Abstract
Mulder and Tyrer recently published a pamphlet against borderline personality disorder (BPD). Although the authors put forward key points for improvement, their hardline runs the risk of throwing the baby out with the bathwater. Despite its flaws, the BPD diagnosis has stimulated increased interest in personality disorders, and scientific research that should not be hastily disqualified. Theories and research have developed specialised treatments which, from a conservative standpoint, yield superiority to treatment as usual 1 ; this is not the case for dimensional approaches suggested as a solution by the authors. The BPD framework further offers possibilities in terms of psychoeducation, for both patients (by providing a clear conceptualisation of their everyday experiences) and caregivers (by helping to develop more accurate understanding and empathy of their experience). Although we agree that a BPD diagnosis can be associated with stigma, no evidence suggests that the stigma is superior to that found for other diagnoses, such as attention deficit hyperactivity disorder (ADHD). Is ADHD another faulty diagnosis? Thus, if healthcare professionals misuse the BPD diagnosis, the culprit is the quality of continued education, and the support they receive in the face of severe emotional dysregulation, rather than a spurious diagnosis that would stimulate maltreatment from mental health professionals. Studies show that providing generalist knowledge regarding BPD decreases the tendency to avoid and dislike patients diagnosed with BPD. 2 Communication is central to the fight against BPD stigmatisation, and that’s why we would call to strengthen training while better science matures, rather than shame a diagnosis and disqualify the science employing its framework. A less polarised position would be more helpful in building from the knowledge base gained to date to improve the management of patients with severe and chronic psychological pain that the BPD diagnosis imperfectly attempts to characterise.