complaint. It might be worth saying that none of the current criticism denies the existence of PDs as such. It is also worth mentioning the clusters as being the outcome of cluster analysis studies and a recognition of the essentially blurred categories. Now I don't know enough about that to write about it. |
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People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder. |
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At present there is no real antipsychiatry debate. None of the "myth of mental illness" that was based on psychopathy after all. It's been ages since I read it but I guess I could pick it up again. --[[User:CloudSurfer|CloudSurfer]] 10:23, 14 Oct 2004 (UTC) |
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:I didn't notice this before. You're right. I tried to make it more accessible. |
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The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there). [[User:Sonurajsharma|Sonurajsharma]] ([[User talk:Sonurajsharma|talk]]) 04:36, 30 July 2022 (UTC) |
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:I doubt the claim that noone denies the existence of PD's however. In my opinion, the dimensional position is a denial of the existence of PD's (at least their existence as disorders which are qualitatively different from 'normal' functioning). [[User:Sietse Snel|Sietse]] 10:54, 15 Oct 2004 (UTC) |
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== intro too abstract == |
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::Yeah, I reread what Sam had written and I agree - on a dimensional basis as described. The counter argument is that ALL disorders and diseases are dimensional but someone draws a line in the sand and says on this side it is sub-clinicial and on that side it is a diseases. We could be talking about asthma or PDs. Diseases are not black/white, they are dark grey - grey - light grey. All of the criteria in DSM could be seen as dimensional. By the way, I made a comment on the project psychopathology talk page about symptoms/signs having only just seen your reply. --[[User:CloudSurfer|CloudSurfer]] 11:45, 15 Oct 2004 (UTC) |
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I'm sorry but the introduction describes an amorphous psychological blob. I minored in psychology, and I can't understand it. From the first sentence: |
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″ enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture.″ |
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:::OK Guys, I have now gone into bat for the DSM to provide some balance. See what you think. [Grin] --[[User:CloudSurfer|CloudSurfer]] 10:22, 16 Oct 2004 (UTC) |
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That describes depression, bipolar, sociopathy, schizophrenia, and pretty much every other mental illness. The rest of the intro seems to go into detail, but there's a lot of repetition of the same abstract phrases; doesn't help. EG: |
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:::: Okay, DSM versus Critics: 1-1. But seriously, the section indeed needed some pro-DSM arguments to make it less one-sided. Good work! |
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* enduring behavioral and mental traits |
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* enduring collection of behavioral patterns |
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* deviating from those accepted by the individual's culture |
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* deviate from social norms and expectations |
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Teach with examples. With bullet points, describe a handful of PD disorders (most common) and also describe similar but non-PD disorders, and why they're not classified as PD. Describe them in enough detail so that one could say "Oh yeah, I know a guy like that". Don't say "patient was deviating from social norms"; be more specific like "patient might pull his pants down in public" or something concrete like that. [[User:OsamaBinLogin|OsamaBinLogin]] ([[User talk:OsamaBinLogin|talk]]) 10:39, 26 April 2022 (UTC) |
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:::: I would also like to add something to the things I have written about the position that PD's 'do not exist'. Of course, you are right that (just about) every disease or disorder can be seen as dimensional instead of categorical. Seeing PD's as not categorically different from normal functioning is in itself not enough reason to deny that they exist. In my opinion, the difference with other diseases is that, presumably, no one would argue that the criteria/symptoms of, say, asthma are neutral. Never shortness of breath is good. Often shortness of breath is bad. I assume that practically everybody would agree. The case is different for personality disorders in my opinion. For example, I don't agree that more emotional flatness, or more desire for solitude is necessarily a bad thing. The argument, as I understand it, is that personality disorders are not categorically different from 'normal functioning', and that the dimensions on which there is a difference are arguably neutral to some extent. [[User:Sietse Snel|Sietse]] 16:22, 17 Oct 2004 (UTC) |
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:: @[[User:OsamaBinLogin|OsamaBinLogin]] The page is meant to reflect what the relevant commonly uses; IMO many personality disorders in the past are now defunct in part for being arbitrary, and the ones that are still in the DSM-5 are defined fairly anomalously. The way that PDs are defined is that to meet a diagnosis a person only needs some subset of a list of symptoms, which necessarily means that statements about them end up being broad/vague because different PDs don't have much in common. |
