Personality Disorders Awareness Network (PDAN)

08/29/2026

08/28/2026

With the ESSPD conference coming soon and a session on the Prevention and Early Intervention of Personality Disorder on first, I wonder:

Before we get too enthusiastic about diagnosing “personality disorder” in children…

The argument is understandable: identify problems, intervene, prevent years of suffering.

But a new RCPsych position statement gives us good reason to pause.

Writing about survivors of childhood sexual abuse, the College identifies misdiagnosis and diagnostic overshadowing as potential iatrogenic harms. It says incorrect diagnoses can be given even when criteria aren’t met, with increased risk for women, people who aren’t heterosexual and people with a history of self-harm.

It also says:

“Restrictive and potentially punitive practices” are more likely when people are given diagnoses such as EUPD.

That’s important when we’re talking about children.

A label in childhood potentially means more years exposed to its stigma, diagnostic overshadowing and consequences.

There’s another uncomfortable overlap.

Michael Kaess and colleagues studied 152 adolescents who self-harmed. Within this already distressed group, greater childhood adversity was associated with more BPD symptoms and a greater likelihood of meeting BPD criteria.

So the children who look most “borderline” may also be disproportionately those who have experienced the most adversity.

The very children we might tell have disordered personalities may substantially overlap with the population the RCPsych is warning us can be harmed when trauma is misinterpreted, medicalised or misdiagnosed.

The RCPsych recommends recognising trauma, relational care and comprehensive biopsychosocial formulation which considers the “potential centrality” of traumatic experiences.

None of this is an argument for making children wait for help.

Early help? Absolutely.

But early help doesn’t require us to tell a child that their personality is disordered.

Before doing that, shouldn’t we be asking:

What additional benefit does the diagnosis provide — and what is the cumulative harm of carrying that label from childhood?

Royal College of Psychiatrists (2026), Addressing the impact of non-recent child sexual abuse on the mental health of adults, PS04/26.

08/26/2026

The RCPsych has come the closest it has (so far) to explicitly naming the harm that can come from giving a personality disorder diagnosis to a survivor of abuse.

Its new position statement on non-recent child sexual abuse has a whole section on iatrogenic harm — avoidable harm caused through healthcare.

Within it:

“Restrictive and potentially punitive practices” are more likely when people are given diagnoses such as emotionally unstable personality disorder (EUPD).

That’s significant.

We often talk about diagnosis as though it simply describes something within a person. But diagnosis can also change what happens to them: how distress and self-harm are interpreted, what clinicians expect, what treatment is offered and, apparently, the likelihood of restrictive and potentially punitive responses.

The College also recognises misdiagnosis and diagnostic overshadowing as potential iatrogenic harms. Remarkably, it acknowledges that an incorrect diagnosis can be made even when criteria aren’t met, with the risk increased for women, people who aren’t heterosexual and people with a history of self-harm.

It describes how diagnostic labels can medicalise distress and perpetuate shame and stigma, and how failing to consider trauma can cause re-traumatisation and further distress.

And it recognises that what clinicians call “symptoms” may actually be reactions to what was done to someone — including ways of coping that helped them survive an abusive childhood.

This doesn’t say every EUPD diagnosis given to a survivor is a misdiagnosis.

But surely it requires us to ask:

What are we attributing to a disordered personality that might make sense in the context of what happened to someone?

And what happens to that person once we give them the diagnosis?

The RCPsych Expert Reference Group on “personality disorder” is long overdue to share the products of its work. It will be interesting to see how that work builds on these findings.

If these harms are now acknowledged in one RCPsych position statement, they surely need to inform what the College says next about “personality disorder”.

Diagnosis isn’t a neutral act.

Royal College of Psychiatrists (2026), Addressing the impact of non-recent child sexual abuse on the mental health of adults, Position Statement PS04/26.

08/24/2026

Assessment

What should an assessment for “borderline personality disorder” actually look like?

If you only knew the diagnosis from some clinical records, you might assume assessment meant establishing whether someone meets enough diagnostic criteria.

