Are Personality Disorders Really Just Interpersonal Disorders by Another Name?

Understanding the Origins of 'Disordered Personalities'

The fascination with human personality and its potential to cause difficulties is not a modern phenomenon. Early thinkers like Confucius and Theophrastus explored the idea of human nature, each in their own way categorizing personalities into types—some virtuous, others less so. Ancient Chinese and Greek philosophers recognized that certain traits could lead to social and personal struggles, often framing these within a context of moral failings or social dysfunction.

Interestingly, the term "character"—the root of our modern understanding of personality—comes from the Greek word "kharakter," which referred to a tool used to stamp or engrave, much like a coin or seal. This metaphor suggests that early thinkers viewed personality traits as something "inscribed in the fabric of a person"—permanent, fixed, and deeply ingrained.

This view of personality as an enduring, almost indelible part of a person continued into the 18th and 19th centuries. Figures like Philippe Pinel and Emil Kraepelin began to formalize the concept of "personality disorders" in psychiatric nosology. Kraepelin’s "psychopathic personalities" were described as inborn defects, further cementing the idea that certain traits could be permanently pathological. These early formulations of personality disorders were often tied to explanations for criminality or moral failings, portraying individuals with these traits as "defective" in ways that couldn’t be changed.

Fast forward to today, and the term "personality disorder" persists in our psychiatric classification systems, as seen in the DSM-5-TR, which includes ten specific types of personality disorders. However, as our understanding of mental health has grown more nuanced, so too has our awareness of the limitations and potential harms of this label.

Reframing Personality Disorders as Interpersonal Disorders 

The term "personality disorder" can feel heavy and stigmatizing, implying something fundamentally wrong or "disordered" about someone's personality—the core of who they are.

This perspective has been around for thousands of years, but is it accurate?

A growing number of psychologists, including Dr. Aidan Wright and his colleagues, believe it’s time to change how we think and talk about these issues. In their 2022 article in American Psychologist, they argued that the label "personality disorder" is misleading and, at times, harmful.

Instead, they proposed adopting the term "interpersonal disorders"—a shift that more accurately reflects the challenges these individuals face and reduces the stigma associated with locating the source of one’s difficulty in their personality.

Why Interpersonal Disorders Make Sense

Wright et al. (2022) highlight several reasons why focusing on "interpersonal disorders" is beneficial.

First, personality isn’t inherently the problem. Everyone has personality traits—some healthy and adaptive, some less so. Research shows that even people with mood disorders, anxiety, and other psychological conditions often score high on scales measuring "maladaptive" personality traits. These traits aren't unique to what we currently call personality disorders. In fact, they’re widespread across various forms of mental health struggles.

As Hopwood (2024) argued, if we relied solely on traits, we would be forced to conclude that either all forms of psychopathology were personality disorders, or there is no such thing as a personality disorder. Traits alone don’t meaningfully distinguish people diagnosed with personality disorders from other common mental disorders.

So, what does?

Wright et al. (2022) emphasize that what distinguishes individuals with these struggles isn’t just their traits, but the specific problems these traits cause in relationships. People who meet criteria for a personality disorder generally experience considerable difficulty forming or maintaining healthy connections with others. They may face frequent misunderstandings or conflicts in their personal or professional lives and feel unstable in their identity or direction. As Hopwood (2024) explains, these struggles are less about the traits themselves and more about how these traits affect interpersonal dynamics and self-understanding.

Finally, the language we use matters. The label "personality disorder" carries a weight that can feel like a judgment of who someone is. Historically, this seems to have been the intent. But this framing is also prone to making people feel ashamed, broken, or unchangeable. By shifting the focus to "interpersonal disorders," the emphasis moves from "What’s wrong with you?" to "What’s causing this pattern of challenges you face in your relationships and self-understanding?" Besides reducing shame, this shift widens the avenues toward healing and likely lessens prognostic pessimism among clients and clinicians alike.

A Kinder Approach to Diagnosis

Wright and colleagues propose this change not only because it’s more scientifically accurate – although that’s the driver of their argument – but also because it’s kinder. It aligns with what clinicians see in therapy every day: people who are not "broken" or inscribed with inherent flaws, but struggling with interpersonal difficulties that are often deeply rooted in pain, trauma, or unmet needs.

