I’m here to call out the psychiatric diagnosis of victims of sexual abuse and violence.

I’m here to call out the psychiatric diagnosis of victims of sexual abuse and violence.

It’s time to stop the practice of diagnosing humans with psychiatric labels and allow them to naturally experience distress, trauma and shock when they are abused and violated by another human being. 

I want to share with you the moment I realised that enough was enough.

In 2012, I took over a rape centre. The centre provided free counselling and group therapy for women, men and children who had experienced recent or non-recent abuse, sexual violence or rape. I trained and line managed around 35 psychotherapists and counsellors and some months we were working with caseloads of over 150 people. We only covered one town in the Midlands so that’s a very high caseload for a small organisation.

Previous to this job, I had managed crown and magistrates courts with responsibility for the VIWs (Vulnerable and Intimidated Witnesses) Programme. I had always worked with people who had experienced trauma from crime, which is a specific type of trauma. Trauma from crime is specific because it is a man-made trauma. It is a trauma caused by the actions and decisions of a fellow human being. It’s not like a natural disaster. Its not like a freak accident. The person copes significantly better with those types of traumas because, eventually, the person can allow themselves to believe that there was nothing they could have done to avoid it and it certainly wasn’t their fault – or anyone else’s fault. No one meant for the freak accident or natural disaster to happen. However, crime – now that’s a different story. Crime is perpetrated by humans. It includes decisions, choices, targets, perpetrators and victims. It leaves people with questions like ‘Why me?’ and ‘Why did they do that?’ and ‘Don’t they care about the impact it had on me?’ and ‘Did I do something to deserve that?’

It’s no wonder that victims of sexual abuse and violence – crimes meticulously planned, based in power and control to violate a human being – suffer such varied and severe emotional distress to what happened to them.

Within about six months of being in post at the rape centre, I noticed a worrying trend.

“Jess, my client has just been diagnosed with Borderline Personality Disorder…” became a common conversation starter from my team. First it was one or two, then it was a handful, then it was ten, then it was thirty.

As I had responsibility for all face to face and telephone counselling and supervised every counsellor and psychotherapist in the centre, I was able to carefully analyse hundreds, maybe over a thousand cases of sexual abuse and rape that we held and realised that almost all of the women and girls referred into mental health teams in the NHS were quickly diagnosed with BPD and medicated. I specifically say ‘women and girls’ because in the rape centre I worked in, I saw very few men and teenage boys with a BPD diagnosis despite them experiencing very similar histories and emotional responses.

I was still very early on in my career and hadn’t yet started to specialise in forensic psychology or feminism but even back then, at 22 years old,  I was horrified by what I was seeing. People who had been abused and raped, who were 100% entitled to be traumatised and struggling with life were being told that they had something fundamentally wrong with their personality. If you could freeze-frame my life at that exact moment and zoom in on the face I was pulling – you would be able to pinpoint the moment I realised that women and girls were being diagnosed with disorders instead of being allowed to be in emotional distress. It felt scarily familiar to ‘hysteria’ diagnoses.

Clients were attending the centre with higher and higher dosages of medication. One 18 year old woman was sexually abused throughout her childhood and had been medicated with three rounds of electro-convulsive therapy (ECT). I remember reading her file and discussing this with her as she had attended one of my groups and she told me that the ECT made her feel like a zombie. I also remember listening to her and thinking ‘I didn’t even know we were using ECT with children in the UK!’ and spent the rest of the evening at home googling it.

A couple of years later, I was chatting to a woman I met whilst in the third year of my degree. We were talking about life and relationships and she started to talk about her relationships breaking down and how she longed to settle in a healthy relationship but had gone round and round the cycle of abuse for nearly twenty years. As always, I didn’t offer any perspective or theory but listened carefully. However, whilst listening to her story I did recognise her life journey as incredibly similar. Eerily familiar…

And that’s when she said it:

“I will never really settle down with anyone because I have this thing called BPD. Its a personality disorder. My CPN told me that’s why all of my relationships are abusive. I attract wrong ‘uns. I always wondered whether it was because I was abused as a teenager but when they told me I had BPD, I was so relieved. I realised that I had a mental health issue and that’s why people keep abusing me…”

I wasn’t at work. I wasn’t duty bound. I was talking to this woman in a personal capacity. I toyed with my ethical duties. I decided to stick my neck out.

“Kaci*, do you truly believe that? That there is something wrong with your personality? I think you are brilliant. But isn’t it possible that you were right all along? That you were experiencing emotional distress from the abuse you experienced as a teenager? And that’s totally okay. You can struggle. You can struggle for years if you need to. Other people abusing you in your relationships was never your fault – even if you were struggling. Don’t you feel its a little unfair to tell you that you have something fundamentally disordered about your personality?”

