Talk:Haltlose personality disorder/Archive 1

Defamatory

As a stub, this entry is obviously incomplete, but it does give the impression that modern psychiatry has not progressed very far since the days of Kraepelin more than a century ago. It describes an “individual” in the terms that a criminologist might use. It would appear that the disorder is considered merely as the product of a wilfully misdirected mind.

As it stands, the stub is defamatory. Perhaps it is hoped that the patient can be shamed into denial and subsequently be declared cured – the diagnosis is the cure - while the underlying problems remain.

The entry needs to include typical complaints with which patients present. It should also consider that the patient might actually be suffering from, and be disadvantaged by the disorder.

The German adjective haltlos (“a” pronounced as in “half”, “o” as in “horse”) describes an absence of Halt, which is obviously related to the English noun “hold”, as in “foothold”. Halt is the metaphysical property that prevents something slipping or falling, or being blown or washed away, thereby enabling it to fulfil its function or purpose. In the figurative sense it might be understood as “faith” in the wider sense, as used in the expression, “to keep the faith” (see also the song of this name by Bon Jovi), meaning that which gives one the inner strength or so-called moral fibre not just

• to not go down the road beyond pragmatism to opportunism, or, in the worst case, criminal activity,
• to resist inappropriate impulses and addiction,

but also the strength

• to keep smiling and be nice to others,
• to persevere and not be discouraged in the face of adversity,
• and, of course, to not despair and succumb to mental illness in any form.

Halt is something children need from their parents and carers to make them resilient and it is what people seek in religion and, unfortunately, in some cases, nationalism, extremism and various other –isms.

There may be a higher incidence of Haltlosigkeit among the so-called undesirable elements in society. However, it is hard to imagine that this subgroup would be capable of much more than opportunistic petty crime, in many cases attributable to youthful folly - in contrast to those with e.g. antisocial personality disorder. And it does not follow that all persons that are not blessed with Halt are potential criminals and drug addicts etc. as might be imagined from the stub. They need help, not condemnation.

The article should take these additional aspects into account in this, the 21st Century. Duncan Dolittle (talk) 00:05, 3 August 2016 (UTC)

ICD

If this is an ICD-10 disorder the corresponding ICD-10 code should be mentioned. I guess it is included in F60.8 ("others"), but I am not sure. --84.115.204.211 (talk) 19:07, 13 February 2019 (UTC)

 Done You are correct, it is included in F60.8, which is listed at Haltlose personality disorder#External links. Daask (talk) 14:11, 14 February 2019 (UTC)

• The incipit now states Haltlose personality disorder (HLPD) is an ICD-10 personality disorder... That looks to me like a possible overstatement, as it could seem to imply that it has its own specific code. Rather, it is cited within the 2021 ICD-10-CM Diagnosis Code F60.89 ("Other specific personality disorders") as one of a series of diagnoses to which this (miscellaneous) code is applicable. In practice, that would mean that if I needed to assign an ICD-10 code to a case, or cases, bearing a diagnosis of Haltlose personality disorder (for example in an epidemiological study) then I would classify it under F60.89 Other specific personality disorders. That doesn't make me think of it as an ICD-10 personality disorder. So, imo, that claim needs to be reassessed/reweighted. 86.180.70.117 (talk) 21:18, 6 October 2020 (UTC)

  I agree, and I'll make 86.180's proposed change. WhatamIdoing (talk) 20:51, 7 October 2020 (UTC)

Adler

A close reading of the Adler source makes it clear there is some overlap between his headings "2" and "3", whereas headings "4" and "5" are clearly discussing other personality disorders. I have tried to honestly represent his intentions in the 1917 journal publication, but welcome discussion if I have interpreted anything incorrectly. HaltlosePersonalityDisorder (talk) 06:04, 7 October 2020 (UTC)

Some awkward reliable medical sourcing issues here

(ping @User:HaltlosePersonalityDisorder). This notable and - apparently (per ICD-10, at least?) - clinically pertinent page currently seems to ignore WP:MEDRS, Wikipedia's reliable medical sourcing guidelines, and this is a major issue here. One particular source of concern is the structural conflation of clinical claims and psychiatric history (for example, description of the disorder directly in the historical words of Adler and others, without secondary sourcing). Clearly, there is a real problem with an apparent dearth, in any language, of even *relatively* recent reliable medical sources in the clinical literature (cf Langmaack 2000 [1], Cullivan 1998 [already cited inline]). In a rapid glance at PubMed, GoogleScholar and GoogleBooks, I largely drew a blank at spotting potential MEDRS in the English language ([2]?), and few obvious candidates in other languages either; I don't know if User:Markworthen (ping :-) might be able to make any rapid suggestions, perhaps based on Psych databases I'm not able to access.