This reframing also offers clinicians clearer guidance. When someone is diagnosed with an "interpersonal disorder," it signals the therapist to pay attention to potential relational difficulties in the treatment process, such as challenges in forming a therapeutic alliance, vulnerability to feelings of rejection or abandonment, a tendency to oscillate between feelings of admiration and disillusionment, and the risk for behaviors like self-harm or impulsivity when relational tensions arise. By focusing on these challenges, therapy becomes a space to untangle the knots of interpersonal pain.

Understanding as a First Step

Addressing interpersonal challenges starts with gaining a clearer understanding of yourself and your life. At our Carmel, Indiana-based practice, we specialize in therapeutic assessment, a collaborative process where we work together to explore puzzling, troubling, or stuck aspects of your experience. This collaborative process aims to provide you with clarity and direction, allowing us to co-create a more accurate and compassionate understanding of your personal experiences.

Through this process, you gain more than just self-awareness; you develop actionable steps toward recovery and lasting change. We provide a supportive environment where you can explore relational challenges and begin to develop new ways of connecting with yourself and others.

Curious about how therapeutic assessment can help? Reach out to us by phone at 317-960-4899 or email us at contact@SycamoreCAPS.com to schedule a consultation.

Writing Stories with Four Hands in Psychological Assessment

Therapy without assessment is often likened to a ship without a rudder, while assessment without therapy is compared to a ship without a harbor. These metaphors contain some truth, but they don’t always fit every situation. Therapy can certainly progress in many cases without extensive psychological testing, and the assessment process itself can sometimes be therapeutic, even eliminating the need for further therapy. However, this analogy points to a deeper difference in how therapists and assessment psychologists often approach their work—particularly in how they understand and define truth.

At the heart of this distinction is the difference between positivist and post-positivist approaches to understanding human experience. Many traditional forms of psychological assessment operate from a positivist epistemology, which assumes that there is an objective reality that can be measured and understood through scientific inquiry. In this framework, tests are designed to reveal these objective truths about a person’s inner life—whether about personality, cognition, or emotional functioning.

In contrast, many therapists, particularly those with humanistic, narrative, or psychodynamic orientations, may operate from more post-positivist or constructivist traditions, which emphasize that all knowledge is filtered through subjective experience. In this view, truth is not a fixed reality to be measured, but something co-constructed and shaped by personal narratives, cultural contexts, and interpersonal relationships.

The Traditional View of Psychological Assessment

Traditional psychological assessment tends to adopt a positivist approach, where the goal is to gather information and measure internal psychological states as objectively as possible. This model assumes that by using standardized tests, psychologists can access and quantify the “truth” of a person’s inner life. While there is great value in this objective data, it can be incomplete if removed from the client’s lived experiences and personal context.

As Wright (2024) observed, psychological assessment has historically centered its validity inquiry on the tests themselves, often leading to decontextualized interpretations of data. This epistemological focus on objective, measurable truth can strip away the client’s subjectivity, making the process feel almost dehumanizing. By prioritizing test scores over personal narratives, assessment may come across as cold or impersonal, contributing to a perception that it is disconnected from the lived realities of clients.

The assumption that objective truth can be cleanly separated from subjective experience reflects a pure positivism that some now see as limited. While objective data is certainly useful, post-positivist perspectives remind us that test data can only be meaningfully understood as one part of a larger picture. When assessment is done without consideration for clients’ personal experiences, it risks being perceived as impersonal or even paternalistic. Put differently, test data provide a map of the territory; clinicians shouldn’t confuse it for the territory itself.

Writing Stories with Four Hands

Collaborative Therapeutic Assessment (CTA) provides a framework that blends both positivist and post-positivist perspectives, acknowledging the importance of objective data while centering the client’s subjective reality. CTA begins with the premise that while psychologists are experts in tests and data, clients are the experts on their own lives. By working together, they can co-create a richer, more accurate understanding of the client’s story—one that integrates both lived experience and psychometric evidence.

Filippo Aschieri (2012) described this process as “writing stories with four hands.” In this model, clients bring their personal narratives, which are often clouded by self-criticism, shame, or incomplete understanding, while psychologists contribute insights derived from objective testing. Through collaboration, the assessor and client co-edit these stories, creating a new narrative that reflects both the subjective world of the client and the objective insights from psychological testing.

This process aligns with the post-positivist emphasis on epistemological pluralism, which recognizes that truth is best understood by integrating multiple perspectives. In CTA, this is referred to as epistemological triangulation—the blending of narratives from both the client, who ‘writes with personal meaning,’ and the psychologist, who ‘writes with numbers,’ to collaboratively ‘write stories with four hands.’