I immediately regretted it.

She stared at me, open mouthed, tears in her eyes.

“I’m so sorry, Kaci*. I didn’t mean to…”

“No, I’m not upset at you. But you just said exactly what I’ve been trying to say to the mental health teams for years! You are the first person to ever say this to me…”

And I have been saying it ever since.

 

Borderline Personality Disorder has a pretty (shall we say… inclusive?) set of criteria, meaning that most of us who have ever experienced a period of distress would fill enough criteria for a diagnosis. In fact, if I am having a particularly shitty time, I can honestly admit that I fulfil most of these.

Criteria for BPD (not all are required for diagnosis):

  • Feelings of anger or irritability at minor issues
  • Risk taking behaviours or engaging in activities without personal regard
  • Acting impulsively
  • Self harming during emotional distress
  • Feelings of being down or depressed
  • Fears of rejection of not being loved
  • Intense feelings of anxiety and fear
  • Emotions easily changeable and unstable
  • Relationships with mistrust and neediness
  • Hypersensitivity to emotions and situations
  • Change or instability in life goals or direction
  • Issues with body image
  • Issues with self-identity

In fact, a piece of research by Middleton (2013) showed that people who have experienced a complex trauma such as sexual abuse, neglect, rapes or exploitation, on average, would have enough ‘symptoms’ to be diagnosed with between 10 and 12 disorders at any one time. You read that right.

Add this to the fact that we are still not 100% sure how psychoactive medications work and we are now much more aware that antidepressants are not the magic cure-all we once thought they were; and we now have hundreds of thousands of people who have experienced sexual abuse and violence being told that there is something fundamentally wrong with them whilst being told to take more and more medications and sedatives to numb their feelings. Their completely valid feelings.

I am here to call out the psychiatric diagnosis of sexual abuse and violence victims. 

Whether its unqualified, knee-jerk front line professionals telling parents or children that they think they have ‘anxiety disorder’ or ‘PTSD’ or qualified, established CPNs and Psychiatrists telling people who have recently been raped or remembered significant histories of abuse and trauma – I’m here to ask you: What is your obsession with pigeon holing people and telling them that there is something ‘disordered’ about their psychology?

Why can’t we just accept that the ongoing, malicious, violent and abusive grooming and violation of children and adults, often by people they trusted most, is possibly one of the most harmful things they could ever go through? Why can’t we create space for people to react and respond and cope in the way they need to without labelling them? Why can’t we support them through their ‘extreme’ responses to extreme harm?

Instead of saying:

“You are showing symptoms of BPD. That’s why you are feeling like this. Not the abuse. You have a personality disorder. Here are some pills that will mask the feelings.”

Why can’t we simply say:

“You have seen and experienced things that have changed your life. Those people hurt you and they have scared you. They have changed the way you react to certain environments and feelings. They have heightened your senses and your emotions. And you know what? That’s totally normal and totally understandable. You are entitled to respond like this. Is there anything I can do to help you to cope with these feelings and thoughts? What do you need right now? What helps and what hinders you?”

Is this response really that unreasonable and unrealistic?

 

 

Jessica Eaton is an independent national specialist writer, speaker and researcher in sexual violence, forensic psychology and mental health. 

Twitter @JessicaE13Eaton

Web http://www.victimfocus.org.uk

 

 

 

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25 thoughts on “I’m here to call out the psychiatric diagnosis of victims of sexual abuse and violence.

  1. I recently rejected the diagnosis of BPD as of last week. I meet a consultant who had known me 45 minutes. It feels like they just love to throw it at people.

    Liked by 2 people

  2. Thank you for these important insights into a dangerously misunderstood phenomenon that is causing more harm to victim Jessica.
    The Standard of Practice for psychiatrists dealing with “family” violence in Canada is to refrain from blaming and pathologizing (labeling) victims (ie- masochistic etc.) which makes the problem “about them” instead of keeping the responsibility for what happened on the perpetrator.
    Despite this, Canadian research Allan Wade noted that police reports, newspaper reports and judge’s rulings 1) Blame victims, 2) Protect perpetrators 3) Obscure violence.
    The cultural social belief system determines the abusive manner in which victims are mistreated simply because they were victims of someone else’s choice to harm them.
    Beyond the failure to address the cultural bias and wide spread systemic abuse, the outdated “cycle of violence” fails to address all too common brain injury in women, damage and injury from the labels and the treatments of labels that are based on the lack of science supporting their legitimacy, non-existent.

