This is a topic I find really interesting and frustrating in equal measures. Mainly because of how quickly these diagnoses seem to be given out and because of how little explanation and collaborative discussion there seems to be around them. I personally feel that this is the main reason people find this such a controversial diagnosis… also because of the terminology which I think is the most personal of all diagnostic names, purely because it sounds as though you are being clinically told that your personality, the root of you, is disordered when that is not the case. I must say, I do believe strongly that there is a place for the diagnosis, albeit with a different name, but I feel that it’s only really as valuable as it is to the person receiving it.
I have answered some questions around this topic on the forum thread “Q&A with a mental health nurse” but I thought it was something that I could spill a few more thoughts on. So, I’ve grabbed a cup of tea, some left over Christmas chocolate, gotten on my soapbox and I’m ready to go. As always, these are wholly and entirely my own thoughts and opinions and I am more than open and welcome to discussion about them.
The reason I find this a particularly controversial diagnosis to be given out so readily is that there really isn’t a set diagnostic criteria for it. There are many personality traits, 10 which are associated with personality diagnoses which are briefly explained here: https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/#.XCULq2T7SCQ. These explanations are by no means exhaustive and people who have the diagnosis or those personality traits will be able to give much more insight into what it’s like to experience each one.
Personally, I don’t feel that someone having maladaptive coping skills or having had a difficult childhood or finding it hard to relate to other people in relationships or work settings is enough to offer someone a formal diagnosis. However, through many conversations with people on The Good Limbo, in general and through work… that seems to have been the basis. The thing is, everybody’s personality is made up of several of these traits, developed through every experience we’ve ever had from birth until death. Things that seem insignificant, moderately impactful or quite traumatic shape us and our way of thinking about who we are, the world in general and our place in it. All of these traits have positive attributes, keeping us safe and helping us to understand things in our own way. Unfortunately though, there are times when these traits and how they help us think can be more problematic than good. When a trait becomes problematic in the majority or all areas of someone’s life over a long time (problematic, pervasive and persistent) then it is considered a disordered trait.
For this reason, I really don’t feel a diagnosis can be given without a thorough discussion with someone about their history and key moments in their life. I believe a collaborative conversation should be had with someone, breaking down each event to discuss whether or not they agree that it is something that is problematic for them. For example, someone who has had several unfaithful relationships could be expected to have difficulty in trusting new partners, however, if this is not something they personally believe to be the case for themselves then we cannot attach that assumption to them. The same can be said for a diagnosis related to someone’s personality trait. Some people after having done their own research or talking to the psychiatrist who is offering the diagnosis may feel that this fits wholly for them and that they can relate entirely to this. For others, they may disagree with elements of the diagnosis and will therefore find little benefit from the treatments offered for this.
In my experience of working with people I have learnt that people will rarely if ever progress and engage with work offered if it doesn’t sit right with them. This is never truer than with diagnoses related to personality. Having someone who does not agree with this as his or her diagnosis or who feels that this has just been placed with them without having it explained or discussed will struggle to accept it (and rightly so). Without acceptance, any treatment will fall short of the mark and leave people even more confused or frustrated than they were before seeking support.
I personally feel that this is the area that most needs to be moved forward in terms of mental health services. Addressing the over diagnosing of personality disorders, the stigma around these and the controversy around the treatments offered. The first step in my mind is to make things more open, have more in depth conversations and be open to discussion and disagreement. Ultimately, it is the individual who matters and only they are impacted by the diagnosis and only they feel the true benefit of treatment offered.
So, my cup is empty, the chocolates are done and I am back on solid ground and that, dear reader, is that… until the next time I get a bee in my bonnet..