If you can be bothered, you can scroll back through Twitter and find me telling people that the diagnosis of personality disorder is useful, that not all staff will treat you like dirt once it’s given, that it isn’t an insult.
At the time, I meant it. Everything around me reinforced the idea that without a diagnosis, we couldn’t help people. That it was necessary. That it was just how things were.
These days I see things very differently. This is a short explanation of how that change came about.
What I Was Taught
My training didn’t help me understand the diagnosis of personality disorder. It certainly didn’t prepare me to work with people who shared my reality but hurt themselves to cope and often wanted to die.
Most of what I learnt came from colleagues. They hadn’t had any training either, so what I picked up was a mix of gut instinct, folklore, and hand-me-down prejudice, all wrapped up as professional wisdom.
Two moments stand out from those early days:
In my first job, in a secure hospital in Scotland, a patient went to court arguing, “I have a personality disorder, but it’s untreatable. You should let me out.” The judge agreed. For months afterwards, the wards echoed with people shouting “I’m untreatable!” It was like a low-budget Scottish version of Spartacus.
In my second job, on an acute ward in London, I asked about a newly admitted patient. The nurse in charge told me, “He’s got a personality disorder.” I asked what that meant. He said, “It means there’s nothing you can do to help him.”
The lesson was fairly clear. These people couldn’t be helped, and spending time with them was a waste of energy.
Things got worse from there. I was told they enjoyed self-harming. That they deliberately split teams. That they sabotaged their own care.
Once that view took hold, it was difficult to see the person in front of you. People stopped being just “hard to help” and became actively resented. Not because of who they were, but because of the lens we were encouraged to view them through.
What kind of person hurts themselves for fun? What sort of person lashes out at those trying to help? Of course we were annoyed at the ones who stayed for months and harmed themselves every time discharge was mentioned. They weren’t “really ill.” They were taking up space for people who REALLY need it.
That was the culture. That was the air I breathed.
A Shift in Direction
There wasn’t a single turning point, but ten years into my career something began to change. A colleague asked if I wanted to work in a new therapeutic community for people with a personality disorder diagnosis. I declined immediately. The idea of spending all day with “them” sounded ridiculous.
But then I read about how the group worked. Decisions were made collectively. Staff were outnumbered by group members. The power dynamics were flipped. It still seemed bonkers, but also... interesting.
I ended up competing for a place. When my 1 year secondment ended 2.5 years later, I left a different person. I couldn’t work in services the same way again.
Why? Because during those 2.5 years, I experienced something transformational. I worked with colleagues who had the diagnosis — and I liked them. I sat in groups where people challenged, supported and validated each other. I saw how self-harm was a coping strategy. How suicidal thoughts made sense given people’s histories. How relational difficulties reflected what had been modelled to them. Mostly, I saw how much pain everyone in the room had lived through.
After that, I couldn’t go back to acting like their pain was less deserving.
Still Inside the System
I wasn’t allowed to stay in the group, but I couldn’t walk away from the work either. I applied all over the country and ended up in Cardiff. My understanding had shifted, but I was still using the diagnosis. I could see how it affected staff and team attitudes, but I told myself it was worth it — that the label led to treatment and helped people understand what was going on. I also didn’t see what the alternative was.
A few key things started to change that.
1. KUF Training
We brought KUF training around personality disorder into the area. It’s delivered jointly by clinicians and people with lived experience. The content itself had some critiques of the diagnosis, but it was the relationships that mattered.
I trained alongside several brilliant facilitators, but spent most time with Hollie Berrigan. As we worked together — and became friends — she helped me question things I’d previously taken for granted.
She pointed out something so basic I had managed to miss it entirely: when you tell someone they have a “personality disorder,” you are telling them their personality — the core of who they are — is disordered. There’s no getting around that. It’s a horrible thing to be told.
2. Doing a Master’s
The MSc I did in Personality Disorder continued in a similar vein. I was taught by — and studied alongside — people who had the diagnosis. I heard repeatedly that they didn’t believe their personalities were disordered, and that they found the label deeply offensive.
In the past, I might have pathologised this resistance. But when someone explains that their life has involved rejection, abuse and being told they were unlovable — and then services confirm it with their actions and a diagnostic stamp — it’s not hard to understand why they might object.
The course also helped me understand how services evolve to exclude people. Eventually, I got to the point where I could see that giving someone the diagnosis almost guaranteed they would be treated worse.
3. DBT Training
I trained in DBT around the same time. It has its flaws, but it’s the therapy with the most lived experience involvement, and it actually explains why people do what they do.