    Liked by 2 people

    1. I agree Judy. Involuntary psychiatry is about protecting the guilty and blaming the victims of sexual assaults. I was in the U.S. military during the Vietnam War (although I wasn’t sent there). There I observed the kind of culture that didn’t hit the press until Abu Ghraib (2004) https://en.wikipedia.org/wiki/Abu_Ghraib_torture_and_prisoner_abuse

      And again reports in 2009 about similar events; http://www.spiegel.de/international/world/scandalous-images-from-kabul-guards-at-us-embassy-organized-humiliating-sex-games-a-646977.html

      Then in 2012 was the movie The Invisible War; http://www.imdb.com/title/tt2120152/
      Unfortunately, as good as the documentary was at bringing military sexual assault into public focus, it did not address how military and VA psychiatry helped protect and extend the culture that such assaults thrive in. It did however help spark pubic discussion; http://www.imdb.com/title/tt2120152/

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  3. You’ve changed my life with this article. They’ve been stuffing me with pills and using ECT on me since I was a teen. I have been diagnosed with BPD many times, but I absolutely do not have it, and I really believe it is a Dx used to control women, brilliant sensitive women.

    I cry when I think of the amazing life/world changing work that could have been created had women not been so suppressed. Physically. Chemically. Emotionally. All across the board.

    Liked by 1 person

  4. Your proposed non-diagnostic alternative response is perfectly reasonable and realistic, Jessica. Thank you for a touching post.

    As a psychotherapist, I don’t diagnose people, yet diagnosis often enters the picture from elsewhere. I’m not opposed to psychiatric diagnosis so long as a) it’s between consenting adults where one is appropriately qualified and acting in the considered interests of the other b) it opens things up rather than shuts them down. Sadly, these conditions are often not met, as you describe so well.

    That said, I don’t think a diagnosis must mean there’s ‘something fundamentally wrong with them’. Everything listed in DSM V or ICD-10 is a syndrome: a group of behaviours. This isn’t a judgement that the behaviours come about because someone is ‘disordered’ or there’s something intrinsically wrong with them. Often those behaviours will be linked to things that happened to them, as you say, and I think the manuals acknowledge that. They are only a ‘disorder’ in the sense that this set of behaviours has some serious negative effect on their life or well-being (or that of others, somewhat more problematically).

    If I wave my hands about you could diagnose me with gesticulation. My ‘gesticulation’ might be the cause of tired hands, but the better question is why I am gesticulating. It only becomes an illness or disorder if I don’t feel in control of my gesticulation and that causes me or others distress. And even then, should apply only if I seek out and agree to such a label, having given informed consent to the pros and cons. I should also be able to disown the label if it no longer serves me.

    Diagnostic terminology isn’t in itself the problem. Used skillfully it can facilitate better conversations. Used carelessly or maliciously, it dehumanises and pathologises people. We all need to tread carefully.

    I hope this is received as a constructive contribution.

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    1. There is always a power differential at play. You may see yourself as a benevolent “helper,” but in fact diagnosis is a form of control imposed by authorities. How can we assist people who are suffering without being in an imbalanced power dynamic with them? Impossible under paternalistic/capitalistic “medicine.” As long as insurance is paying the bill and corporations are in control of accrediting provider/prescribers you will be in power and you will do damage to your clients.
      https://www.madinamerica.com/2013/09/psychiatric-diagnosis-process-qualify-degradation-ceremony/

      Liked by 1 person

    2. There is a lot to be said about this commentary that is NOT helpful. I have started a response and will complete it when I have time.

      Like

  5. This is such an important post. I wish every health care worker could read it. However I was given a diagnosis of BPD several years ago now (after a series of things happened in quick succession in my life). I remember sat in am assessment though being told by a psychiatrist: “well you must have experienced abuse or neglect or you wouldn’t behave like this”. Are only victims of abuse allowed a personality disorder diagnosis? Is BPD created exclusively to diagnose victims because that’s easier than dealing with the abuse?

    I’m thankful for you saying it’s ok to act a certain way after trauma and I wish I’d heard it several years ago instead of being subjected to endless medications and therapies that didn’t help and left me labelled as a “complex” and “non-compliant” patient.

    Liked by 2 people

  6. Thank you for sharing this very important post. The diagnosis is a way to get the help that is needed so that a person can recover. If the diagnosis does not give this relief then there is no use. With BPD I have seen it stigmatize women who are competent, but because of trauma can have a problem with trust. The problem with handling emotions is just because the trauma has been ignored. To continue the ignorance by giving them the BPD-diagnosis is never going to give them full recovery, because they are not living in reality. The need of being seen is not truly met. Worst cases, which I have also experienced, is when family members who are abusive/perpetrators, gets full access and right to blame the victim for the abuse because she is the “sick” one. The violence is legitimized because the girl/woman who has “BPD” now is to blame. In this way the health system, that is supposed to help the girl/woman, now re-enacts the violence. In a family therapy framework this is when a person in the system is carrying the symptoms of the dysfunctional family.

