Talk:Personality disorder
From the article:
- "Personality disorders are represented on Axis II of the DSM-IV, and are particularly controversial because they often seem sexist, "
Which ones are regarded as being sexist? -- The Anome 10:04, 23 Jun 2004 (UTC)
- (this sentence has since been removed from the article) Sietse 13:41, 16 Oct 2004 (UTC)
Criticisms
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.
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. --CloudSurfer 10:23, 14 Oct 2004 (UTC)
- I didn't notice this before. You're right. I tried to make it more accessible.
- 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). Sietse 10:54, 15 Oct 2004 (UTC)
- 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. --CloudSurfer 11:45, 15 Oct 2004 (UTC)
- OK Guys, I have now gone into bat for the DSM to provide some balance. See what you think. [Grin] --CloudSurfer 10:22, 16 Oct 2004 (UTC)
- Okay, DSM versus Critics: 1-1. But seriously, the section indeed needed some pro-DSM arguments to make it less one-sided. Good work!
- 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. Sietse 16:22, 17 Oct 2004 (UTC)
- 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. --CloudSurfer 23:21, 16 Oct 2004 (UTC)
- 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. Sietse 16:22, 17 Oct 2004 (UTC)
- 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. Sietse 13:41, 16 Oct 2004 (UTC)
List of personality disorders not covered in this page
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". Matt Stan 10:33, 18 Dec 2004 (UTC)