Suddenly, self-harm made sense. Suicidal ideation wasn’t madness. Low self-worth wasn’t a symptom — it was something life had often literally beaten into people.
More Cracks in the Wall
Since then, plenty more has pushed me further away from the diagnosis.
There was the CMHT who refused to work with “those” patients, or attend meetings if they were present. There was the nurse who said she’d provoke an informal patient into being sectioned just to avoid being blamed if she let them out. There was the time I raised concerns about harm, only to be investigated myself.
It kept adding up.
4. Finding the Online Community
I set up a Twitter account at BIGSPD in 2015 and shared thoughts about the diagnosis. Not everyone welcomed them. Quite a few people who had been hurt by services pushed back hard.
I resisted. I thought I was listening. In truth, I wasn’t — not properly.
Accounts like “Drop the Disorder,” “Recovery in the Bin,” “Survivors Against PD,” and a few very direct individuals wouldn’t let it lie. They challenged the science. They challenged my assumptions. Eventually, I started listening properly.
The final nudge came at a Drop the Disorder event. I still remember my manager got paid to go while I had to use annual leave.
In person, the people I’d found challenging online were lovely. Lucy Johnstone talked through a case of someone who had been seriously hurt, taught never to show emotion, and taught not to trust people.
When asked what would help, the answers were obvious.
Don’t take away her power.
Don’t expect instant trust.
Don’t insist she work with a man.
Don’t tell her she’s mad, or ill.
Don’t tell her that her personality is disordered.
Where I Am Now
I no longer believe anyone should be told they have a disordered personality. There’s no way to soften the language or pretend it means something else. It’s always going to be an insult.
The majority of people with a BPD diagnosis have lived through trauma. Most of the time, the “problem” is the things that were done to them — not who they are.
It might be that the nine NHS Trusts I worked in were uniquely stigmatising, but I doubt it. In every one, the diagnosis functioned as a way to excuse poor care or shut the door on people.
Sometimes we tell ourselves it’s helpful — that it leads to treatment. Occasionally, people feel relieved to have a name for what’s going on. But let’s not kid ourselves: that feeling of clarity doesn’t protect them from what happens next. Once those three letters appear on someone’s notes, empathy tends to vanish and out of our sight they will be mistreated by people responding to the diagnosis we have given them.
Mental health professionals hold more stigma towards people with BPD than the general public. If we’re going to give someone a label that invites discrimination, we’d better be sure it actually helps. I don’t think it does.
The Diagnosis Doesn’t Hold Up
Here are just a few problems:
Diagnoses are often based on gut feeling.
“Smells a bit PD” gets used for people who are neurodivergent, traumatised, hormonally affected, or just not particularly palatable to professionals.
Women who self-harm almost always get the label, regardless of what else might be going on.
With 5 out of 9 criteria required — and over 250 combinations — two people with a BPD diagnosis might share almost nothing in common.
The criteria are vague. Judging the appropriateness of someone’s emotions is incredibly subjective — and often shaped by gender bias.
Most people who meet criteria for one “type” of personality disorder also meet criteria for others. It’s not a neat or valid construct.
There is no therapy that requires someone to believe their personality is disordered in order for it to work.
Final Thoughts
In 1988, Louis Appleby wrote “Personality Disorder: The Patients Psychiatrists Dislike.” It’s difficult to read it without concluding that many psychiatrists label the people they dislike — rather than disliking the people they label.
All the anti-stigma training in the world hasn’t changed the fact that this diagnosis leads to worse care. It’s not needed to inform treatment. It does more harm than good. It needs to go.
If you have the diagnosis and feel it fits you…
You absolutely have the right to describe yourself however you choose…
But I’m sorry that services encouraged you to see yourself that way.
If you said, “I’m worthless,” we’d challenge it.
If you said, “I’ll never be good enough,” we’d push back.
Only when you say, “My personality is disordered,” do we say: “Yes, that sounds right.”
* I’ve tried to be really honest about what I’ve thought at different points in my career. I’m ashamed of many of the things I’ve thought and done. There was an entire system that helped me to think in the way that I did and while there might be some pain and discomfort reading what I’ve described, I genuinely believe that the prejudice and stigma that shaped me is shaping the mental health staff of tomorrow. Because of the work I do and have done, I don’t have the luxury of being able to brush of the semantics of diagnosis because I see the stigma and discrimination that results in real time. 20 years since No Longer A Diagnosis of Exclusion was published and in 20 years time I think we’ll still be talking about how people are mistreated once we label their personalities as disordered.
Sometimes I’m told that anything useful I say in this area is stolen from survivors. That might be true but a lot of passionate people made a huge effort to get me to listen. I did.