    Liked by 2 people

  7. My daughter is suffering through this at the moment. She was groomed and abused by 2 men at a local church and when her behaviour got extremely out of control and she started self harming and attempting to recreate the abuse she was placed into a care home and has been told that she has everything from post traumatic stress disorder to attatchment disorder to borderline personality disorder. The whole time this has been going on ( almost a year ) she has had no therapy, no counselling , no treatment, nothing and they wonder why she is slowly getting worse. I wish they would just consider getting someone in to talk to her about her trauma and listen to her instead of trying to find a label for whats wrong with her instead of what someone else has done to her.

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  8. Hi Jess great post

    It sounds like one of the major things missing from these diagnosis you describe is consideration of situation and whether the issues you listed are long-term impairments or a relatively temporal response to immediate stressors. It is true that a history of abuse is a risk factor for BPD, but its also true that highly stressful events result in highly stressful reponses.

    It’s odd to hear that diagnosis are being thrown around so freely, in my field professionals are fairly hesitant (probably appropriately) to diagnose BPD although I will say the ‘some traits of BPD’ is a little overused at times.

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  9. While I’m self-diagnosed, I have actually found the diagnostic labels helpful to insight for myself. While I have had some time with professionals, Not having something to look into and pull together all the pieces in a way that fits what I feel left me feeling very confused and frustrated trying to figure out what I felt something was “wrong with me”.

    And the point about how I could probably have a number of “official” diagnosis’s is well taken. Im all over the place in many ways. The “label” did help me find enough experiences from others to actually start pulling the denial and self-delusion off so I could at least start to process why I felt like I flip between different personalities. But it was only helpful when I found more specific descriptions of subtypes that I could get some kind of understanding.

    I’m moving away from that feeling of being “broken”. There’s a lot about some of my behaviors I don’t like. But having some kind of way to understand it is helping and as I research further and find ways that I can embrace some part of this, I have to admit as much as I’ve fought labels in all kinds of areas all my life, I can stop thinking about things as being so black and white.

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  10. Excellent piece. If I have to hear of one more woman being given the sexist diagnosis of BPD I’m going to scream.

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  11. For me, it’s not so much the label per se that’s the problem, it’s the stigma that the label holds. Women with BPD are routinely dismissed by HCPs whether they have come to the GP for physical or psychological difficulties, everything is blamed on their Dx. The other problem is that as soon as a woman is diagnosed with BPD it is used as an excuse not to offer further psych help, because “everyone knows BPD can’t be cured” and while DBT works well, very few MH trusts can afford to provide the kinds of wrap around care that DBT demands, so they either don’t offer it or offer a watered down version with no evidential backing.

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  12. There is a tacit policy in the U.S. DOD and VA that the correct procedure to use in instances of sexual assault is to pathologize the victim & protect the perpetrator(s). Ie;”treatment” not justice or, blame the victim. And anything except holding the perps accountable within either the criminal justice or civil judicial system.

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  13. I’m carrying around 3 labels as well as the ‘common cold’ label of depression because I suffered from neglect and abuse as a child. The labels no longer fit me because i’m 30 years into my recovery and have learned healthy coping mechanisms and have healthy and supportive relationships. But the labels are fixed and there forever. I’m now prejudiced against by the authorities because their lack of understanding of mental health.

    Like

  14. Thankyou for this I am currently batteling with this exact diagnosis although no doctor has ever discussed this with me ,iv been given this diagnosis.It is in my notes and apparently can’t be removed? If suffered a lot of abuse of all nature’s .Can you please if you have time tell me how I can have this diagnosis from my medical notes ? I’m now in recovery from addiction where I believe my was a result of escape from my abuse and abuser. THANKS AS THIS HELPED ME FEEL THERE MAY BE HOPE FOR ME FROM THE PEOPLE OBBSESSED WITH LABELS.

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    1. Hey Gemma,
      I hear that it’s really difficult to have the labels removed.
      If you’re on Facebook, we have a group called ‘drop the disorder’.
      If you join it and post your question in there, there are people who know how to get the labels removed from files

      Like

  15. Thank you for sharing, I didn’t even know I had the diagnosis until recently stumbling upon it reading my PCP notes. It was devastating. I was hurt my therapist had not shared this with me. It destroyed me thinking my personality was broken. Not totally understanding the diagnosis. Again thank you.

    Like

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