Relevant to this process is the concept of ‘life validity,’ a term coined by Fischer and Finn (2014) to emphasize the importance of contextualizing test results within the client’s personal life story and current circumstances. This stands in contrast to decontextualized score interpretations, which may ignore the broader emotional, relational, and cultural dimensions of the client's life. By focusing on life validity, CTA moves beyond a strictly positivist approach, ensuring that the data resonates meaningfully within the client's lived reality.

The Benefits of Collaborative Therapeutic Assessment

By integrating both positivist and post-positivist perspectives, CTA offers clients a more holistic understanding of themselves. It not only provides them with objective data but also helps them use that data to reshape personal narratives in ways that are compassionate and empowering.

This process can be particularly powerful for clients who have struggled with negative or self-limiting beliefs. Through CTA, they can begin to reframe their understanding of themselves, incorporating the insights from psychological testing into a broader, more compassionate story of who they are.

Research shows that CTA is effective in improving clients' self-understanding and emotional well-being. It also aligns with the therapeutic goals of many practitioners who believe that assessment can—and should—be more than just information-gathering; it can also serve as a transformative experience that promotes healing.

Conclusion

Psychological assessment, when done collaboratively and contextually, doesn’t have to be cold or detached. By blending the objective rigor of tests with the rich subjective narratives of clients’ lives, Collaborative Therapeutic Assessment offers a way to “write stories with four hands.” This approach honors both positivist and post-positivist epistemologies, recognizing that truth is not one-dimensional but emerges from the intersection of data and experience.

Whether you're a therapist in Carmel, Indianapolis, or the broader Central Indiana area considering referring a client for assessment, or a prospective client yourself, know that our goal is not just to collect data, but to help co-create a meaningful, accurate, and supportive understanding of your life. Together, we’ll write your story—using both numbers and narratives—to guide you toward greater understanding and self-compassion.

References

Aschieri, F. (2012). Epistemological and ethical challenges in standardized testing and collaborative assessment. Journal of Humanistic Psychology, 52(3), 350-368.

Fischer, C. T., & Finn, S. E. (2014). Developing the life meanings of psychological test data: Collaborative and therapeutic approaches. In R. P. Archer & S. R. Smith (Eds.), Personality Assessment, 2nd Edition (pp. 401-431). Routledge.

Wright, A. J. (2024). Queering psychological assessment. Professional Psychology: Research and Practice. Advance online publication. https://dx.doi.org/10.1037/pro0000594.

Suggestion for Further Reading

Fantini, F., Aschieri, F., David, R. M., Martin, H., & Finn, S. E. (2022). Therapeutic Assessment with Adults: Using Psychological Testing to Help Clients Change. Routledge.

Sensory Seeking and Avoidance: What Parents and Caregivers Should Know

What is sensory seeking and sensory avoidance in children?

Alex’s parents watch as their child turns upside-down on the couch. When Alex gets tired, his parents often find him in an inverted state: head down, feet or bottom in the air. What many parents don’t realize is that this position sends a strong sensation to the inner ear. What’s more, many children with neurodevelopmental challenges, including ADHD and Autism, find this sensation highly soothing. 

Sensory seeking and sensory avoidance can show up across all 5 senses - sight, sound, touch, smell, and taste - as well as vestibular - the inner ear system that helps us know if we’re right side up or makes us feel dizzy after too much spinning. The behavior that children use to satisfy their sensory needs can be hilarious, sweet, inconvenient/irritating, or downright dangerous. There’s a reason that most kids like to roll down hills, snuggle when sick, and get sucked into videos with bright colors and catchy music. Everyone has sensory needs!

When is sensory seeking or avoidance a problem? 

Sensory behaviors become a concern when they start to interfere with daily life. For example, if your child’s need for sensory input gets in the way of school, friendships, or safety, it’s worth paying attention. For example, children that seek sensory input to the extreme may engage in repetitive movements that distract them and others from their surroundings, increasing learning and behavioral challenges. Sensory seeking can also lead to dangerous behavior, like darting away on a busy street, putting dirty or harmful objects in their mouth, or self-injury. Children who are high in impulsivity and sensory-seeking, like in some forms of ADHD or when Autism and ADHD combine, are especially vulnerable. 

