I-RAP
Improving Recognition and Understanding of Autism and Personality Disorder
Information about autism and personality disorder
1. Highlights
Trigger warning: this section contains references to trauma.
-
Some people argue that borderline personality disorder is not a personality disorder and that it is not a useful diagnosis.
-
Some people argue that no-one should ever be diagnosed with any personality disorder, because:
-
It is insulting to suggest someone’s personality is disordered
-
It ignores the role of trauma and blames trauma survivors for their distress
-
The diagnostic label leads to stigma and discrimination by clinicians
-
2. Further Information
Some scientists and clinicians have argued that for something to be validly described as a “personality disorder”, it should look like an extreme version of personality traits that all of us have to a greater or lesser degree. So like the extreme end of a “personality spectrum”.
They say that the types of difficulties described by the label “borderline personality disorder” are not really a “personality disorder” because a. they describe behaviours and emotional experiences rather than personality traits and b. they are not just exaggerated versions of personality traits that we all experience to a greater or lesser degree. For this reason, when a group of scientists and clinicians got together to make the new UK and European diagnostic guidelines [1], some of them wanted to leave out “borderline personality disorder” altogether. But others felt it was important to keep it in as it can help to decide whether to offer someone certain types of psychological therapy that are tailored to that diagnosis. So it stayed in, but it was downplayed a little compared to the previous version of the diagnostic guidelines. You can read more about this debate here and here.
Some people – including some people that have been given a personality disorder diagnosis themselves, as well as some clinicians – feel very strongly that the idea of someone having a “personality disorder” is not valid and that no-one should ever be given any personality disorder diagnosis [4].
One reason for this is that people with this diagnosis can sometimes experience really negative attitudes and even discrimination from mental health clinicians [2, 3]. Whilst training can improve attitudes [4], and individual clinicians may strive to deliver empathic and compassionate care, recent research suggests that stigma against people with this diagnosis is still inherent in the mental health system [5].
Irrespective of this, some people argue that it is inherently insulting to say that someone’s personality – the very core of who they are – is “disordered.” Many of the people given this diagnosis are survivors of trauma, often childhood sexual abuse [6]. It has been argued that describing trauma survivors as having a disordered personality disorder is akin to blaming that person for their difficulties, when in fact it is the perpetrator of the trauma that is responsible. Further, the types of difficulties experienced by people given a “borderline personality disorder” diagnosis could be seen as necessary coping mechanisms or strategies that person needed, in order to survive the trauma, rather than as a “disorder” [7]. Childhood trauma increases the chance that a person will develop other types of mental health difficulties too, so it is not exclusively associated with “borderline personality disorder”, but research does show that people with this diagnosis are three times more likely to describe a history of childhood trauma compared to people with other mental health diagnoses [8]. Whilst not everyone diagnosed with “borderline personality disorder” has a history of childhood trauma, its sometimes argued that our understanding of what constitutes “trauma” is too narrow and that emotional abuse, emotional neglect, bullying, discrimination and societal oppression should be considered here too [9]. The Collabor8 and Survivors Voices group of child abuse and sexual violence survivors has outlined their experiences of being harmed by being diagnosed with BPD and have called for trauma-specific treatment pathways that allow their experiences to be understood and treated outside of the personality disorder framework [10]. Some good resources to find out more about these ideas are the X ("Twitter") handle #traumanotPD and the writings of Jay Watts and Wren Aves [e.g. 11, 12].
Despite these difficulties, it is important to note that some people do find receiving a diagnosis of personality disorder to be a helpful process in learning to understand themselves and in feeling less alone, and feel they have benefited from the access to specialist evidence-based treatment that the diagnosis facilitates [13, 14, 15, 16, 17].
3. References
[1] World Health Organization (WHO) (2019). International Classification of Diseases, Eleventh Revision (ICD-11), https://icd.who.int/browse11. [2] Chartonas, D., Kyratsous, M., Dracass, S., Lee, T., & Bhui, K. (2017). Personality disorder: still the patients psychiatrists dislike?. BJPsych bulletin, 41(1), 12-17. [3] Klein, P., Fairweather, A. K., & Lawn, S. (2022). Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review. International Journal of Mental Health Systems, 16(1), 48. [4] Watts, J. (2019). Problems with the ICD-11 classification of personality disorder. The Lancet Psychiatry, 6(6), 461-463. [5] Baker, J., & Beazley, P. I. (2022). Judging personality disorder: A systematic review of clinician attitudes and responses to borderline personality disorder. Journal of Psychiatric Practice®, 28(4), 275-293. [6] Foye, U., Stuart, R., Trevillion, K., Oram, S., Allen, D., Broeckelmann, E., ... & Johnson, S. (2022). Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study. BMC psychiatry, 22(1), 72. [7] Zanarini MC, Williams AA, Lewis RE, et al. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. Am J Psychiatry 154: 1101–1106. [8] Brickel, R.E. (2019). A Compassionate Look at “Borderline Personality Disorder” From a Trauma-Informed Lens. https://brickelandassociates.com/borderline-personality-disorder-trauma-informed-lens [9] Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2020). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1). [10] Lomani, J. (2022). New ways of supporting child abuse and sexual violence survivors: a social justice call for an innovative commissioning pathway. https://osf.io/preprints/osf/svz3w [11] Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). [11] The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society. https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework [12] Aves, W. (2020). BPD: It's More Than Borderline Abusive. BPD: It's More Than Borderline Abusive (psychiatryisdrivingmemad.co.uk) [13] Watts, J. (2017). Testimonial injustice and borderline personality disorder. [Blog post]. Available from: https://www.huffingtonpost.co.uk/dr-jay-watts/testimonial-injusticeand_b_14738494.html [14] Lester, R., Prescott, L., McCormack, M., Sampson, M., & North West Boroughs Healthcare, NHS Foundation Trust. (2020). Service users' experiences of receiving a diagnosis of borderline personality disorder: A systematic review. Personality and mental health, 14(3), 263-283. [15] Katsakou, C., Pistrang, N., Barnicot, K., White, H., & Priebe, S. (2019). Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study. Journal of Mental Health, 28(6), 604–612. [16] Rothwell Blake G (2021). “BPD impacts my life in every way” – Gabby’s story. https://www.rethink.org/news-and-stories/blogs/2021/05/bpd-impacts-my-life-in-every-way-gabby-s-story/?fbclid=PAAabkwJKt3yBursVaCu58dh2C1P34_R6iCr1_AErT8AEnxH9En-Gnh1peIFU_aem_AZda9bBX4Pm3hNrhmbkWyvtYh1ADP1nDaIpck6cLdrz7Xl3MD_bu-E3r--LB--cTrew [17] Stoffers-Winterling, J. M., Storebø, O. J., Kongerslev, M. T., Faltinsen, E., Todorovac, A., Jørgensen, M. S., ... & Simonsen, E. (2022). Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. The British Journal of Psychiatry, 221(3), 538-552. [18] Tedesco, V., Day, N. J. S., Lucas, S., & Grenyer, B. F. (2023). Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience. Personality and Mental Health.
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
Your answer is submitted!
Thank you for your feedback!
Your answer is submitted!
Thank you for your interest in our work!