New Ways of Supporting Child Abuse and Sexual Violence Survivors: a social justice call for an innovative commissioning pathway

Abstract

This report outlines the needs of child sexual abuse and sexual violence survivors in relation to the current conceptualisation and provision for 'personality disorder'. It has been collaboratively written by a socially diverse collective of survivors of child sexual abuse (CSA) and sexual violence (SV). Many of us have been forced to accept a personality disorder diagnosis and we wanted to come together to share our experiences and to propose less harmful approaches to future service provision for our population.We are asking for trauma-specific pathways, separate from personality disorder (or any re-named personality disorder) services. As a group, we have been profoundly harmed by both the application of the personality disorder construct, i.e. the ways in which services treat us as a result of the construct, and also by the treatment pathways which are harmful for our population.As a group, we suffer from high levels of dissociation and trauma specifically related to our CSA/SV experiences. These have long been neglected because the only current provision for people like us sits within the personality disorder (PD) field.In addition to this, we are bringing attention to the harm caused by current behaviourist approaches and systems that criminalise our distress rather than provide alternative support.We explain how LGBTQ+ survivors are being doubly failed by services in that they are having their sexuality and gender identity understood and pathologised as a symptom of 'PD' leading to increased shame and self-hatred.Ultimately, this report highlights how we have been failed and re-traumatised by state systems that are supposed to protect and support us when we were at our most vulnerable. It also shows how 'PD' has been used to silence and reframe our experiences. We finish by making recommendations for new trauma-specific pathways and services that are completely removed from a personality disorder frame of understanding.

Commentary: Bringing together lived experience, clinical and research expertise – a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?)

“…While we acknowledge there is no ‘one size fits all’ approach to treating mental health difficulties and no framework of understanding should be imposed, it is important that young people are able to access effective and compassionate treatments for traumatic experiences. Diagnosing young people with BPD is likely to provide an additional obstacle to the already difficult process of accessing therapeutic services and trauma‐specific therapy (Charlie, 2019; Lomani, 2022; WrenAves, 2020).…”

“…The New Ways of Supporting Child Abuse and Sexual Violence Survivors Report (Lomani, 2022) recognises the re‐traumatisation that the BPD construct brings and outlines proposals for trauma‐informed, trauma‐specific pathways and services that are completely removed from a personality disorder frame of understanding. There is an acknowledgement that across services, access to trauma‐informed care is essential for all young people accessing mental health services, and that there should be access to trauma specialist therapy for all young people who have experienced complex PTSD.…”

“…We were surprised that the editors were unable to find such contributions. We would signpost interested parties to the Twitter hashtags #HumanNotPD #TraumaNotPD #PDInTheBin, the @SurvivorsNotPD and @RITB_ accounts, https://madcovid.wordpress.com/, https:// stopsim.co.uk/, and the recent commissioning report by Lomani (2022). These represent just some of the many communities where the PD construct and associated models of care are actively resisted.…”

Commentary: Bringing together lived experience, clinical and research expertise – a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?)

“…Whilst we acknowledge there is no 'one size fits all' approach to treating mental health difficulties, it is important that young people are able to access effective and compassionate treatments for traumatic experiences. Diagnosing young people with BPD is likely to provide an Commentary on the May 2022 Debate Issue additional obstacle to the already difficult process of accessing therapeutic services and traumaspecific therapy (Charlie, 2019;Lomani et al, 2022;WrenAves, 2020).…”

Response: Sometimes we wish Chris and Sam had died of cancer! – a response to Commentaries on the May 2022 Debate

“…We have read the paper recommended by Hartley et al. entitled ‘The New Ways of Supporting Child Abuse and Sexual Violence Survivors Report’ (Lomani et al., 2022) and commend it as a valuable addition to the debate. Our concerns are that ALL people who suffer from BPD symptoms require help.…”