I first came across the diagnosis of personality disorder when I started working on an inpatient ward in a mental health hospital in Greater Manchester in 2008.

The undergraduate degree in psychology I did at Lancaster University did not have a module on ‘abnormal and clinical psychology’. This is where they teach you about mental health diagnosis. It wasn’t until I was doing the doctorate in Clinical Psychology at Cardiff University that I realised this was ‘abnormal’.

At the time, as part of a group called Psychologists for Social Change Cymru, we wrote to the universities in Wales asking them to reconsider the use of this term and move toward inclusive, non-judgemental, non-pejorative understandings of mental health, trauma and distress. Cardiff University was the only university not to respond. All the other universities replied saying the would or had already begun processes of review for this.

“Don’t do that again.” said my colleague, a nursing assistant on the adult acute inpatient ward I had just started working on. She has worked there for as long as I’d been alive. I was 21.

“Don’t do what?” I asked.

“Do what she says.” She replied in a hushed tone staring at me with a serious and annoyed look.

I was confused. “Don’t help her with the hair dryer?” I asked. It was, as I’d observed, normal to provide a level of personal support.

“Yes,” my colleague almost spat in a half whisper. “She’s an FPD.” She continued.

“A what?” I asked straining in closer to her not wanting to make a scene.

“A f—–g personality disorder,” she responded.

As she continued to speak it was becoming clear to me that something had happened earlier in the day that she was not happy about.

“It wasn’t that bad,” interpreted a second colleague, another nursing assistant who had been around just as long. She laughed a little. The two had worked on the ward together for over a decade. They were both kind and meant well. The second colleague had a warm sense of humor. The first had seen it all before and was probably burnt out. It was hard to properly tell.

“Worse thing they did was bring in human rights. Now we’ve got to ask them first,” the first colleague continued.

As long ago as 1988 an article in the British Journal of Psychiatry reported research showing that psychiatrists treated patients with a diagnosis of ‘personality disorder’ as more difficult and less deserving of care compared with other patients. Little has changed since.

But the issue runs deeper. The use of the diagnosis of personality disorder causes diagnostic overshadowing of developmental and complex trauma and/or neuro diversity, difference and variation from a variety of origins including developmental cortico-limbic stress adaptations.

Its continued use masks many things including the hidden epidemic of child abuse and neglect and prevents people, especially women from receiving appropriate treatment and support.

But also prohibits them from being treated fairly. Not only does the ‘diagnosis of personality disorder’ then overshadow pain and suffering it sets up mental health professionals to exacerbate and perpetuate that too.

The diagnosis of personality disorder is how the mental health world has long silenced women, particularly victims of abuse. Its predecessor was the catch all diagnosis of hysteria with links to ancient Egypt where women’s emotionally charged responses became associated with things like “spontaneous uterus movement.”

Although recently retired as a diagnosis in 1980 it continues to have an influence on the perceptions of women’s mental health. When we use the term ‘personality disorder’ we are part of that continued silencing. That silence perpetuates harm and violence.

It’s time to move to a holistic, social justice and trauma informed understanding of mental ill-health that can accommodate the complexity and breadth of issues at play.

I recently wrote an article for IWA with a colleague outlining the need to review the use of the term ‘personality disorder’. You can read it here: https://www.iwa.wales/agenda/2023/02/how-the-mental-health-system-discriminates-against-girls-and-women/

Some details in the story have been changed to protect the identities of those involved.

Speak your truth: your own experiences can help create change

If you want to share your experiences around this diagnosis you can take part in Platfform’s Truth Project.

Platfform are campaigning for a review of the use of the diagnosis of PD. Add your voice to our call for change by sharing your story. We will share these with Welsh Government and use them to strengthen our campaign.

For more information, and to access the survey, click here.

If you are in a mental health crisis, please read this paragraph

If you have been affected by anything in this story and would like to talk to someone you can call Samaritans on 116 123. You can also call the national mental health support line for advice on 111 (press 2.)