Comment

Is this actually PTSD? Clinicians divided over redefining borderline personality disorder

16 May 2024

We welcome The Guardian article of 11 May 2024, ‘Is this actually PTSD? Cliniciansdivided over redefining borderline personality disorder’. 

We do so, however, while acknowledging the article in question had a largely Australian focus and note that within the UK this is also an important area which requires research, exploration and discussion in the public domain. Within the UK around 52% of mental health outpatients and 70% of inpatients meet the diagnostic criteria for this serious and severe mental health condition and it’s one which deserves parity of esteem with other conditions (Dale et al, 2017). 

We agree the condition is one which is marked with significant stigma often simply because of the term ‘Personality Disorder’. The current classification of personality disorder within the UK and Europe no longer separates the differing types of personality disorder but sees it as a single condition which is classified by severity, the condition of Borderline Personality Disorder is not included as a separate condition (National Institute of Clinical Excellence, 2022).

Those with the condition can have difficulties making and maintaining relationships, have an unstable sense of identity, fear rejection or abandonment, engage in risk taking behaviour, and have difficulty with emotional regulation, all of which have a significant impact on their lives.

Many of those living with Personality Disorders will also have experienced trauma in their lives, and as such, assessment and treatment should indeed include a trauma-informed approach. In addition it is recognised by the Royal College of Psychiatrists in Scotland (2018) that personality disorder is a clinical and public mental health priority. The Royal College goes onto acknowledge that’s those with such a diagnosis are more likely to have experienced childhood traumas but that not all will have had these experiences (2018). There is evidence for the effectiveness of psychological therapy among these are Dialectical Behavioural Therapy (DBT) and Schema therapy both with in the family of CBP. In addition to this Mentalisation based therapy (MBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS) and Transference Focused Therapy (TFP). These are effective approaches and indeed recovery is possible (RCPSYCH, 2018).

Therefore, we would agree that this is an area which should be explored and researched to gain further understanding as to the biopsychosocial nature of the condition. This of course must include a better understanding for assessment, treatment and the development of services and support for patients and their families. It should be remembered that National Institute for Mental Health in England published the Policy implementation guidance for the development of services, ‘Personality Disorder No longer a diagnosis of exclusion in 2003 the purpose of which was to:

• To assist people with personality disorder who experience significant distress or difficulty to access appropriate clinical care and management from specialist mental health services.
• To ensure that offenders with a personality disorder receive appropriate care from forensic services and interventions designed both to provide treatment and to address their offending behaviour
• To establish the necessary education and training to equip mental health practitioners to provide effective assessment and management '(DoH, 2003, p.6).

Can we say that today in 2024 the purpose of this guidance has been successfully implemented? Whilst we acknowledge this policy implementation guidance is England focused the BABCP would call for, welcome and support additional research and development of evidence-based services across all four jurisdictions.