The following is just one of my short opinion pieces on the DSM...
Diagnosing personality disorders in individuals who have experienced significant trauma sparks intense debate among health professionals including myself.
Benefits?
On one hand, some people with lived experience and therapists argue that accurate diagnoses can pave the way for effective treatments, create opportunities for funding, and foster validation and understanding (Campbell et al., 2020). And to be honest, there was a time I identified as being “Borderline”. Thinking it made me and separated me.
However, the darker side of diagnostic practices highlights inherent biases, particularly around gender.
The darker sides
Studies like those by Henry and Cohen (1983) emphasize how diagnostic frameworks often stigmatize behaviors deemed typical in men or categorized under traditional notions of masculinity, while simultaneously enforcing outdated narratives like female sexuality being passive or queerness as abnormal. The Diagnostic and Statistical Manual (DSM) exacerbates these issues, reinforcing binary health/illness perspectives and framing women’s sexual expression through a narrow lens.
Recent work by Ma and Else-Quest (2024) brings attention to how dominant psychological models stigmatise women diagnosed with Borderline Personality Disorder (BPD). They argue medical frameworks decontextualize and pathologize gendered violence, stripping away environmental and social factors.
Rodriguez-Seijas (2023) builds on this, suggesting that the DSM’s focus on personality disorders within individuals fails to recognize adaptive behaviors as responses to stigma, discrimination, and structural inequalities. Behaviors that resist conformity to societal norms are often misinterpreted, labeled as pathological, disordered and even criminalized (Ma & Else-Quest, 2024).
Alarmingly, a 2017 Australian survey revealed that even when diagnosed only 50.69% of participants living with BPD reported receiving adequate information about their diagnosis from healthcare professionals (Proctor et al., 2021). This gap underscores the need for transformative approaches that prioritize context, education, and equity in diagnostic practices such those that critically analyse socio-cultural political and instiutional environment such as occupational therapy. Using practices that reduce power imbalances and use co-constructive experiences such as narrative, nature and movement challenges traditional therapy approaches such as those that are abbreviated to three letter words.
The ongoing debate calls for a critical reexamination of diagnostic norms, urging health professionals to account for social, structural, and environmental factors alongside individual behavior.
By acknowledging the complexities surrounding trauma and personality disorders we are changing the landscape for people who have experienced trauma.
Laura Ludowyke OT
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