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:::::Yes! This is the nub of it. The key DSM criterion is, "The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning". (General diagnositc criteria for a PD. By the way, these general criteria really belong on the article page.) So, if the person does not present their personality as causing clinically significant distress, that is one point. Then comes the subjective part. The judgement as to whether the remaining elements are present. However, usually the person is willingly sitting in your office because of such problems so there is usually no contest. --[[User:CloudSurfer|CloudSurfer]] 23:21, 16 Oct 2004 (UTC) |
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:: That also means what you are suggesting to add examples seems problematic at face value, as person 1 with a hypothetical 1-PD might "might pull their pants down in public", person 2 with 1-PD may not, and person 3 with another hypothetical 2-PD may only "pull their pants down in public" only when experiencing "frantic efforts to avoid real or imagined abandonment." (Which is one of the criteria for BPD.) If you can find a reliable source with qualitative reports that could be used as examples, that could potentially be used, but I think it would be [[WP:OR]] in any other case due to the diverse causes and presentations of PDs. |
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:: I will number the things you have pointed out as 1-4.To illustrate that these are accepted descriptions from the psychology community, I will quote the opening section on personality disorders from the DSM-5: |
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:: "A personality disorder is '''an enduring pattern of inner experience and behavior''' that '''deviates markedly from the expectations of the individual’s culture''', is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment." |
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:: 1 and 2: an enduring pattern of inner experience and behavior |
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:: 4: deviates markedly from the expectations of the individual’s culture |
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:: That being said, I do think the article could be better written and structured. I don't think it's possible to summarise all 10 currently recognised PDs in the lead section. But it could help to move the table "Millon's brief description of personality disorders" further to the top of the page, maybe [[WP:SS]] at least for the 10 ones in the DSM-5, maybe more clearly distinguishing those from PDs no longer recognised. |
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:: I started by filling in the epidemiology table, and hope to improve other parts of this article too. |
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:[[User:Darcyisverycute|Darcyisverycute]] ([[User talk:Darcyisverycute|talk]]) 14:23, 26 April 2022 (UTC) |
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::Thanks for your reply and explanation. The issue is comprehension by laymen, vs scientific accuracy. Meanwhile, the DSM will be revised over the years. I know that when I started reading psychology, many terms seemed so nebulous as to not have any meaning. I'm thinking about that level of understanding in the audience. Details must be left out; you can't ram it all into their brains without a BS degree. |
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::Most people know someone with PD, or see them in the news. While it's dangerous to diagnose people at a distance, seeing concrete examples makes all the difference. Maybe, case study is what's called for - used all over the medical and psychological world. |
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::Millon's table is a great start - but again, each definition must be very general to be accurate. Brief descriptions of his brief descriptions would help - they all seem very different. And, there's 14 of them. Simplify, simplify. Take 3 or 4 of them - different extremes - and the first sentence in each description is a brief summary. NO MORE. That's good for a quick intro to PD. "Here are some example PDs:" then a bulleted list. |
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::How about Willy Loman in [[Death of a Salesman]]? Specific example, many people know the story, and he seems to exhibit lots of PD symptoms - Borderline, Avoidant, I don't know. The advantage of Willy Loman is you don't have to explain the story - it's already published. |
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::[[User:OsamaBinLogin|OsamaBinLogin]] ([[User talk:OsamaBinLogin|talk]]) 21:21, 5 March 2024 (UTC) |
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:::There are different phenomena that Wikipedia has pages for that are difficult to understand for a layman. Relativity for example. The reason Personality Disorders (PD), which are very real, are difficult to explain is because it is very meta, and I personally feel the article does a pretty good job explaining why this is. (Everyone has a personality. People with a PD have personalities that aren't working very well for them and often for those around them.) |
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:::To your point, while the initial sentence can be applied to the other mental health maladies you mentioned, all of them have additional diagnostic criteria that must be met for a diagnosis. If you sat in one of my groups for those with PD's, it wouldn't take you long to realize that something wrong was happening with them that was global, resistant to treatment, and resistant to the client's own awareness. Some might have co-occurring mental health issues such as Bipolar, but these are honestly, usually not difficult to tease out of the pathology picture. |
