Talk:Personality disorder

Profound lack of information on PD assessment

When reading through the section titled "Categorical vs Dimensional Approach", i noticed the following tow paragraphs, which stand out as not fitting in perfectly:

"In clinical settings, personality disorders are typically diagnosed through comprehensive interviews conducted by psychiatrists or clinical psychologists. These assessments often include a mental status examination and may be informed by collateral reports from family members or close acquaintances.

One structured approach to diagnosis involves standardized interviews accompanied by scoring systems. Patients respond to a series of questions, and trained clinicians evaluate their answers based on predefined diagnostic criteria. Although effective, this method is often time-consuming and resource-intensive, which may limit its practicality in some clinical settings."

I wanted to move them somewhere, but then I realized that this article quite frankly omits discussing assessment procedures at all. This would be of importance in the further development of this article, and fits well in this specific article, as specific PDs are also assessed through general PD assessment. I guess these paragraphs should not be removed immediately, and should perhaps be moved somewhere instead, in order to facilitate correct attribution in the article's history; I do not think it is a good idea to copy this back-and-forth between Talk and the Article. BlockArranger (talk) 23:37, 30 May 2025 (UTC)

I also think this section is a bit inaccurate in my opinion. In my (limited and anecdotal) experience most personality disorders are diagnosed after months or years of clinical observation and interviews/scoring tools are used to reinforce the diagnosis after suspicion has arisen. I don't think I have citations to back this up but while anxiety and depression screenings are often handed out on the first appointment with a clinician this is not true of personality disorders. The psychology field seems to have distanced itself from using rating scales and the like as the sole basis of a diagnosis for a PD. I'm not sure if I'm making my point correctly here but I think our current article has a very simplistic view of the diagnostic process for a PD. IntentionallyDense ^(Contribs) 04:42, 31 May 2025 (UTC)

Well, we could of course work on a draft section or subsection in a sandbox, for example. I suggest that people weigh in on this, suggesting what might be of the greatest importance to consider in this regard. Anecdotally, I know that there are several people who seem like they might have some things to say in this regard.

I know that it sometimes takes a lot of time until a PD is assessed for and diagnosed, but I would not say that it is strictly out of necessity. I would, again so far without referring to any specific studies, say that it seems like this may to a notable degree be a result of ideological opposition to the diagnosis of PDs, due to stigma and people seeing it as labeling someone as fundamentally "wrong" or bad as a person. However, it would stand to reason that this is furthered by PD diagnosis being directed to those with more severe pathology. BlockArranger (talk) 16:51, 31 May 2025 (UTC)

I agree, I'm focusing on the treatment section right now but once that is organized it may be a good idea to start a sandbox and get input from WP:MED and WP:PSYCH IntentionallyDense ^(Contribs) 03:03, 1 June 2025 (UTC)

I have another suggestion, namely that of creating a diagnosis section, which could include the "In children and adolescents" so that we could finally come close to deleting the awkward group called "Issues". I got the Categorical vs Dimensional section moved to Classification as that is the main difference between the current diagnostic systems. However, a lot of the information in the section could retire into the main article, if we could find newer content which actually fits well into the section. BlockArranger (talk) 19:22, 19 June 2025 (UTC)

Managment section

BlockArranger (ping since you have a lot of knowledge on this topic and we've discussed this before) I have revised the management section to provide a brief overview of what treatments are available for the various (DSM) PDs. I used the most up to date and high quality studies I could find for each disorder. While my addition definetly needs some copy editing and revisions, I think it is a good starting point. I think this allows us to get rid of much of the unsourced or unencyclopedic text under this heading.

The part I added was: There is a limited amount of evidence in regards to the treatment of AvPD, DPD, HPD, NPD, OCPD, PPD, SzPD, and StPD. Proposed treatments include behavioural therapy, cognitive therapy, brief psychodynamic treatments, schema therapy, graded exposure, social skills training, psychodynamic psychotherapy, and supportive–expressive psychotherapy for AvPD; clarification-oriented psychotherapy and cognitive therapy for DPD; lifestyle modifications, medication, and psychotherapy such as CBT or group therapy for HPD; psychodynamic therapy, cognitive therapy, and radically open dialectical behaviour therapy for OCPD; CBT for PPD; medication, socialization groups, and psychodynamic psychotherapy for SzPD; and risperidone, olanzapine, and social skills training for STPD. Treatment guidelines focused on managing ASPD and BPD emphasize treating comorbid diagnoses. For ASPD, NICE guidelines recommend group therapy focused on cognitive and behavioural techniques to manage symptoms and discourage the use of medication to treat the symptoms associated with ASPD. The Cochrane Review for ASPD found that there was no good quality evidence for the use of medication or therapy for the treatment of ASPD. The NICE review for BPD recommended DBT and discouraged the use of medications in the treatment of BPD symptoms. The American Psychiatric Association and Cochrane both found that psychotherapy was effective in treating BPD but that the evidence for medication was weak. IntentionallyDense ^(Contribs) 15:09, 4 June 2025 (UTC)