Normally, a page regarding a clinical condition would be structured broadly along the lines of WP:MEDMOS#Diseases or disorders or syndromes in such a way as to distinguish between clinical claims of current relevance (requiring MEDRS sourcing) and historical content (requiring WP:RS, but not necessarily WP:MEDRS; eg[?] PMID 31114930), as has has been done with other personality disorders currently recognized by DSM (eg Borderline personality disorder, Antisocial personality disorder, etc) or otherwise (eg Passive–aggressive personality disorder). To me, that seems problematic here, due to the apparent lack of available MEDRS.

As I find it difficult to know what to suggest in practice, I'm wondering whether (in addition to Markworthen) User:WhatamIdoing (a further ping :-) – a highly experienced WP:MED editor who has an interest in such editorial issues – might have some thoughts on this. 86.144.125.239 (talk) 16:02, 7 October 2020 (UTC)

Thank you for the ping Agent 86. ;^] ¶ I had never heard of Haltlose personality disorder! Very interesting. I suggest trying to improve the article as you (we) are able. I agree that it needs work. But it is not so bad that it should be deleted. The more medical citations needed tag/template is spot on. Mark D Worthen PsyD (talk) [he/his/him] 18:18, 7 October 2020 (UTC)

Thanks for the discussion, as the person being discussed - I appreciate that people are at least reading my work, even if some of the criticism seems ill-placed :) I don't have a "main" Wikipedia account, I created this simply because while reading about other PDs I had clicked through to "Haltlose" same as you no doubt did, and was shocked to see an ICD-10 diagnosis listed as a two-sentence stub. I think it had a longer article in the Romanian or Serbian or something Wikipedia.

There are some English-language sources that seem reputable, the only source that I agree is "weak" is "the youtube one" which I included because the YT account had an official-sounding name, but looking more closely at it I see it's not likely an RS; that said, it is literally only being used to say it's potentially Cluster-A related. If that detail has to become (cite needed), I doubt anyone would mind.

But does it appear to be a European-centric diagnosis, uncommonly used in the English speaking world? Yes - very much so; though as you can see from the article, that fact has itself been criticized by leading professionals as causing a paucity of further research on the subject. *shrugs* Whether it's only of "historical" interest and not "current", as a layperson I may tend to agree - but medically it's still included in the ICD-10 and I assume we have to go with that, not our gut feelings. JSTOR has a few more Germanic-language sources I intend to mine for information, including more recent ones - but ultimately I imagine what would be the most useful for ensuring the best possible article might be to encourage other de.wikipedia.org editors to help write one there (I prefer reading en. and thus working on en.), and then in six months we can compare the two.

I do find it odd that the MEDRS template you put at the top of the page just recommends things like Google Newspapers, rather than medical databases - or am I misunderstanding your complaint and you would wish for less scholarly research used as references and like newspaper reports better? That would seem ill-advised if we wanted accuracy, but I do not know Wikipedia policy on such and do not feel like reading dozens of pages of decades of croft to determine such - beyond noting that WP:MEDRS makes zero mention of psychiatry/psychology concerns - it is related to ensuring it does not offer medication dosage recommendations or other "biomedical" advice incorrectly.. HaltlosePersonalityDisorder (talk) 18:58, 7 October 2020 (UTC)

Thanks for that HaltlosePersonalityDisorder. Just a few very rapid replies :-) ... Please don't think I was making "complaint"/s - rather, I was just trying to identify editorial issues that need to be addressed. WP:MEDRS regards *all* (and any) types of clinical claims, including - as here - psychiatric ones. Given the paucity of recent clinical medrs, combined with the apparent enduring clinical usage of the diagnosis (at least per ICD) I really don't have any straightforward solutions to propose. But, clearly, that doesn't mean I don't want to encourage you from your constructive editing of a topic which Mark D Worthen PsyD considers "Very intersting". Quite the opposite! Also, please don't worry about the details/quirks of the MEDRS template I applied (basically to alert readers of the page that the clinical information isn't current, per Wikipedia MED guidelines) - I certainly wouldn't suggest searching newspapers for reliable medical citations (lol, I hadn't noticed that one - decidedly odd!). Also... I didn't intend to criticize you username (the problem here arose from a good-faith concern that a username which coincides with a page that user is intently focused on expanding might conceivably be an indication of a possible WP:COI - because such things have been known to happen...).