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:::Finally, all of this are models we use to understand a real world mental health phenomenon that doesn't fit into a "medical model" of mental health very well, one of discrete illnesses - thus a Dimensional approach/model is far more helpful to understanding what is going on, in order to help the client understand what is going on, in order to help them change it. - Retired [[Special:Contributions/129.228.28.197|129.228.28.197]] ([[User talk:129.228.28.197|talk]]) 09:48, 8 November 2024 (UTC) |
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== Neurobiological correlates - hippocampus, amygdala and not prefrontal cortex? == |
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::::::I think I see what you mean, but I don't agree. The impairment-criterium sounds neutral. I concur that in most cases clients would agree about whether they have such impairments, but I still think that such judgements can be especially subjective when they concern people with personality disorders. For example, judging social impairment in someone who is thought to have a paranoid personality disorder almost by definition involves disagreement with the client. The client will surely blame someone else. In addition to possible disagreement about impairments, I also think that at least some kinds of impairment are only problematic if they are seen as such by the client (e.g. social impairments that do not involve antisocial behaviour), even if the clinician thinks that it causes problems. Clients come to treatment to solve problems, but personality disorders are often secondary diagnoses, so a client may think that an impairment is not a problem. For these reasons, I think that the impairment-dimension is also (arguably) neutral. [[User:Sietse Snel|Sietse]] 16:22, 17 Oct 2004 (UTC) |
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cf [[#Neurobiological correlates - hippocampus, amygdala]] - I would think a developmental disorder of the [[prefrontal cortex]] would also play a role? Anybody has time to delve into that? Thy, [[User:SvenAERTS|SvenAERTS]] ([[User talk:SvenAERTS|talk]]) 12:32, 18 August 2022 (UTC) |
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:::: I'll reply to your points about [[Insanity]], symptom categories, and [[Homosexual panic]] on the talkpages of those articles. Sorry if I missed any earlier replies. My watchlist apparently sometimes misses updates. [[User:Sietse Snel|Sietse]] 13:41, 16 Oct 2004 (UTC) |
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== There must be a criticism section somewhere in the academic literature. == |
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== List of personality disorders not covered in this page == |
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The whole world became witness recently of two professional psychotherapists having completely opposing views on the 'spectrum' and 'disorder' of the same individual. Nothing happened against any of them because they could both rely on the generalized nature of the guidelines that can easily mislead in court towards any 'spectrum' or 'disorder' because of the subjectivity and also broad nature of the guidelines. [[User:Fs|<b><span style="color:#336666;">f</span><span style="color:#339999;">s</span></b>]] 07:49, 13 November 2022 (UTC) |
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*Intermittent Explosive Disorder |
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*Bipolar Disorder |
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*Separatemental Disorder [http://www.deltabravo.net/custody/malice.htm] |
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:How mental health issues/phenomena are presented/used in court such as "Innocent by reason of insanity" and "Incompetent to stand trial" have little to do with the field of mental health, neither diagnosis and/or treatment. Like everything else about our criminal justice system, its twisted, bent and broken by lawyers, judges, and the law. Its - highly - unfortunate that Forensic Psychology is used for this purpose as it damages the general public's understanding and beliefs about mental health, intensifying the stigma, making it hard for those who have mental health issues from getting help and being supported by those around them regarding these issues. [[Special:Contributions/129.228.28.197|129.228.28.197]] ([[User talk:129.228.28.197|talk]]) 10:16, 8 November 2024 (UTC) |
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This list may be indicative of absence of systematic taxonomical distinctions (in my own mind) between what appear just to be called "disorders" and "personality disorders". [[User:Matthew Stannard|Matt Stan]] 10:33, 18 Dec 2004 (UTC) |
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== Too Long == |
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This article is so long and detailed - it's huge! Maybe it should be broken up? I have no idea how. <!-- Template:Unsigned --><small class="autosigned">— Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:OsamaBinLogin|OsamaBinLogin]] ([[User talk:OsamaBinLogin#top|talk]] • [[Special:Contributions/OsamaBinLogin|contribs]]) 21:32, 5 March 2024 (UTC)</small> <!--Autosigned by SineBot--> |
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Bipolar disorder is NOT a PERSONALITY disorder. They might exist together, but are seperate Axis I, and Axis II disorders.
Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.
People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.
The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there). Sonurajsharma (talk) 04:36, 30 July 2022 (UTC)
intro too abstract
[edit]I'm sorry but the introduction describes an amorphous psychological blob. I minored in psychology, and I can't understand it. From the first sentence:
″ enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture.″
That describes depression, bipolar, sociopathy, schizophrenia, and pretty much every other mental illness. The rest of the intro seems to go into detail, but there's a lot of repetition of the same abstract phrases; doesn't help. EG:
- enduring behavioral and mental traits
- enduring collection of behavioral patterns
- deviating from those accepted by the individual's culture
- deviate from social norms and expectations
Teach with examples. With bullet points, describe a handful of PD disorders (most common) and also describe similar but non-PD disorders, and why they're not classified as PD. Describe them in enough detail so that one could say "Oh yeah, I know a guy like that". Don't say "patient was deviating from social norms"; be more specific like "patient might pull his pants down in public" or something concrete like that. OsamaBinLogin (talk) 10:39, 26 April 2022 (UTC)
- @OsamaBinLogin The page is meant to reflect what the relevant commonly uses; IMO many personality disorders in the past are now defunct in part for being arbitrary, and the ones that are still in the DSM-5 are defined fairly anomalously. The way that PDs are defined is that to meet a diagnosis a person only needs some subset of a list of symptoms, which necessarily means that statements about them end up being broad/vague because different PDs don't have much in common.
- That also means what you are suggesting to add examples seems problematic at face value, as person 1 with a hypothetical 1-PD might "might pull their pants down in public", person 2 with 1-PD may not, and person 3 with another hypothetical 2-PD may only "pull their pants down in public" only when experiencing "frantic efforts to avoid real or imagined abandonment." (Which is one of the criteria for BPD.) If you can find a reliable source with qualitative reports that could be used as examples, that could potentially be used, but I think it would be WP:OR in any other case due to the diverse causes and presentations of PDs.
- I will number the things you have pointed out as 1-4.To illustrate that these are accepted descriptions from the psychology community, I will quote the opening section on personality disorders from the DSM-5:
- "A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment."
- 1 and 2: an enduring pattern of inner experience and behavior
- 4: deviates markedly from the expectations of the individual’s culture
- That being said, I do think the article could be better written and structured. I don't think it's possible to summarise all 10 currently recognised PDs in the lead section. But it could help to move the table "Millon's brief description of personality disorders" further to the top of the page, maybe WP:SS at least for the 10 ones in the DSM-5, maybe more clearly distinguishing those from PDs no longer recognised.
- I started by filling in the epidemiology table, and hope to improve other parts of this article too.
