A simple guide to avoid receiving a diagnosis of ‘personality disorder’.

This is a leaflet based on a discussion on personality disorder diagnoses that we had on the Facebook group. Thanks to the wonderful Dolly Sen for her designs.

The leaflet has been in Clinical Psychology Forum No 279, March 2016 , published by the British Psychology Society.

PD GuidePD Guide2PD Guide3PD Guide4

A simple guide to avoid receiving a diagnosis of ‘Personality”Disorder’.

Disclaimer: unfortunately our suggestions above are not foolproof and we’re not encouraging…

Recovery In The Bin (TM)

1) Try not to be female (for BPD).

2) Do not argue your point of view with the professionals.

RITB How not to get a diagnosis of PD Guide3) You cannot be seen to like some staff members more than others (this is SPLITTING behaviour).

4) Do not under any circumstances harm yourself. (This will more than likely be seen as a) manipulative b) attention seeking c) a communication of your distress caused by your underlying PD).

5) Do not make statements, which can be interpreted as black and white thinking. For example, the nurses all hate me. Try instead to make unrealistic, robot like, rational statements such as ‘Enid, Mary, Silvia, John, Mark and Boteng have all shown epic disdain at my presence on the ward, but an agency nurse once smiled at me in 1992.’

6) Do not admire or pin any hope to a professional who appears to understand the social context of your distress (this is idealization, my dear).

7) Do not complain about anything. Ever.

8) Try to avoid working with professionals who look a bit tired. If they eventually go off sick you will inevitably be blamed for this. (Of course, because you are a difficult patient).

9) Things you can talk about: how medication is helping you, mood swings (BUT only extreme ones that last long enough to fit within a diagnosis of bipolar, that’s an ok one as Stephen Fry made it a bit edgy), Do talk about how much the system is helping you, be eternally grateful to every professional you meet, tip your hat slightly to the side and say the words ‘thanking you kindly for your ‘help sir’.

10) Things you should not talk about: Abuse – of any kind, patterns in your relationships because of this abuse, existential dilemmas, perceived flaws in the system or anything to do with individual staff members.

11) You never ever; over/under eat, drink, exercise, and are never impulsive with sex, shopping, driving and you LOVE being alone.

12) If you are from cultures seen as “traditional”, never say you even think about sex unless you are in a proper family approved heterosexual marriage.

13) To avoid BPD diagnosis you must not point out that the psychiatric teams are blaming you for their own inadequacies, their ‘externalised locus of control’ and ‘refusal to take responsibility’.

14) Do not tell the psychiatrist you think you may have PTSD. (Don’t be stupid now, everyone knows only soldiers can get this, are you a soldier?).

15) Try somehow not to be addicted to medication you are forced to take. Prepare yourself to be accused of lacking in coping skills when addiction inevitably does happen.

16) Talk with enthusiasm at the idea of being abandoned. Relish the idea whether it’s real and/or imagined.

17) If you attempt suicide make sure you are successful or it will be deemed attention seeking.

18) If you do by chance happen to self harm, make sure it is a life threatening, Stephen King style canyon of a gash, anything less than this will be clinically defined as ‘superficial’ adding to the likelihood of the PD label being applied.

19) BPD diagnosis is a mirror to professionals’ behavior, described as the personal characteristics of the service user.

20) Never phone the crisis team and say you’d like another visit (tick box dependency issues).

21) Hide any teddy bears or suchlike when they come round to visit (“too childish”).

22) Never refer to your psychiatrist’s affection for the DSM as ‘ideas of reference’…

23) When they suggest cutting back on support, appointments etc, pause and think and then say, “yes, that’s good, I feel I am ready to be more independent”.

24) Be attractive but not ‘coquettish’.

25) Do not at any point mention that you sometimes question who you are. You should know exactly who you are, be definite, unchanging about this (only people with PD ever question their identity

26) Do not change your hair colour too frequently. This will be interpreted as evidence of the above.

27) Always repeat when questioned that your attachment with your mother & father was always loving and supportive.

28) All depression, voice hearing and suicidality is ‘pseudo’ so please ensure the death certificate is recorded as ‘pseudo death’ and according to Joel Paris MD it was a ‘career’ so make sure your CV is updated posthumously.

29) Remember that inequality does not exist; it is your perception that is flawed.

30) Never, if you can manage it, express anger to MH professionals. Even when it’s understandable, genuine and valid!

31) The appropriate response following an OD to the question ‘how much did you take’ is ‘clearly not enough’. This is also likely to get you sectioned.

32) Never become a ‘skilled’ Service User. Understanding the games that nurses play will only get you described as ‘playing games’.

33) Your mental health team believes in its adequacy, despite all evidence. Do not do or say anything that threatens professionals’ fixed delusional beliefs, they may ‘decompensate’, becoming either coldly punitive and violent or weirdly smiley and dissociative, forcing you to have too much ‘service’ and then none at all.

34) Don’t ever ask a MH prof to ‘see you all the time and kiss your cuts better’ (as stated by a PD expert).

35) Act dumb as intelligence is viewed as a facet of PD (unlike psychosis where it’s assumed you’re less intelligent).

