An open letter to the President of the Royal College of Psychiatrists and the Secretary of State for Health and Social Care:

Two years ago, we wrote an open letter challenging the claim that diagnosing Borderline Personality Disorder (BPD) in children was “no longer controversial”.

We argued that giving children a diagnosis associated with stigma and worse treatment was potentially harmful. The letter was signed by clinicians, academics, people with lived experience and former Health Minister Sir Norman Lamb. The Royal College of Psychiatrists did not reply directly to the letter, although representatives of the College commented in the media. Since then, the College has published a position statement which we think makes this issue much harder to ignore.

In 2020, the Royal College's position statement on personality disorder said that ICD-11 facilitates diagnosis in people over 14 and:

“it is important that the diagnosis is made in this age group.”

In 2026, the College published a position statement on the impact of non-recent childhood sexual abuse. It includes a substantial section on iatrogenic harm – avoidable harm caused through healthcare. It describes misinterpretation, misdiagnosis, inappropriate treatment, diagnostic overshadowing and re-traumatisation. It also says:

“Restrictive and potentially punitive practices used with survivors. These practices are more likely to be seen when people are given diagnoses such as emotionally unstable personality disorder (EUPD).”

One survivor quoted in the statement says:

“The personality disorder construct is systemically harming childhood sexual abuse survivors. We have known about this harm for many years.”

We welcome the College being so clear about this, but we don't think this sits comfortably alongside a recommendation that it is important to diagnose personality disorder in young people.

There is understandable public outrage when we hear about children being sexually abused and exploited, including by grooming gangs. We wonder whether there would be similar concern if more people understood what can happen to some of these children later, once their distress is understood as evidence of a disordered personality.

Many of the experiences associated with a BPD/EUPD diagnosis – self-harm, intense emotions, difficulties with relationships and trust – are also common amongst people who have experienced significant childhood adversity. In addition, not only is sexual abuse more commonly experienced by girls, but girls and women are three times more likely to be given a BPD/EUPD diagnosis. A child can move from being understood as someone to whom terrible things have happened to being understood as someone with a disordered personality. That matters if the diagnosis changes how other people respond to them.

This isn't a new concern. In 1988, a British paper was titled Personality disorder: the patients psychiatrists dislike. Decades of research since have documented negative attitudes within mental health staff towards people given this diagnosis. The College's new position statement now acknowledges that people given diagnoses such as EUPD are more likely to experience restrictive and potentially punitive practices. We think that should change the threshold for giving this diagnosis to a child. None of this means children should wait for help - children who self-harm, experience overwhelming emotions, struggle with relationships or are living with the consequences of trauma need good, timely, evidence-based care. They simply don't need to be told that their personality is disordered in order to receive it. DBT, MBT, EMDR and other psychological interventions can address the difficulties a young person is experiencing. Understanding trauma doesn't require a personality disorder diagnosis. Neither does formulation, risk management or compassionate care.

There is a fairly straightforward research question:

If two groups of children are offered the same help, do the children who are not told that their personality is disordered do worse?

If giving the diagnosis itself improves outcomes, that should be possible to demonstrate. If it doesn't, we need to ask why we are exposing children to a label which the College's own work acknowledges can be associated with harm.

Until there is robust evidence that children offered the same help do worse when they are not told that their personality is disordered, we believe personality disorder diagnoses should not be given to children in the UK.

Children need help. Telling them that their personality is disordered is not a necessary part of providing it.

Signed

Rt Hon Sir Norman Lamb & Sue Sibbald OBE

Former Health Minister Mental Health Campaigner

Co-Chairs of the Personality Disorder Consensus Statement

Professor Linda Gask

Professor of Primary Care Psychiatry, University of Manchester

President's Medal by the Royal College of Psychiatrists

Dr Jo Stubly

Consultant Medical Psychotherapist

Co Chair RCPsych Working Group on the Impact of Non-Recent Child Sexual Abuse on the Mental Health of Adults

Dr Maria Podlejska-Eyres

Consultant Psychiatrist in Medical Psychotherapy

Co Chair RCPsych Working Group on the Impact of Non-Recent Child Sexual Abuse on the Mental Health of Adults

Jane Chevous

Director and CEO, Survivors Voices

Lived Experience Expert member RCPsych Working Group on the Impact of Non-Recent Child Sexual Abuse on the Mental Health of Adults

Professor Robert Poole

Honorary Professor of Psychiatry

Manchester School of Health Sciences

Dr Dickon Bevington MA MBBS MRCPsych PGCert FRSA

Consultant in Child and Adolescent Psychiatry

Co-Lead for Mental Health, Cambridge Children's Hospital

British and Irish Group for the Study of Personality Disorder Keynote Speaker

Dr Julia Blazdell

Former President British and Irish Group for the Study of Personality Disorder 2019-2024

Consultant to the Royal College of Psychiatrists Position Statement on Personality Disorder 2020

Tom Mullen RMN

Former President British and Irish Group for the Study of Personality Disorder

Retired

*Unless explicitly stated signatories are signing as individuals rather than on behalf of any group or organisation.