Sorry, I shouldn't have bad-faithed your good-faith, my bad. That said, the note at the top is a little large compared to some templates so it seems intrusive, but its purpose seems fair (it should just be cleaned up, reduced, or a more appropriate one perhaps found). Is there a "not current" template that might work better? Because I see this article essentially how I see female hysteria - except for the fact it's officially "still on the books" and occasionally diagnosed...but mostly of historical interest. HaltlosePersonalityDisorder (talk) 04:02, 8 October 2020 (UTC)

I'd like to take more time to consider the question of historical/clinical content in the light of what you're saying, and of course listen to the views of others (unlike Markworthen, I'm a complete layman here :) .... Editorially, my initial thought is that, given the ICD-10 status as a listed diagnosis it could be good to glean at least a little current clinical information, in the broad spirit of the WP:MEDRS (including WP:MEDPRI, etc, and the most elastic reading possible of WP:MEDDATE; maybe post 1990[?]). Then the remaining information could be reframed from an appropriately historical perspective, using secondary sourcing wherever possible (maybe with suppporting primaries to direct interested readers to the original texts). Maybe WhatamIdoing will have some thoughts of her own? :-) Cheers, 86.144.125.239 (talk) 20:24, 7 October 2020 (UTC)

Those sourcing templates are very generic and do look a little misleading. The only recent Review article I've found is PMID 31114930, which is already linked but not used. This is an article about this history of the condition, so it would make a fine source for a new ==History== section (this is the "In fourteen hundred ninety-two, Columbus sailed the ocean blue" sort of history, not the "Patient reports cough for three weeks" kind of history). It could probably also be used to replace basic/uncontroversial claims currently supported by 'worse' sources (i.e., primary sources, sources that are 10+ years old, etc.).

@HaltlosePersonalityDisorder, sources don't have to be in English. If you've got a recent medical school textbook or professional reference book lying around, then that's a good option, even if it's not in English. WhatamIdoing (talk) 21:01, 7 October 2020 (UTC)

This book:

Svrakic, Dragan M.,. The fragmented personality : an integrative, dynamic, and personalized approach to personality disorder. Divac-Jovanovic, Mirjana,, WebCom, Inc. New York. p. 86. ISBN 978-0-19-088457-4. OCLC 1053904049.{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)

calls it "dubious". WhatamIdoing (talk) 22:03, 7 October 2020 (UTC)

I like the book you found, but searching the preview on Google Books for haltlose returns no hits? If you have the page number of where it calls it a "dubious" diagnosis (or whatever language it uses), I would fully support adding that detail into the article that a 2018 text dismissed the validity of the diagnosis. I just don't think "oh, this book says it's fake" means we shouldn't collect and present all the information about it regardless - just like we have female hysteria despite it being debunked (and HLPD isn't debunked, it's just not commonly seen/referenced seemingly). I believe textbooks as you suggest would count as tertiary sources - but I'll point out that Kraepelin is literally titled "Psychiatry: A textbook for students and physicians (7th ed.)" (and Jaspers, Roth/Slater are also similar reference works), so I'm not sure I understand your complaint - and it gets more bizarre when you say you want sources that are printed post-2010. There's absolutely no need for such sources; if they exist, let's use them - but even if something was only written about from 1915-1998, we'd still have as detailed a write-up as we could on it surely? But again, literally 41 of the footnotes are dated post-1995; so while yes, that leaves even MORE footnotes that are pre-1995, that's simply a function of when it was being written about (in articles and books whose text is fully available online, at least). The only reason I haven't used PMID 31114930 in-line yet is because sci-hub isn't giving me a full copy of it, as soon as I get ahold of the full document I would hope to be able to use it to more fully round out the article and see what it supports/doesn't from the other references. If the two sources you like are strong enough, we could even add a "Skepticism" section to flesh out such opinions? I'm not wedded to proving it exists or doesn't, I just don't like the idea of removing information from people like relevant doctors who wrote rather widely-published books on the subject; I'm not using "case histories" or anything. HaltlosePersonalityDisorder (talk) 03:50, 8 October 2020 (UTC)