NICE asks for considerably more than that.

When assessing someone for possible BPD, NICE says services should fully assess:

• psychosocial and occupational functioning
• coping strategies
• strengths and vulnerabilities
• other mental health difficulties and social problems
• need for psychological treatment
• need for social care and support
• occupational rehabilitation or development

And NICE’s quality standard says people should have a structured clinical assessment by a mental health specialist before being given the diagnosis.

The Not So NICE Guidelines offered a rather different interpretation:

“Social problems should be rebranded as ‘choices’.”

And:

“Look for ways to say no. Previous ‘non engagement’, the mildest of forensic histories, dependency, hostility… pretty much any identified symptom of BPD is a reason to decline.” not-so-nice-full.pdf

Again, it’s satire.

But there’s something uncomfortable underneath the joke.

Imagine someone struggling with relationships, housing, occupation, trust, distress and ways of coping that sometimes frighten professionals.

The guidance says:

Understand those things. Assess their needs. Identify their strengths. Think about what support might help.

But what if the assessment instead becomes an exercise in deciding:

What’s wrong with this person?

Or worse:

Why shouldn’t our service help them?

There’s a particularly strange circularity when behaviours associated with a diagnosis become reasons to exclude someone from the services intended to help with the difficulties associated with that diagnosis.

NICE is actually remarkably clear on this:

People should not be excluded from health or social care services because of the diagnosis or because they have self-harmed.

So here’s the question for part two:

Is assessment being used to understand what somebody needs — or to decide whether they deserve it?

08/22/2026

A new study has asked people told they have “personality disorder” what it is actually like to be prescribed psychiatric medication.

The title captures one of the findings rather well:

“It seems like they are guessing.”

The study interviewed 10 people, most told they have EUPD, about their experiences of medication and prescribing.

And there’s a pretty uncomfortable gap between what guidelines tell us and what people described.

Guidelines generally discourage medication for the core features of “personality disorder”. Yet prescribing remains widespread: the authors note that in Sweden only around 10% are medication-free a year after diagnosis, while a third are prescribed three or more psychotropic medications at the same time.

People certainly described medication sometimes helping.

But they also described:

* trying medication after medication, searching for the one that might finally work
* prescribing that felt arbitrary or like trial and error
* not understanding why particular drugs had been chosen
* medication being offered while they waited for the help they actually wanted
* involvement in decisions that sometimes felt tokenistic
* inadequate follow-up
* being left to work out whether medication was helping themselves
* and, perhaps most troublingly, blaming themselves when medication didn’t work.

One participant had tried around 20 different medications:

“If one didn’t help, they added another.”

Another said:

“Sometimes it feels like they’re just guessing.”

And when someone disagreed with their doctor, even that disagreement could be interpreted through the diagnosis:

“This is very typical for your diagnosis, that you get angry [when you disagree].”

Their response?

“It has felt like my feelings have been brushed aside.”

There is something particularly troubling here.

When a treatment with limited evidence doesn’t work, the conclusion should surely be that the treatment hasn’t worked.

Yet some participants instead came to wonder whether they were the problem.

The authors conclude that prescribing needs clearer rationales, genuine shared decision-making, predictable follow-up and integration with broader psychosocial care.

But I think there’s an even more basic question worth asking:

If guidelines tell us not to routinely medicate “personality disorder”, why are so many people still accumulating years of medication — sometimes several medications at once — without being entirely clear what they are supposed to be treating?

“It seems like they are guessing” is a patient perspective.

We should probably be interested in why prescribing can feel that way.

08/19/2026

These are diagnostic codes in the ICD11 manual. Can we only help this person if we tell them their personality is disordered?

