Thread by @DaleWhetter

We had #dclinpsy teaching on 'Personality Disorder' on Monday and it's been on my mind ever since as I can't see past the illogical falacies presented.

The speaker recognised that 'PD' is a contentious diagnosis that's highly stigmatising. They agreed that it's inappropriate to give anyone under 18 the diagnosis as it 'stays with them for life.' Instead, they felt that 'emerging PD' was more appropriate (whatever that is)

So why is it, acknowledging it as a stigmatising label that stays with people, inappropriate to give this diagnosis to a child, but fine once you turn 18/25? What changes? Do people over 18 not deserve compassion?

Are adult personalities not still developing too? I'm 25 and feel that my personality has developed leaps and bounds in response to life events over the past few years. I'm convinced my personality also would have developed if any of these events were traumatic.

What is it about adding 'emerging' to the diagnosis thats means this doesn't also stay with the person? It feels incredibly naive to me, 'sticking a plaster' over the problem, as it were. Does this just relieve clinician discomfort and make us feel that we're doing something?

I was also struck by the speakers way of coping with the complexity and contentiousness of the diagnosis. When thinking about what things might look like going forward, their response was "That's not for me to work out, you guys are the future of these services" ???

I understand where it comes from but it feels incredibly unhelpful. We have to begin to engage with complexity and put ourselves in uncomfortable positions.

This deflection of responsibility in the face of contentiousness doesn't help anybody, especially not those who've received a diagnosis of 'PD'.

I've also reflected on the recent @WrongKindOfMad podcast episode in which one of the people involved in ICD-11 'PD' revision reflected that whilst dropping the 'borderine PD' label was considered, there were concerns that all the previous work around it would go to waste?

If we're going to improve our services and mental health 'care' we need to redistribute the power, regardless of how uncomfortable it makes those who currently hold it feel.

How else does meaningful change ever arise if all we do is cling on to old ways of doing things, despite their pitfalls, and pass the buck when complexity arises? (hint, it doesn't)