@IntentionallyDense Thank you for your contribution to the mission! I'll look into it and see if there is something I would like to changer and/or improve. BlockArranger (talk) 15:17, 4 June 2025 (UTC)

Although I haven't checked any of the sources you cited (unless I have by chance happened to read one in the past), I can say that this seems like a good starting point. However, I believe that this format would be more optimal for splitting into the specific PD management sections; I believe it would be better, especially in the longer term and for a sophisticated article to instead group by approach type first, like "psychotherapeutic approaches" and "pharmacological approaches", and then add subsections like CBT, DBT; antidepressants, antipsychotics and so on. Regarding medications, I am unsure how much we should dedicate to it (perhaps it does not need subsections), as medication is not understood to be a PD treatment; however, it is de facto used and research has been conducted on the topic. If we follow my idea, I believe it would be reasonable to design a structural outline here at talk first, because it may be rather radical to just go in and change everything at once, which seems to be what could be the result of any of our approaches. The cohesion is not optimal now to say the least, but the management section is really a work in progress anyway at this point. BlockArranger (talk) 21:07, 4 June 2025 (UTC)

I agree the cohesion is not great currently but I mostly wanted to give a starting place for readers. The issue I found is that aside from ASPD and BPD, there is no guidelines and barely any reviews. If we wanted to use the best sources possible, DPP, AvPD, and schizotypal would have virtually no information and as you could probably predict, BPD and ASPD would dominate the conversation. I do agree that we should be careful with our emphasis of medications in PDs. The guidelines I looked at basically said there is little to no utility aside from crisis situations and the treatment of comorbid conditions. Hopefully some of the sources I provided could give some more information as well. The other thing that I'm thinking is, how much detail is needed. For example, why would a reader want to read a lot about the management of BPD when the BPD article is certaintly more comprehensive. That's not to say that more detail isn't needed but just that I don't think it needs to be a particularly lengthy section. IntentionallyDense ^(Contribs) 05:24, 5 June 2025 (UTC)

Well, for starters it could be a good idea in my opinion to include as a fact that borderline and antisocial PDs have significantly more specific and recommended guidelines, whereas treatment guidelines are more lacking for some other PDs. I agree that this should not be a mirror of either the BPD or ASPD treatment sections. However, we could of course look into several treatment modalities that are used for PDs, and give of them short descriptions and perhaps the disorders they are especially suitable for, along with whatever else may be of relevance. I will hereby also ping @Lova Falk because she has been involved in the Wikipedia coverage of mental disorders for a long time. Perhaps we could also ask if any of the seemingly several very dedicated people over at Talk:Borderline personality disorder (and other actively discussed PDs as well) along with people at Wikipedia:PSYCH would have anything they could contribute in order to nuance the picture. If Lova Falk reads this, perhaps she has some ideas also concerning best practices for proceeding. BlockArranger (talk) 07:35, 5 June 2025 (UTC)

I agree, Tasman’s Psychiatry has a breakdown of management based on The Trait Domains which may be an interesting perspective to look at. This article breaks it down based on cluster and medication/therapy. These two articles both focus on early interventions . This source gives some cool tables with a breakdown of different modalities for different PDs . This book gives a huge overview of different modalities. This article focuses on a residential setting. This book again goes over the modalities and has a chapter on issues that arise during therapy. IntentionallyDense ^(Contribs) 03:24, 6 June 2025 (UTC)

BlockArranger I aplologise for the late answer. I haven't worked as a psychologist for eight years now, and I have basically left all psychology related articles. I have read what was written, but I have nothing really to contribute. Lova Falk (talk) 04:56, 8 June 2025 (UTC)

Thank you once again! I have so far only briefly read through the first source you provided, but it seems to be useful, indeed. In general, I believe that it would be unwise to have a huge expansion and possible duplication of content by grouping, say, first by cluster, then by AMPD/ICD-11 trait domains, followed by whatever else could come up. All of these things are useful as scientific evidence, but for an encyclopedic article on the topic, I believe a hierarchy of treatment modalities, with descriptions of how they work and what their aim is and how they are used for and impact upon personality disorder(s). I believe that it is very likely that these sources could be useful for me while editing several articles, so big thanks for that as well! I think now is a good moment to wait and see what others may think, so that we can form a better basis for our drafting of the new management content. BlockArranger (talk) 10:49, 6 June 2025 (UTC)

I agree with not wanting to duplicate material much. I think for the treatment section in general, we should add a bit more about the lack of guidelines outside of BPD/ASPD then make subheadings for medication (as it does come up often and I do think we could also talk a bit about the misuse of meds in PDs) and therapy modalities. I think it would also be interesting to add a bit about treating comorbid conditions in PDs as that came up in a lot of the studies. I also think some version of what we currently have about the difficulties in treating this population should be mentioned as it is significant. Also I think we should have something about early intervention. If I decide to make a sandbox for this I'll drop a link here so that others can contribute as well. IntentionallyDense ^(Contribs) 16:46, 6 June 2025 (UTC)

I have made a draft for the management section: User:IntentionallyDense/Personality disorder anyone is free to edit it. IntentionallyDense ^(Contribs) 16:17, 7 June 2025 (UTC)

Thank you for making your draft! I had likely just forgotten about its existence, and thus I started heavily modifying the Management section directly on my own; the major edit is now over, for now. However, it turns out that my design seems to be very compatible with yours. Thus, I suggest that we may well use your draft for some more creative experimenting.