Imagine someone comes into mental health services.
Using ICD-11, we could describe them like this:
QD50 — Poverty
They don't have enough money.
QD71.2 — Problems related to living in a residential institution
They hate where they live and desperately want to get out.
QE82.0 — Personal history of physical abuse
People have hurt them.
QE82.2 — Personal history of psychological abuse
People have frightened, humiliated or emotionally harmed them.
QE04 — Target of perceived adverse discrimination or persecution
They experience discrimination.
QE50.4 — Relationship with parents, in-laws or other family members
Family relationships are difficult.
MB24.1 — Anger
Sometimes they get really angry.
MB24.7 — Dysphoria
They experience intense emotional distress.
MB23.E — Non-suicidal self-injury
Sometimes they hurt themselves to cope.
MB26.A — Suicidal ideation
Sometimes they think about dying.

In some ways, I've just described almost everyone I've ever worked with.
And look how much we already know.

We know something about what has happened to them.
We know something about the circumstances they're living in.
We know about their relationships.
We know how they feel.
We know something about what they do when those feelings become unbearable.
None of this means their difficulties aren't real.
None of it means they don't desperately need help.
But ICD-11 allows us to describe all of these things without saying:

6D10 — Personality disorder
So I think there's an important question for those of us working in mental health services:

What clinically useful information does “personality disorder” add that we didn't already have?
And perhaps a more important one:
Can we only help this person if we tell them their personality is disordered?

08/17/2026

08/14/2026

Do you ever get the sense that the people who are supposed to help you are frightened?

I’ve really enjoyed reading this new paper by Michael Haslam and colleagues about what happens when people experience mental health crisis and come into contact with Crisis Resolution and Home Treatment teams.

There’s an idea in it that really stayed with me:

“Reciprocal insecurity.”

The paper suggests that both the person experiencing crisis and the professional supporting them can feel frightened and uncertain.

But they may look for safety in very different places.

For the person in crisis, safety might come from being listened to, believed, understood and having a relationship with someone who can stay alongside them.

For the professional, safety might come from risk assessments, procedures, structure, observation and having a sense of control.

The difficult bit is that one person’s attempt to feel safer can sometimes make the other person feel less safe.

The paper talks about what happens when people become reduced to diagnoses, risks or behaviours rather than being understood as people with their own experiences.

It also raises an important point about people feeling that they have to “prove” how distressed they are when they don’t feel believed.

That feels particularly important when we think about people who have received a diagnosis of personality disorder.

What if some of the things we describe as evidence of someone’s “disordered personality” are actually responses to feeling frightened, unheard, invalidated or unsafe?

And what happens when the response to that distress is more control, more distance and more risk management?

We could end up with a cycle:

distress → crisis → increased control → feeling less safe → greater distress → another crisis.

The authors don’t simply blame professionals for this. They describe nurses as working within systems that can make them feel unsafe too.

I think that matters.

Because if we want people to feel safer, perhaps we need to think about whether the systems supporting them feel safe enough for staff to remain curious, compassionate and relational when things get difficult.

And it leaves me wondering:

What does this cycle cost people?

How many more crises?

How many admissions?

How many days in hospital?

How much restrictive practice?

How many emergency interventions?

And how much staff burnout and turnover?

The paper doesn’t answer those questions.

But perhaps they’re questions we should start asking.

Because relational practice isn’t just about providing a nicer service.

What if it could also be a way of reducing the demand created when people and systems repeatedly become frightened of each other?

A really thoughtful paper — and one that I think deserves a much wider conversation.

Keir Harding OT

08/12/2026

How much should we help people to think that their personality is disordered?

I’m often told I shouldn’t tell people that the way they understand themselves is wrong - And I agree.

But what do we do when someone DOES believe their personality is disordered?

Someone with lived experience was very clear that her personality was disordered. It fitted with how she understood herself.

I found that difficult.

I was so used to arguing that we shouldn’t tell traumatised people that their personalities are disordered that I realised I was in danger of simply reversing the process:

“You don’t really have a disordered personality. You only think you do because you have been hurt.”

Which is remarkably similar to the paternalism I was objecting to.
So I tried something different.

Rather than telling her she was wrong, I talked about the contested science, the history of psychiatric diagnoses, the stigma attached to the label, and other ways of understanding her experiences.