36) Failure to respond to medication or recover (or the CMHT needs to reduce numbers with discharges) means reclassification to PD.

Another Disclaimer: “You do not have the right to say anything without it being used against you. Anything you say can and will be used against you. You have the right to legal assistance. If you cannot afford legal assistance, you are buggered. Do you understand the rights I have just read to you? With these rights in mind, do you wish to engage in our therapeutic relationship?”

Critical articles:


Click to access papermepstein.pdf



Shaw, C. & Proctor, G. (eds.) (2004) Women at the Margins: Special Issue on women and Borderline Personality Disorder. Asylum magazine 4(3).
Sulzer (2015) Does “difficult patient” status contribute to de facto demedicalization?



page 23 ‘The most savage insult’  http://www.scie-socialcareonline.org.uk/…/a1CG0000000Gg…


Between 3 and 4.07 mins “you want me to see you all the time and kiss your cuts >better”: https://www.youtube.com/watch?v=kasiSXppCVA

Joel Paris: Half in love with easeful death: https://drive.google.com/…/0B2o15rQwZLh7MlRjc2F…/view…

Linehan: https://www.nimh.nih.gov/news/media/2011/linehan.shtml For the research funding she had to choose between BPD and Major Depression as the named mental disorder – she chose BPD, the diagnosis was attached to fit the intervention for the funding. She wanted the most difficult & challenging patients. So who was in the control group?

Click to access Wilkinson%20Paul%20Sept14.pdf

NHS Choices discriminatory advice/liver transplants

Members of Recovery in the Bin have been writing to NHS Choices over their liver transplant page which stipulated that people dx with psychosis/bipolar wouldn’t receive new livers due to ability to follow the regime of follow-up appointments & immunosuppressant meds. Members challenged this and NHS Choices replied by the following:-

“Thank you for contacting us regarding the liver transplant topic on the NHS Choices website.

The section about mental health conditions you refer to is talking about the patient’s ability to follow the regime of follow-up appointments and immunosuppressant medication needed after a liver transplant.

No mental health condition, including bipolar disorder, will automatically exclude someone from having a liver transplant – but an assessment will be necessary on an individual basis to determine whether the condition is severe enough that it might impact on their post-transplant care.

We only mention bipolar as an example because some studies have looked at this issue specifically.

However, after reconsidering our information, we have decided to remove the examples of mental health conditions from our liver transplant topic, as it’s more the severity that’s important, rather than the specific condition. By only giving a couple of examples, we think it could potentially be misleading.

Thanks again for bringing this matter to our attention. We hope this response has been helpful.

Best regards,

The NHS Choices Editorial Team”

Letter to Luciana Berger (Shadow Minister for Mental Health in England and Wales)

Dear Luciana Berger – Shadow Minister for Mental Health, England and Wales.

We are writing to you to raise our concerns and priorities for Governmental Mental Health care and provision in the UK. We enclose the first of a number of our “position statements” that we intend to send to you.

We are a User Led Mental Health Activist Facebook Group campaigning for Social Justice and Equality in MH care and practice, with a focus on critiquing and challenging mainstream ‘recovery’ ideology. At the time of writing our membership stands at 474 and this is growing by the day.

We believe ‘recovery’ has been colonised by MH services, commissioners and policy makers. We reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation, language, techniques and outcomes. Some of us will never feel “Recovered” living under these intolerable and inhumane social pressures.

We believe access to quality housing and disability benefits designed for mental health claimants would give people a stable and secure environment to raise their quality of life and health. This would enable efforts towards going back to study, work IF people choose / aspire to this. Allowing people to volunteer indefinitely and claim benefits if this improves their quality of life and MH – and recognise how valuable this work is to society.

Our first “position statement” is about the Welfare State and Social Housing.

We will cover the following issues: –

  • Work Capability Assessment (WCA)
  • Benefit Sanctions
  • Personal Independence Payment (PIP)
  • Employment
  • Voluntary Work
  • CBT in Job Centres
  • Social Housing & Homelessness

We look forward to hearing from you about the matters we have raised.

Yours Sincerely,

Recovery In The Bin

Copy: Jeremy Corbyn MP and Leader of Labour Party.
John McDonnell MP and Shadow Chancellor.
Owen Smith MP, Shadow Secretary of State for Work and Pensions.
Mental Health Resistance Network.
Social Workers Action Network (SWAN).
Psychologists Against Austerity.
Critical Mental Health Nursing Network (CMHNN).
Critical Psychiatry Network.
Disabled People Against Cuts (DPAC).
The Peoples Assembly.

Welfare State and Social Housing

Work Capability Assessments (WCA)

  • The Work Capability Assessments (WCA) for Employment Support Allowance (ESA) appear to be weighted in favour of those with physical disabilities, and often fails to take into account fluctuating conditions, common to mental distress, such as anxiety and depression.
  • A Service User initiated judicial review of WCA found that MH claimants were at a “substantial disadvantage”. (http://www.rethink.org/…/unfair…/wca-judicial-review-faq). To date the DWP has failed to take concrete steps to address that disadvantage.
  • Access to welfare advisors and advocacy workers has been severely reduced due to cuts to funding, services and the legal aid budget.
  • We are aware of a number of deaths related to the “reforms”, including recent reports that a coroner has ruled that the WCA contributed directly to the suicide of a claimant, and that steps need to be taken by the DWP to prevent further such incidents. (The Independent 20.9.2015).
  • We believe the WCA needs to be abolished as a matter of urgency.

