Borderline Personality Disorder No Longer Belongs in Clinical Practice

From Mad in the Netherlands: Borderline personality disorder (BPD) is a diagnostic category within the DSM-V and ICD-10/11 that is constantly criticized from different angles. Some critics feel the term does more harm than good because of the stigma attached to the label and the way it pathologizes responses to trauma. There are also researchers who question the scientific validity of BPD because it has a significant overlap with other diagnostic categories. Several of them, including psychiatrists Roger Mulder and Peter Tyrer, think it’s time to abolish this label.

Read the original article here and the English translation here


  1. In my experience in life and in clinical practice, borderline personality disorder is closer to a trauma response and massive defensive structures rather than personality. However, it can develop into a way a of being. I have not informed some patients of this diagnosis due to clinical judgement of doing more harm then good. This has seemed to serve them well to ” hold them” in clinical work as well as help to create trust and what a caring therapeutic can be- no easy task . Looking at the diagnosis now and in the future will hopefully take into account several other variables related to traumatic experience and the normal anxiety responses that unfold when attachments are broken.

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  2. We may need to re-name Borderline Personality Disorder (BPD) because the name has developed stigma, but getting rid of the diagnosis is throwing the baby out with the bath water. A lot of the negative views of BPD by the medical community were likely was that, going back to Freud, we thought the symptoms were untreatable. That really changed with the work of Margret Linehan in Dialectical Behavioral Therapy as well as Otto Kernberg’s work in Transference Focused Psychotherapy. Diagnosis then started to do what it is supposed to, which is lead to particular treatments. e.g. “If your symptoms are similar to those of other folk, then maybe what helped them will help you.” DSM did toss out the idea of Axis II, which was that there were un-changeable patterns of personality symptoms, but left the diagnosis because it is still a pattern that people clearly recognize, and which has clinical usefulness. In terms of etiology and overlap with Complex PTSD (C-PTSD), the article points out that 30% of folk with BPD don’t seem to have recognizable trauma. Some researchers think that BPD is more closely related to Bipolar Disorder than to PTSD, but that hasn’t held up too well as Bipolar typically responds much better to biological treatment than to psychotherapy, whereas BPD (like C-PTSD) responds better to therapy than to biological treatment. Personally, my hypothesis is that we are just missing the inciting trauma, and that in both C-PTSD and BPD, the trauma starts very young, often before the age of memory. Maybe a new term could be something like “trauma symptom disorder without identified trauma.” In terms of getting rid of the term “disorder,” I don’t see how that is useful, as there needs to be a distinction between healthy or harmless post-traumatic changes and those that lead to serious consequences and therefore require intervention. Remember, C-PTSD has a fatality rate by suicide that is five times the average, and BPD is at least ten times as high. For BPD that is similar to the rate in Bipolar Disorder or Schizophrenia.

    Here are some videos on how psychiatric diagnosis leads to treatment,

    and on PTSD specifically.

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    • “the article points out that 30% of folk with BPD don’t seem to have recognizable trauma.”

      Unfortunately, science isn’t built on “seem to” and “recognizable” (how is this word being defined? Recognizable to whom, under what conditions? A fifteen minute appointment with a psychiatrist?)

      The fact that they keep changing the diagnosis is proof that there’s no science happening. “It’s definitely real, we’re sure of it, we’re just not sure what it is yet” is not science.

      DBT has hurt a lot of people. Just ask the members of the “Stop DBT” Facebook group.

      Maybe the high suicide rates of people carrying SMI diagnoses have more to do with how they are treated by the mental health system and society in general. Maybe people who have gotten BPD diagnosis are just tired of being dehumanized and ostracized and criminalized every day of their lives.

      The stigma came from the “experts” that invented the diagnosis. The stigma was intentional. It did not develop over time. As you said, it started with the idea that this was a serious disorder that was inseparable from the person and was “untreatable”. The stigma was built in from day one.

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