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

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.