Benefit Sanctions

  • Sanctions remove the very means of existence, and as a consequence the related death toll is rising.
  • Those in the ‘Work Related Activity Group’ face huge cuts to their benefits in the near future, even if they manage to avoid being sanctioned.

Personal Independence Payment (PIP)

  • PIP is not MH orientated and self-harm/suicide risk factors have been removed from criteria.
  • MH claimants struggle to obtain the necessary medical evidence because MH services are now short term, and once discharged no specialist reports can be secured.
  • Loss of DLA/PIP to MH claimants who are not in receipt of ESA because they’re doing some part-time work or self-employment will be rendered unable to continue working or plunged into poverty, being under immense pressure to work more hours, which could lead to mental distress and deterioration.


  • It’s a fact that 70% of working age adults with a mental health condition in England are unemployed (http://www.theguardian.com/…/cuts-threaten-mental-health-pr…).
  • There are approximately 700,000 vacancies and 2 million (possibly more if you count those who are sanctioned/on Workfare) applying for those 700,000 vacancies, therefore the maths don’t work here.
  • It’s evidenced that Workfare doesn’t work and only provides massive profits to private companies using public funds and plunges more people into sanctions/food banks.
  • MH claimants have been and are being targeted as the ‘low hanging fruit’ (their description) in the full knowledge that MH (and Learning Difficulties) has the lowest employment rates.
  • Temporary and zero contract hours shift work is evidenced as being bad for anyone’s mental (and physical) health, but this looks set to become more common for MH claimants who are at threat of sanction/workfare.

Voluntary Work

  • We often carry out highly valued long term voluntary work within Trusts, University’s and Charities, so chosen voluntary work (with appropriate evidence) needs to be considered as an additional outcome to employment, as for some people that’s the most ‘doable’, maintaining the best ‘stability’.
  • Voluntary work gives a person greater flexibility, and provides less pressure to work when s/he is not feeling up to it.
  • MH claimants have had benefit claims stopped/reviewed for doing voluntary work (even when organised by own MH Trust & MH professionals have had to intervene by advocating that it’s part of their treatment).

Cognitive Behavioural Therapy (CBT) in Jobcentres.

  • We do not support targeting MH conditions with CBT, where there is contradictory evidence that this therapy is effective, and its unproven in helping people back to work. https://www.gov.uk/…/attachment…/file/193382/812summ.pdf.
  • We believe getting back to work, especially after many years of unemployment, due to MH complexities, is unlikely to be resolved by a “quick fix” such as CBT.
  • Many of these initiatives are being piloted in Labour controlled authorities. For example, in June 2015, Service Users protested outside the Streatham Job Centre, which had been identified as a site for trialling the introduction of CBT inside Job centres.

Social Housing & Homelessness

  • Some Councils/Housing Associations are losing over 90% of their stock, and letting agencies/private landlords don’t want tenants on housing benefit. This is a significant factor with respect to the increasing levels of homelessness that should not be acceptable for any Government.
  • Very vulnerable mentally distressed people are ending up sleeping rough because of refusal to join groups in high support mental health housing, which means they have refused an offer of housing and are deemed voluntarily homeless.



Dear Recovery in the Bin Group,

Thank you so much for taking the time to get in touch with me.
Firstly, I want to apologise for the delay in getting back to you. Since my new role was recently announced I have been inundated with hundreds and hundreds of emails from people getting in touch to share their stories, and I want to get back to everyone individually.

I read your letter and your position statements with interest as I share many of the same concerns. The Labour Party has made a commitment to take a cross-departmental approach in addressing mental health challenges, and this is especially true when it comes to the impact of DWP policies on mental health. Many of the emails I have received since my appointment echo this.

Just before Christmas I opened Labour’s Opposition Day Speech on mental health, and highlighted a number of the things you mention in your letter, including capability assessments and benefit sanctions, and the fact that a majority of people on the Work Programme told Mind it made their mental health worse. You can watch it here.

I have also been using Parliamentary Questions to probe the Government’s policies, including on the services in Job Centres that you mentioned.
Currently, I am working with John Healey to ensure Labour’s policies on housing and homelessness are developed with mental health in mind.

The point you raised about volunteering having a detrimental impact on welfare claims is a concerning one, and something I plan to ask the Government to clarify their position.

My immediate priority is to hold ministers to account for their broken promises on mental health, and to speak up for people who are being let down. Thank you for sharing your ideas with me which I will feed in to the work I continue to do to hold the Government to account. We must work together to tackle taboos, challenge stigma, and redesign services to match the needs of so many people.

In the coming weeks and months I may circulate updates of what I have been doing in my shadow ministerial role on mental health. Please let me know if you would not like to be included in this mailing list.

Thank you again for getting in touch.

Very best wishes