Borderline Personality Disorder: To diagnose or not to diagnose? That is the question

Int J Ment Health Nurs. 2020 Oct;29(5):972-981. doi: 10.1111/inm.12737. Epub 2020 May 19.


There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.

Keywords: DSM5; borderline personality disorder; diagnosis; diagnostic practice.

Publication types

  • Review

MeSH terms

  • Borderline Personality Disorder* / diagnosis
  • Borderline Personality Disorder* / therapy
  • Diagnostic and Statistical Manual of Mental Disorders
  • Humans
  • Personality Disorders
  • Prevalence