To:
Dr Mario Maj - Editor World Psychiatry
Dr Lade Smith - President of the Royal Collage of Psychiatry
Victoria Atkins - Secretary of State for Health and Social Care
Wes Streeting - Shadow Secretary of State for Health and Social Care
In 2018 former Health Minister Sir Norman Lamb co-chaired the Personality Disorder Consensus Statement where groups including the Royal College of Nursing, the British Psychological Society and the Royal College of General Practitioners wrote "We would like to abandon the term ‘personality disorder’ entirely. The label is controversial for good reasons: it is misleading, stigmatizing and masks the nature of the problem it is supposed to address”(1).
Earlier this year, World Psychiatry, the official publication of the World Psychiatric Association, published the article “Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies”(2)
Within this article was the statement "Although still utilized with caution, the diagnosis of BPD in adolescents is no longer controversial”(2). With this letter, we aim to show that in the UK at least, a significant number of mental health professionals (and others) view labelling children with a personality disorder between abhorrent, unethical, harmful, dubious, but not least - controversial.
Borderline Personality Disorder (BPD) is a diagnosis where 1-2% of the UK population meet the criteria. It is frequently described as the most stigmatised mental health condition. Females are diagnosed twice as often as males. The diagnosis is associated with recurrent self harm, suicidality and is the mental health condition most associated with childhood abuse(3). Some studies have shown the numbers of those with a BPD diagnosis with a history of abuse is over 80%(4). When we talk about 'children with BPD' we are talking about traumatised children.
Marsha Linehan, creator of the most researched therapy for BPD advised people with the diagnosis not to tell medical staff due to the negative impact this would have on their treatment(5).
An Australian review of the stigma around BPD(6) stated:
"the diagnostic label of ‘BPD’ elicits particular negative beliefs and emotions in psychiatric nurses"
"these beliefs extend to other staff, such as psychologists, psychiatrists and social workers"
"clinicians report having particularly negative beliefs about young people with BPD, including erroneous beliefs about trustworthiness and dangerousness, and that they are ‘bad, not ill’.
"the majority (of clinicians)…viewed the BPD label as stigmatising, with the diagnostic category including pejorative language and value judgments, and the diagnosis leading to stigmatisation, marginalisation, and therapeutic pessimism."
"The label of BPD does not evoke the same stigma in the general community as it does in mental health clinicians"
Lived experience accounts of being given the BPD diagnosis are littered with examples of poor treatment, less empathy and a withdrawal of help once the label has been applied(7). These include people having self harm wounds stitched without anaesthetic and being denied physical health care.
The Welsh Charity Platfform has an archive of chilling accounts of people living with the BPD diagnosis(8). They are currently campaigning for the Welsh government to review the use of the diagnosis in Wales(9).
The stigma around Personality disorder was highlighted in the 1988 paper "Personality disorder - The Patients Psychiatrists Dislike"(10). In 2022 the Royal College of Psychiatrists advertised a course containing the statement " Personality Disorder (PD) is a thorn in the flesh of many clinicians"(11). The stigma has not noticeably declined over the past 25 years. .
We maintain that giving children a diagnosis that results in harm and worse treatment is controversial. Until there is conclusive proof that this diagnosis does not harm children we say it should not occur in the uk. We know many ways to help traumatised children and not one of them relies on those around them believing they have deficits in their personality.
Yours,
The Right Honourable Sir Norman Lamb
Former Health Minister, Co Chair of the Personality disorder Consensus Statement
Sue Sibbald BEM Co Chair of the Personality disorder Consensus Statement
*other signatories will be added below
1 - mind.org.uk/media-a/4408/consensus-statement-final...
2 - Falk Leichsenring, Peter Fonagy, Nikolas Heim, Otto F. Kernberg, Frank Leweke, Patrick Luyten, Simone Salzer, Carsten Spitzer, Christiane Steinert Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies World Psychiatry (2024;23:4–25)
3- Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand. 2020 Jan;141(1):6-20. doi: 10.1111/acps.13118. Epub 2019 Nov 18. PMID: 31630389.
4 - Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 9.
5 - https://www .youtube.com/watch?v=G08IYl2DAMg&t=34sv
6 - orygen.org.au/Our-Research/Research-Areas/Personal...
7 - platfform.org/system-change/truth-project/personal...
8 - platfform.org/wp-content/uploads/2022/03/Briefing-...
9 - onlinelibrary.wiley.com/doi/10.1002/wps.21156...
10 - Lewis G, Appleby L. Personality disorder: the patients psychiatrists dislike. Br J Psychiatry. 1988 Jul;153:44-9. doi: 10.1192/bjp.153.1.44. PMID: 3224249.