The purpose of this paper is to explore the historic policy context and social implications of the diagnosis of personality disorder and also consider formulation-based and trauma-informed understandings of distress.
Ongoing changes to (and splits between) medical understandings of what is being labelled as personality disorder have eroded the label’s cultural capital, adding weight to lived-experience-led calls to Drop the Disorder (Watson, 2019). This paper explores the impact and implications of the historic policy and practice context through a lived experience lens.
Such diversity of views in the lived experience and medical communities on personality disorder has allowed alternatives to diagnostically informed understandings of distress (such as formulation-based and trauma-informed approaches) to gain traction with practitioners (Bloom and Farragher, 2013; Johnstone and Boyle, 2020). The broader assimilation of these alternative perspectives into dominant medical ideology is evidenced by the fact that the Royal College of Psychiatrists (RCP) is now also exploring alternatives to diagnosis (2023). This suggests even more change ahead for how we understand people and their relationships with trauma and distress.
This paper discusses UK policy and does not include broader global policies.
This paper would be helpful for any student interested in where the ideas that underpin personality disorder diagnosis stemmed from and why so many lived experience practitioners and experts by profession question the diagnosis' legitimacy.
As the RCP is now considering alternatives to diagnosis, it is even more critical that practitioners are aware of the competing narratives surrounding this contested diagnosis – as the author believes this will promote more compassionate, trauma-informed working practices.
This is the author’s own work and includes not only the RCP position change but also directly quotes Professor Tyrer (who wrote the International Classification of Diseases 11), giving his views on the changed RCP position, as he recently presented at a conference here in Cornwall. The author is a part of Lighthouse peer support group and wrote this paper as preparation for a Participatory Action Research project they are planning, where they will evaluate the Sanctuary Approach with their membership to create a lived experience-designed trauma-informed charter. Before starting that work, the author wanted to better understand the historic policy context and created this paper to fill that need.
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