top of page

“Do's and Don’ts” for Diagnoses

On this page you can find out more about:
1. Do ask about
2. Do not assume
3. Think about
4. Be conscious of some other pitfalls

1. Do ask about/consider:
 

  • What lies behind a ‘behaviour’ (triggers/motivation for self-harm, as well as its purpose)

  • How many prior diagnoses someone has been given (e.g., may include OCD, psychosis) and what does the person feel fits them?

  • Masking - the cost of fitting into a neurotypical world.

  • Neurodivergent family members.

  • Culture and era someone was born into.

  • How someone experiences changes to plans: feelings of abandonment or rejection versus routine change and unpredictability. 

  • What life is like when things are going well (i.e., not in 'crisis').

  • Be curious and open to other diagnostic explanations, rather than seeing everything through the lens of an existing diagnosis. 


2. Do not assume:
 

  • Someone understands what you are saying and how questions on assessment measures can be unclear (e.g. ‘I feel empty’)]

  • Non-cis gender identity indicates ‘identity disturbance’

  • Self-harm history is a signifier of ‘borderline personality disorder (BPD)’

  • Seeing someone during a crisis/meltdown gives a realistic picture

  • Not being able to see your perspective is an inability to mentalize.​

    • ​Black and white thinking is attributed to rigidity of thinking (although could fit with autistic experiences)

  • Experiencing rejection deeply is a ‘real or imagined fear of abandonment’ 

    • This may be Rejection sensitive Dysphoria (ADHD/autism)

  • Because someone performs well in one area, they perform well at everything (e.g., work versus social situations).


3. Think about:
 

  • Neurological signs (e.g. excessive blinking, small gestures such as tapping, hair twirling)

  • Ehlers's Danlos/hypermobility

  • Eating disorders (are they about sensory needs, control, or trauma-related?)

  • Facial expressions and whether they are congruent with what is being said

  • Menstrual cycle and hormones

  • Performance in structured versus unstructured situations (and therapies)

  • The age at which someone started to find life more tricky – especially social interactions/understanding social rules and boundaries in relationships:

    • What might be trauma from unrecognised autism

    • School experiences

  • If someone does meet criteria for autism and ‘BPD’, what adaptations could be helpful in therapy.


4. Be conscious of some other pitfalls
 

  • Moving from CAHMS to adult services can change a diagnosis in order to access service (e.g. where there is more support for autistic children vs ‘BPD’ adults).

  • Communication can be tricky for both groups – may attribute frustration as anger due to ‘personality disorder’.

  • Labelling someone as a way of managing risk (or your anxiety).

  • Someone may not be aware they are masking – spending more time with them can help here

  • Autistic people can learn scripts for small talk!

  • Consider gender stereotypes.

  • Personal or unconscious bias, check this out with colleagues.

  • If a therapy is not helpful, is it the wrong therapy rather than ‘failure to engage’ – could adaptations be useful?

 

Possible suggestions:

 

  • Using diagnostic hierarchies; these can be helpful to rule out similar diagnoses.

You can support us!

We are dedicated to enhancing our web design and content. Please provide your rating for this page to help us understand what we're doing well and where we can improve.

We are conducting an exciting research study and would love to keep you updated with our findings. Enter your email address below to get a summary of our findings once they are published.

How would you rate this page overall?
Enter your email
Don’t love itNot greatGoodGreatLove it

Your answer is submitted!

Thank you for your feedback!

Your answer is submitted!

Thank you for your interest in our work!

bottom of page