Recently, she sent me this:
“You popped up on my feed and I’ll never forget when we were working together on a project at RCPsych and your contributions made me completely change my mind on diagnoses of personality disorder. My views have changed so much and my perspective on mental illness has changed and I now take a social constructionist approach to how I view diagnosis.”

She’s a lived experience expert.

People are often given a diagnosis with little opportunity to understand the arguments against it.

They are told:
This is your diagnosis.
This is what you have.
This is what the science says.

But the science isn’t nearly as settled as that presentation suggests.
The categories are constructed and have changed repeatedly. Some diagnoses have disappeared altogether. “Personality disorder” also carries considerable stigma.

If we don’t tell people that, can they really make an informed choice about whether the diagnosis is useful?

This is where health professionals have enormous power.
We can tell someone who has survived abuse that their personality is disordered and present that as scientific fact.

Or we can explain the diagnosis, its limitations, the arguments about it, and other ways of understanding what has happened to them.

Then ask:

What do you think?
That isn’t telling someone that their understanding of themselves is wrong.
It’s giving them the information they need to decide for themselves.
I don’t think we should tell survivors of abuse that their personalities are disordered.
But I also don’t think we should tell someone who believes their personality is disordered that they are wrong.

Perhaps the line is simpler:
We should stop pretending that we know what someone’s personality means better than they do.

Give people the evidence.
Give them the alternatives.
Be honest about the uncertainty.
And then let them decide.

Telling survivors of abuse that their personality is disordered — and telling them that this is simply scientific fact — is a choice.
We can make different choices.

08/07/2026

If Borderline Personality Disorder is a useful diagnosis, you’d expect mental health professionals to value it. But what do mental health professionals think when the diagnosis is suggested for them?

Chloe Beale is a consultant psychiatrist:

“My experience of becoming a psychiatric patient when I was already a consultant psychiatrist was that I have to behave in a certain way. I have to be a perfect patient otherwise I know what people are likely to say about me. I’m a woman and if I’m perceived in any way difficult they might label me as having a personality disorder and that might mean that I get dismissed and told that I’m demanding and manipulative. This is a diagnosis that is hugely stigmatised within mental health services (and) I know the fear I carried as a psychiatrist knowing the inner workings of my profession and the absolute terror that if I was perceived as too demanding or too manipulative I would be dismissed as difficult and get that woman out of our services.”

Chloe is describing personality disorder as a label given to women seen as “too difficult” and recognising that if her problems had been described as Borderline Personality Disorder, all help would have been taken away.

A psychiatric nurse who had been told her personality was disordered messaged me recently and said:

“(BPD is) an umbrella term that serves nothing but stigma and a switch off to the actual issues.”

For her, the diagnosis functioned as a barrier rather than a route to help.

Perhaps the person most closely associated with Borderline Personality Disorder is Marsha Linehan, the creator of DBT. She has written and spoken openly about her own experiences of being detained in psychiatric hospital, where self-harm and suicidality became major difficulties. She said:

“I tell my patients if you end up in an emergency room for a medical disorder for God’s sake do not tell them you meet the criteria for BPD, do not tell anybody because there is such a stigma and you’ll be treated differently most of the time, and many, many, many mental health practitioners will not see someone who meets the criteria for BPD.”

If the diagnosis is so clinically useful, why do some of the people who understand mental health services best fear receiving it themselves? Why are people not routinely warned about the stigma that so often accompanies this diagnosis before it is given?

I’ve worked in mental health for 25 years, and for around 15 of those years I’ve worked almost exclusively with people whose distress has been described as “personality disorder”. If someone I loved were struggling, I’d do everything I could to make sure they received compassionate, evidence-based care. I would also do everything I could to avoid them acquiring a diagnosis that so many people—including mental health professionals themselves—believe will lead to stigma, poorer treatment, or exclusion from services.

For balance, every message I’ve received from a mental health professional telling me that being diagnosed with Borderline Personality Disorder reduced stigma, improved the care they received, and made their life easier is reproduced below.

….

Thanks for reading

From Keir Harding - other opinions are available