There is currently a debate raging: is borderline personality disorder (BPD) actually a personality disorder? Some experts argue against the current classification as a personality disorder. This debate focuses around etiology and the roles of nature and nurture. That is, is the cause of BPD mainly genetic or is it a response to traumatic experiences and genetic predisposition?
Personality disorders are defined by by the DSM-5-TR as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture”. However, in common use, personality disorders often label life-long patterns of behavior and thinking. The significance of this definition becomes very apparent with BPD.
Arguments in favor of this being a trauma response point out that symptoms of BPD can go into remission at times. This differs from other personality disorders, such as antisocial personality disorder. Additional arguments revolve around correlations between the diagnosis of BPD and adverse childhood experiences and invalidating environments. So then is BPD simply a response to trauma?
Arguments for the continued use of the diagnosis focus on the symptoms unique from additional diagnoses and the benefits gained from diagnosis. One argument in favor is the access to treatment that occurs with speedy diagnosis which outweighs the stigma surrounding the diagnosis. Current treatments for BPD include dialectical behavioral therapy and mentalization-based therapy. Additionally, other research supports the diagnosis and argues that symptoms distinct from co-occurring disorders are identifiable.
Another area to consider is the practice of classifying and diagnosing disorders. Usually a set of symptoms occur in a certain pattern that negatively impact people lives in specific ways (e.g., thoughts of being judged and avoidance in social anxiety). Diagnosing clinicians do not typically say the diagnosis is not occurring because of how it developed. Instead, they diagnose the condition and focus treatment on contributing processes like patterns of cognition, emotion, and behavior.
Regardless of whether the condition continues to receive the label of personality disorder, some aspects of it will not change. This includes understanding risk factors associated with the identified symptoms and using recommended treatments. For now, this controversy remains purely in the categorical arena and does not impact the treatments we use to help.
