Commentary: Bringing together lived experience, clinical and research expertise – a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?)

Abstract

Background: There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. Method: We bring together lived experience, clinical, and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. Results: We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. Conclusions: We ask readers to consider these concerns, perspectives, and ideas.

Response: Sometimes we wish Chris and Sam had died of cancer! – a response to Commentaries on the May 2022 Debate

“…One fascinating observation we have made is that almost every anti‐BPD commentator who has lived experience of BPD admits that they found the diagnosis helpful and welcomed it initially – however bad their subsequent experiences may have been. Hartley (2022) in her article quotes Maddie as saying ‘The “EUPD” diagnosis did initially feel validating and like an explanation of something previously not understood.’ This does not surprise us at all. People with BPD (like Sam and Chris) know something is ‘wrong’.…”

“…Hartley (2022) goes as far as to state ‘the causal link with a “lack” of PD diagnosis has not been evidenced’. Do she and her coauthors not consider our story as ‘evidence’ – including the extensive findings of the Inquests and the Serious Case Reviews referenced in our original article?…”

“…The articles are full of unevidenced opinions that diagnosing BPD in teens 'might', 'could', 'likely to', 'run the risk of' potential negative consequences. Hartley (2022) goes as far as to state 'the causal link with a "lack" of PD diagnosis has not been evidenced'. Do she and her coauthors not consider our story as 'evidence'including the extensive findings of the Inquests and the Serious Case Reviews referenced in our original article?…”

Commentary: Commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents

“…This commentary focuses on some key points raised in the Twitter discussion initiated by @HartleySamantha, who invited people to collaborate on a collective response, which was later published in CAMH (Hartley et al., 2022), and responded to by Tyrer (2022b). Although Twitter commentary is neither peer‐reviewed, nor subject to the requirement of being evidence‐based, we have chosen to address selected, salient Twitter comments because we believe that they represent important social and/or cultural beliefs that are often presented in day‐to‐day practice but are rarely tested in the context of scientific evidence.…”

Response: Personality disorder is here to stay across the lifespan – a response to Commentaries on the May 2022 Debate

“…My response to the Commentary (Hartley et al., 2022) is simple; the time is now to embrace the concept of personality disturbance in all its forms, at all ages, and at all levels of society, not least in mental health services. Why do I make this bold claim?…”