Sensory avoidance can show up in many different ways. Aversions to certain food textures can lead to food refusal and nutritional concern. Extreme sound sensitivities can cause meltdowns at unexpected loud noises. Recent research shows that high levels of sensory seeking and avoidance are more common in youth with ADHD and/or Autism than in kids without these diagnoses.

How can parents help? 

If you suspect your child has strong sensory reactions, one way to help is to start by making some observations. Write down the behavior, the situation, and what happened before and after. This will help you see any patterns to the behavior. Also note - is this sensory-related behavior causing problems? Is it injuring my child or someone else? Is it getting in the way of the child’s social life or education? If you decide to consult with a provider, this will be important!

How can psychological assessment help? 

If you feel like a child’s sensory seeking or avoidance behaviors are creating challenges at home, in school, or other parts of their life, a psychological evaluation might offer some clarity. In this kind of assessment, we partner closely with families to explore the unique ways a child thinks, feels, and behaves. We may look at how they solve problems, communicate socially, and manage their attention and impulses. Our goal is to help you understand whether these sensory experiences are a part of a diagnosable condition, and, if so, how to best support your child moving forward.

Every child’s development is unique, and there’s a wide range of what’s considered ‘normal’ behavior. But as a parent, caregiver, or provider, you know the child in your care the best, and that gut feeling when something seems off is worth listening to. If you’re noticing sensory behaviors along with things like trouble focusing, impulsivity, or difficulty connecting with others, a psychological assessment can help shed light on what’s happening and offer guidance on the next steps.

Disclaimer: This blog is intended for informational and educational purposes only and should not be considered therapy or any form of treatment. Our psychological testing and assessment practice, based in Carmel, proudly serves clients from Indianapolis, the surrounding suburbs, and throughout Central Indiana. If you’re in the area and have questions, or would like to consult with an experienced child psychologist or discuss any specific psychological concern, please contact us!

On Being Seen: Why Collaborative Psychological Assessment Matters

In a world of rushed, surface-level interactions, being truly seen and understood is a rare commodity. It’s not just about kind gestures or validation of the parts of yourself you’re proud of, but about a genuine understanding—where someone sees all of you, warts and all. Your strengths, your compassion, but also your secrets, fears, regrets—everything—and accepts you because of it, not despite it. It’s in these moments of shared humanity that we truly feel seen, and the acceptance from another allows us to embrace ourselves more fully. 

The Need to Be Seen

From the moment we’re born, we start looking for connection. It’s not just about talking or listening—it’s about really connecting with someone. Finn talks about this as a fundamental human drive, right up there with our need to form attachments. And when you think about it, it makes perfect sense. We want to be seen and known, not just by others but by ourselves too.

This need is strikingly evident in the work of Harvard developmental psychologist Ed Tronick, who developed the ‘still face paradigm.’ In unsettling experiments, parents were coached to keep their faces completely still in front of their infant children—no smiles, no gestures, no acknowledgment at all. Almost invariably, the infants quickly became distressed, with many bursting into tears. It’s as if, without the mirroring and validation from their parents, these babies felt they’d ceased to exist, and that’s terrifying for them. This shows how deeply ingrained our need to be seen is. And while it’s easy to observe this in young children, the truth is that this need never really goes away—it just goes underground for most of us.

More Than Just a Diagnosis

Getting a diagnosis can be important. It provides a framework to understand what someone is going through and can begin to guide treatment. But most people we see in our practice are looking for something more than just a label. They want to understand themselves better, make sense of their experiences, and feel validated in their struggles.

This is where collaborative psychological assessment, the kind Finn developed, comes in. It’s not just about diagnosing someone; it’s about going on a journey together. In this process, the client is at the center. We start by exploring their questions—what they want to learn about themselves. Then, we work together to chart a path that helps them make sense of the results in the context of their life.

This collaborative approach can be transformative. It helps people build a more accurate, compassionate story about who they are, which can lead to real change. Research shows that this kind of assessment not only helps reduce symptoms but also boosts self-esteem and cuts down on shame. It’s about more than just answers; it’s about a new way of seeing oneself.

Quiet Motivations

Here’s the thing: a lot of times, people don’t even realize they’re seeking to be seen and understood. Often, there are unconscious aspects to their motivations for seeking assessment. And when they find it—when they begin to feel understood—it’s like a light bulb goes off. They’re more engaged, more open, and more motivated to dive into the process.

That’s what makes collaborative assessment so powerful. It’s not just about checking off a box with a diagnosis. It’s about meeting a fundamental human need—to be seen, to be known, and to be understood.