It doesn't say very much: 'A noteworthy difference between the DSM and the WHO's ICD system is that the DSM classifies narcissistic personality disorder, whereas the ICD appears to be ambivalent toward it and classifies it secluded from other subtypes, together with dubious entities such as "haltlose," "immature," and "psychoneurotic" personality disorder.' WhatamIdoing (talk) 02:11, 9 October 2020 (UTC)

COI?! COI?! Clearly if anything I'm OCD! lol

Just a bit of a laugh seeing Wikiproject:Medicine notes this article has received the second-highest amount of edits in the past week of any of its articles, as enumerated below.

1322 edits White House COVID-19 outbreak

183 edits Haltlose personality disorder

156 edits COVID-19 pandemic in the United States

151 edits COVID-19 pandemic

Oh yeah baby. HaltlosePersonalityDisorder (talk) 03:57, 8 October 2020 (UTC)

Claims needing WP:MED sourcing

Ping HaltlosePersonalityDisorder: Irrespective of the appearance of the hatnote (and of the objective difficulties regarding current usage of the diagnosis in clinical practice) mentioned above, Wikipedia articles are simply not allowed to make clinical claims without following WP:MEDRS guidelines. Rather than applying a series of "medical citation needed" tags across the page (something that might conceivably be useful), I feel it may - initially at least - be more helpful to trim (here) one standout example of the sort of improperly supported clinical claim that has no place on Wikipedia.

Please do not interpret these observations as a form of attack or personal criticism. That's *not* the intention at all. I actually believe that an appropriately sourced page containing *mainly* historical content on this diagnosis could be of real encyclopedic value (ping Markworthen :). As far as I can see, the only strong reason for considering this diagnosis as having current clinical significance derives from its continued ICD listing. There are obvious questions regarding what editorial weight to give to the currency of the diagnosis in ICD-10 (albeit merely in a catch-all listing of "other" diagnostic labels). The approach of WhatamIdoing in this] edit seems to me entirely appropriate, as do her other considerations above. Imo, the continued clinical pertinence of the diagnosis needs to be acknowledged in passing, before rapidly moving on to an historical narrative, appropriately based on reliable secondary sources (engendering some apposite quotation from historially notable figures, such as Adler, Jaspers, etc). Given the apparent lack of MEDRS-compliant sourcing, the main focus of the page must clearly be historical (for a very rapid consideration of the issue, cf WP:MEDORDER). In doing this, care needs to be given to weight any direct quotations appropriately. This would include avoiding undue emphasis on relatively low-quality secondary sourcing, such as through editorially questionable use of quotation (see WP:QUOTE), including the deployment of quotation boxes.

As I say, I do hope this doesn't soun negative - it's not intended to be. 86.186.94.204 (talk) 13:51, 9 October 2020 (UTC)

I am confused, I am trying not to be insulted or upset, but it seems like medical sources get called "Oh these are primary sources, no good" and non-medical sources get called "Oh these aren't proper medical sources" - the truth is, except for Wetzell's book "Inventing the Criminal" and Ledig's "Kriminologie", essentially every other source already IS a medical source, typically peer-reviewed; it's the American Journal of Psychiatry, the Acta Psychiatra, the Worterbuch der Psychiatrie, American Psychiatric Journal, Psychiatric Emergencies in Family Practise, the Deputy Medical Superintendent of Cheadle Royal Hospital, etc. And I've been careful to not use something like Adler's extensive case history notes in any fashion since I am not qualified to draw conclusions on the basis of the fact he might say "David has HLPD and hates frogs" myself, unless someone has discussed that in a published non-specific-instance related to HLPD. The one you removed as "improperly supported clinical claim that has no place on Wikipedia" is from the seemingly peer-reviewed "A group of hysterical psychopathic personalities is characterized" which states at the top of the article "All iLive content is reviewed by medical experts to ensure the highest possible accuracy and consistency with the facts. We have strict rules for choosing sources of information and we only refer to reputable sites, academic research institutes and, if possible, proven medical research. Please note that the numbers in brackets (,, etc.) are interactive links to such studies."...I'm not sure how it could possibly be any better supported realistically? I have restored the detail, since it is one of the few from the last ten years which I believe you were the one who said were more necessary since half the references were from a century ago - but in deference to your objection, I have modified the language to tone it down a little more. I did also add in your previously mentioned Sravkic reference which calls the diagnosis "dubious" (even though it seems less supported as a source, but I still see value because it appears to be a not-uncommon skepticism). HaltlosePersonalityDisorder (talk) 23:12, 9 October 2020 (UTC)