As it currently stands, I have split your content regarding treatment of BPD and ASPD in two, with the same citations in both places. This has resulted in there being a paragraph on the treatment of these under Pharmacological. Psychotherapies are left as they are, quite high up in the Management section. I believe now would be a good time for starting more intricate work on Psychotherapy, which would be conducive to the inclusion of findings regarding psychotherapeutic approaches to the other distinct PDs under there, instead of being dumped where they are now. Otherwise, we seem to be well on our way when it comes to this section! BlockArranger (talk) 22:08, 16 June 2025 (UTC)

Millon's descriptions

I am of the opinion that contributors to this article should consider whether or not it is reasonable that we have a big table with Theodore Millon's description of categorical DSM PDs, both current and previous or suggested. I am not suggesting that his descriptions and subtypes are useless work, but I am suggesting that perhaps the table could retire over at the article about him. There, it would be much less problematic to use space as needed in relation to his work.

My suggestion, as it pertains to this (PD) article, is that we could instead use WP:SUMMARY style for a subsection dedicated to his descriptions and subtypes, in some reasonable manner, and we could perhaps even go as far as to afford it a navigational hatnote, which I guess would be Further in this case. This could greatly cut article size and save space for what is relevant. BlockArranger (talk) 20:13, 16 June 2025 (UTC)

Well, I have gone ahead and been WP:BOLD through moving the stuff over. It wasn't perfect anyway and was not fully based on Millon's own descriptions. Seems like people have made misguided attempts at expanding the information in it. Yet, I believe it is good to have this transparently displayed on this Talk page, and I invite comments on how to improve for example the summarization of Millon's work and its significance. BlockArranger (talk) 20:16, 17 June 2025 (UTC)

"Nosology" section/personality vs non-personality?

Good article, was wondering if a greater emphasis/collecting content on the notion of the personality disorder itself, specifically its nosology, might improve it further?

I guess my case is that Psyciatric diagnostic categories are split into disorders that are personality disorders and the remaining disorders that aren't. Obviously the "personality disorder" notion is contestable in academia, but with patients/outside academia it goes a bit further, it's sometimes seen quite unfavourably (see e.g., on the move to the DSM 'trait' model). For both PDs and non-PDs, there's rarely objective biomarkers, and so these are labels to decribe sets of observed/self-reported behaviour and self-reported emtions (/internal experiences) that are often found together, and some PDs and some non-PDs have each other as differential diagnoses e.g:

* Autism & Schizotypal personality disorder

* Avoidant personality disorder & Social anxiety disorder

* Obsessive–compulsive disorder & Obsessive–compulsive personality disorder

PDs exist regardless of whether they "exist", i.e. they exist in practice (i.e. clinical use & outside the clinic) regardless of if they're a useful predictive diagnostic (/model/falsifiable/etc...), and as the distinction between a cluster behaviours/emotions that's a PD and a cluster that's not is a lot harder to understand than most other nosology questions, I feel like it'd be really good to have a decent amount of emphasis on the "meta"-aspects of PDs, rather than PD itself/PDs themselves. Storsed (talk) 04:59, 28 September 2025 (UTC)

Well, it is easy to say that we should have it, and for me to agree with the general idea of expanding the article with useful information; however, we need to focus on actually finding good WP:RS supporting the content before writing it, for the sake of WP:VERIFIABILITY. Do you have something specific in mind? BlockArranger (talk) 00:29, 20 October 2025 (UTC)

Classification section and article

As some may have noticed, I have created a standalone article on Classification of personality disorders, in order to be able to describe the matter in more detail, such as in regards to the dimensional and categorical approaches. At the same time, as has also been noted by @IntentionallyDense, there seems to be a need to shrink the Classification section of this article. As I see it, the standalone article is a solution to this. Thus, I intend to commence iterative work on making the Classification section be a higher-quality WP:SUMMARY of the main article. If however anyone opposes anything or has suggestions, I request that such matters be accordingly discussed here. BlockArranger (talk) 00:53, 22 October 2025 (UTC)

Comorbidities

I think the units are missing for the comorbidity table. 94.134.252.93 (talk) 21:07, 29 October 2025 (UTC)