The Case for Comprehensive, Collaborative Psychological Assessment

We all know that insurance companies often push for quick, diagnostic-only assessments. And sure, there’s a place for that. But people are more than just a diagnosis. They’re complex, with stories and experiences that deserve to be fully understood. That’s why we’re such big advocates for comprehensive, collaborative assessment. It offers something deeper, something that goes beyond just putting a label on someone.

Because at the end of the day, the need to be seen and known is as fundamental as it gets.

And honestly, who wouldn’t want that?

So, if you make the decision to call and schedule your collaborative assessment at our Carmel, Indiana-based psychological testing and assessment practice, or learn more about our services, remember that asking, 'When can I be seen?' may mean more than we initially realize.

Comprehensive ADHD Evaluation: Why Quick Screenings Might Miss the Mark

Understanding the Challenges of ADHD Diagnosis

In our Carmel, Indiana-based psychological testing and assessment practice, we often meet individuals who have been diagnosed with ADHD based on a quick checklist or a brief conversation with a provider. Despite following prescribed treatments, many find themselves still struggling, frustrated by a lack of progress. When they come to us for comprehensive ADHD testing for children, adolescents, and adults, they’re not just seeking a diagnosis—they’re seeking clarity. Unfortunately, we frequently discover that their initial diagnosis missed the mark, leading to years of unnecessary suffering that could have been avoided with a more thorough evaluation.

The Complexity of ADHD and Symptom Overlap

ADHD is commonly associated with difficulty concentrating, being easily distracted, and impulsivity. However, these symptoms aren’t unique to ADHD; they appear in a variety of psychiatric conditions. For instance, difficulty concentrating is a symptom in 17 different psychiatric diagnoses in the DSM-5-TR (Forbes et al., 2024). In fact, 36.8% of the 628 distinct psychiatric symptoms in the DSM-5-TR overlap across multiple diagnoses. This significant overlap complicates the diagnostic process and increases the risk of misdiagnosis.

What’s more, ADHD isn’t near the top of the diagnostic hierarchy for difficulties with concentration, which means that meaningful differential diagnosis requires consideration of other conditions before arriving at a diagnosis of ADHD.

Consider a child struggling to focus in school. They might have ADHD, or they could be experiencing anxiety, depression, or simply boredom due to being academically gifted. Similarly, an adult feeling overwhelmed and struggling to keep up at work might have ADHD—or they could be dealing with anxiety, depression, or another condition that shares similar symptoms.

The Limitations of Quick ADHD Screenings

Because online tools and quick symptom checklists are so widely available, many people turn to them for answers about ADHD.  While these can be a helpful starting point, they have significant limitations. Screening tools that focus solely on one condition often overlook other potential causes of similar symptoms, leading to misdiagnosis and ineffective treatments. For example, anxiety and depression can impair concentration, mimicking ADHD. If these cognitive symptoms are misattributed to ADHD, individuals may miss out on the appropriate care, such as targeted therapy or mood support, and may also receive inappropriate care or medication, potentially worsening their condition.

The Importance of Comprehensive Psychological Assessments

The question 'Do I have ADHD?' is common, but it’s only part of the picture. In collaboration with the client, an experienced clinician will work to reframe the question, exploring together why concentration and focus are challenging. By broadening the perspective in this way, we can jointly explore a wide range of diagnostic possibilities, ensuring that the treatment plan addresses the underlying issues effectively.

So, why does it matter to broaden the question beyond just 'Do I have ADHD?' Reframing the issue this way is key because if the answer is yes, we can confidently move forward with the right diagnosis and treatment plan. But if the answer is no, you’re still left struggling with concentration and productivity. Simply knowing that you don’t have ADHD isn’t likely to help you perform better at school or work. Understanding the true underlying issue—whether it’s anxiety, depression, or something else—ensures that you’re not left without a roadmap toward recovery and support. A comprehensive assessment provides a clearer understanding, guiding the development of a personalized treatment plan that gives you the best chance to overcome your challenges.

The Bottom Line

Psychiatric symptom overlap makes accurate diagnosis challenging, particularly with conditions like ADHD. A quick screening might suggest ADHD, but without a comprehensive psychological assessment, there’s a significant risk of missing the real issue. If you or someone you know is struggling with symptoms that might suggest ADHD, consider seeking a thorough evaluation. It’s the most reliable way to ensure the right diagnosis and treatment, paving the way for real progress and relief.