- Darcyisverycute (talk) 14:23, 26 April 2022 (UTC)
- Thanks for your reply and explanation. The issue is comprehension by laymen, vs scientific accuracy. Meanwhile, the DSM will be revised over the years. I know that when I started reading psychology, many terms seemed so nebulous as to not have any meaning. I'm thinking about that level of understanding in the audience. Details must be left out; you can't ram it all into their brains without a BS degree.
- Most people know someone with PD, or see them in the news. While it's dangerous to diagnose people at a distance, seeing concrete examples makes all the difference. Maybe, case study is what's called for - used all over the medical and psychological world.
- Millon's table is a great start - but again, each definition must be very general to be accurate. Brief descriptions of his brief descriptions would help - they all seem very different. And, there's 14 of them. Simplify, simplify. Take 3 or 4 of them - different extremes - and the first sentence in each description is a brief summary. NO MORE. That's good for a quick intro to PD. "Here are some example PDs:" then a bulleted list.
- How about Willy Loman in Death of a Salesman? Specific example, many people know the story, and he seems to exhibit lots of PD symptoms - Borderline, Avoidant, I don't know. The advantage of Willy Loman is you don't have to explain the story - it's already published.
- OsamaBinLogin (talk) 21:21, 5 March 2024 (UTC)
- There are different phenomena that Wikipedia has pages for that are difficult to understand for a layman. Relativity for example. The reason Personality Disorders (PD), which are very real, are difficult to explain is because it is very meta, and I personally feel the article does a pretty good job explaining why this is. (Everyone has a personality. People with a PD have personalities that aren't working very well for them and often for those around them.)
- To your point, while the initial sentence can be applied to the other mental health maladies you mentioned, all of them have additional diagnostic criteria that must be met for a diagnosis. If you sat in one of my groups for those with PD's, it wouldn't take you long to realize that something wrong was happening with them that was global, resistant to treatment, and resistant to the client's own awareness. Some might have co-occurring mental health issues such as Bipolar, but these are honestly, usually not difficult to tease out of the pathology picture.
- Finally, all of this are models we use to understand a real world mental health phenomenon that doesn't fit into a "medical model" of mental health very well, one of discrete illnesses - thus a Dimensional approach/model is far more helpful to understanding what is going on, in order to help the client understand what is going on, in order to help them change it. - Retired 129.228.28.197 (talk) 09:48, 8 November 2024 (UTC)
Neurobiological correlates - hippocampus, amygdala and not prefrontal cortex?
[edit]cf #Neurobiological correlates - hippocampus, amygdala - I would think a developmental disorder of the prefrontal cortex would also play a role? Anybody has time to delve into that? Thy, SvenAERTS (talk) 12:32, 18 August 2022 (UTC)
There must be a criticism section somewhere in the academic literature.
[edit]The whole world became witness recently of two professional psychotherapists having completely opposing views on the 'spectrum' and 'disorder' of the same individual. Nothing happened against any of them because they could both rely on the generalized nature of the guidelines that can easily mislead in court towards any 'spectrum' or 'disorder' because of the subjectivity and also broad nature of the guidelines. fs 07:49, 13 November 2022 (UTC)
- How mental health issues/phenomena are presented/used in court such as "Innocent by reason of insanity" and "Incompetent to stand trial" have little to do with the field of mental health, neither diagnosis and/or treatment. Like everything else about our criminal justice system, its twisted, bent and broken by lawyers, judges, and the law. Its - highly - unfortunate that Forensic Psychology is used for this purpose as it damages the general public's understanding and beliefs about mental health, intensifying the stigma, making it hard for those who have mental health issues from getting help and being supported by those around them regarding these issues. 129.228.28.197 (talk) 10:16, 8 November 2024 (UTC)
Too Long
[edit]This article is so long and detailed - it's huge! Maybe it should be broken up? I have no idea how. — Preceding unsigned comment added by OsamaBinLogin (talk • contribs) 21:32, 5 March 2024 (UTC)
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