A note elaborating myself, it appears that the reference is written by Dr. Alexey Portnov and peer-reviewed by Dr. Lior Cohen, Psychologist per https://iliveok.com/health/types-personality-psychopathies_129682i15956.html - Dr. Portnov is the Publishing Editor and a 2005 graduate of Kiev National Medical University per https://iliveok.com/about-portal/alexey-portnov_131128i89697.html and Dr. Cohen is from the Hebrew University of Jerusalem and a member of the Israeli Cognitive Behavioral Therapy Association per https://iliveok.com/about-portal/doctor-lior-cohen_131204i89697.html HaltlosePersonalityDisorder (talk) 23:30, 9 October 2020 (UTC)

• That source clearly fails MEDRS requirements (cf WP:MEDRS#Other sources). Although the web page may have been informally "reviewed", it is not (per the intended meaning of my edit summary [3]) a peer-reviewed journal, and at least some of the language/content (even stretching to aromatherapy hints in a section titled Treatment of psychopathy folk remedies) is characteristic of popular science (and Harvard-like inline citation is used without any reference list). 86.144.125.192 (talk) 11:51, 10 October 2020 (UTC)

I think you're laying down arbitrary expectations far beyond those seen in the actual rules and reading MEDRS and elsewhere - as a quick note see PubMed: Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives, Pubmed: The Effectiveness of Aromatherapy for Depressive Symptoms: A Systematic Review, Pubmed: Aromatherapy for the Treatment of Patients with Behavioral and Psychological Symptoms of Dementia, Psychological effects of aromatherapy on chronic hemodialysis patients , etc...I am in no way defending Aromatherapy (personally I believe it is nonsense) - but your complaint when it is pointed out that you initially objected the sources were not medical until it was pointed out they were very medical, then claiming you were just opposed because they weren't peer-reviewed until it was pointed out they were peer-reviewed, then saying it's an issue of primary, secondary and tertiary sources being missing from the article and/or too reliant until it was pointed out all three types are properly present, then you complained that really it's about the fact that none of the sources were recent until it was pointed out that roughly a third of them were indeed from the last twenty years and it contained all known reputable sources from that period it was simply less frequently a subject in that era...it is starting to strain my continued belief that now all of those arguments are abandoned without defense and now the focus is "well CLEARLY this fails because of their stance on Harvard citation and the fact no reputable source would discuss Aromatherapy". I have read through the WP links you've provided, and even where they are rules rather than guidelines, they do not appear to me to be as draconian as suggested.

I have agreed with the edits made by other parties to tweak the wording of the article, I have added the offered information about the diagnosis being labelled "dubious" even in a single sentence in an otherwise unrelated book that simply lists it among three offhand criticisms of the ICD-10 (and I certainly welcome more robust sources saying the same thing, happy to have an entire section dealing with skepticism/criticism of the diagnosis over the years if we can find sources), I have said I am amenable to removing the "International Advocacy" reference since closer examination shows it to be a dubious self-pub source (although your own MEDRS link#Other notes " A lightweight source may sometimes be acceptable for a lightweight claim, but never for an extraordinary claim.", and it was only being used as a source for giving the appearance of being "potentially Cluster-A"; but as I've said, I'm willing to change that to a [citation needed] upon reviewing it myself if others wish to do it) HaltlosePersonalityDisorder (talk) 12:36, 10 October 2020 (UTC)

• Just a quick note that personally I have not included reputable sources when it is not clear that they are discussing Haltlose as a diagnosis rather than a symptom - the word simply being a German loanword for instability. Thus I have not used any sources listing "emotionally unstable personality disorder" nor German sources labelled Haltlosen Komplexität (Haltlosen Complex)(and definitely nothing using Haltlos as an adjective even if paired with psychiatry) unless somebody whose medical training was IN German wants to assure me that those are references to HLPD as a specific diagnosis, not simply to a Complex (psychology) HaltlosePersonalityDisorder (talk) 15:34, 10 October 2020 (UTC)