I don't know of any studies, but I think it depends. There are times when patients get diagnosed with BPD, it is a big relief as they get acknowledged that their symptoms and feels are due to some disorder.

Others believe that labeling a patient is not a good idea as there is some judgment attached to it.

No, I don`t think so. In the contrary it is a stigma to have this diagnosis because people will think that you are a very difficult patient. Some years ago I worked as a physician in Psychiatry. During this time I had some collegues who didn`t like to treat borderline patients. It can also be difficult to find psychiatrists who want to treat these people after hospital.

I think there is still a wider belief that BPD patients are not mentally unwell in mental health professionals ( not having primary mood or psychotic symptoms) , which leads to differential treatment and emergence of negative attitude to people with this diagnosis. But at the same time having a diagnosis can be a relief for some and also can lead to appropriate treatment if available ( though rare at most places) .

More needs to be done to educate professionals in primary care and even in Tertiary care towards the acceptance of this condition as something different from malingering and attention seeking.

I completely agree to your statement, that more must be done to educate professionals to the acceptance of and in the treatment of this condition. I can also say that most of these psychiatrists who refused to treat borderline patients were juniors. More experienced physicians in hospitals didn`t behave like that. But there were also some physicians who worked outside hospital and were more experienced who didn`t want to treat BPD patients.

I believe the issue is availability of resources for management of BPD. By resources I mean clinicians skills and adequate time. In my experience with time services have become better in dealing with this intractable problem. Diagnosis is an important starting point for developming understanding of the problem.

I agree that the diagnosis can be helpful for the patients.

Having diagnosed 100s of patients with this disorder over the years, I do believe that overall, it is helpful to make this diagnosis.

Provided, of course, the diagnosis does not lead to direct or indirect discrimination, and the clinician uses a positive approach in explaining what it all means and how the patient can be helped (using psychosocial and pharmacological managements). Indeed, patient should be advised that he or she can improve his/hers prognosis by taking certain measures such as avoidance of misuse of alcohol and illicit substances.

My experience suggest that most patient do not object to this diagnosis, provided its used to help them.

I think of Borderline Personal Disorder less as a medical diagnosis and more as a calculated insult.

Definitely not! Borderline Personality Disorder is a value judgement, not a diagnosis and is entirely negative in its connotations. Labelling has never assisted in improving a patients treatment and has often resulted in appalling stigma and indeed making their condition worse. Out of all of the faux diagnostic labels concocted in recent decades this one is one of the worse. No one has a personality 'disorder', that would suggest that somewhere out there is an 'ordered personality', a norm we should all aspire to. A preposterous statement based more on ideology than medicine or humanity.

A colleague says me that a diagnostic label as BPD ( or any tag in the field of mental disorders) only must be established if this led to a better management and better prognostic "in the concrete patient" that we are attending.

That’s a principle that we would add to the basic ethical principles: “a diagnosis should exist only if it is useful for the patient”

I think Jose Nunes makes very good point.

I find it hard to believe that doctors/psychiatrists make this diagnosis (of course with care) to insult the patient (as some colleagues have suggested) and cause them harm)

I can share with colleagues the relief numerous patients of mine have expressed when this diagnostic possibility is carefully and sensitively discussed (making sure the patient does not feel guilty and having positive approach).

Indeed, we need to have some understanding of what we are communicating about (the patient and the doctor) and using a diagnostic label usually helps.

As for the prejudice and stigma, to conquer this, we need to work on our own minds and on the minds of fellow members of society.

Jose does make a good point indeed! A diagnosis that marginalises someone to the point of being shunned is of no use to a patient. Personality Disorder is not a disease and it is not a diagnosis. It is a value judgement saying "this persons personality is flawed" The very essence of the person here is judged (not diagnosed) they are disordered, outside the norm, a reject. It is difficult to imagine how a patient cannot feel guilt about being abnormal to their very core. Even a patient with the similarly stigmatising label of schizophrenia can be thankful that their personality is sacrosanct.

BPD says that we must conform to some culturally determined norm or be categorised in the 'out group'. Some of the greatest minds in history had irascible and even anti-social personalities. We would be in a sorry state indeed if we had 'diagnosed' Newton, Rousseau, Bentham, Nightingale, Einstein and countless others with BPD.

A little knowledge can do more harm than good, as we can see from some comments here. However, it would be odd to argue against expertise categorically on a site called "ResearchGate". With that set aside, the diagnosis is extremely helpful, if not life changing, when applied accurately and accompanied by up to date information. Here are the benefits of accurate, early diagnosis: 1. less inappropriate exposure to anticonvulsant mood stabilizers in non-bipolar women of child-bearing age, 2. less inappropriate exposure to atypcial antipsychotic drugs, 3. enhanced self understanding and more rapid entry into intensive psychotherapy, 4. less hopelessness and improved prognosis, with the long term prognosis not too different from major depression. In my practise I find that younger patients are less likely to get hung up on the word "personality" and are able to understand that all diagnoses are constructs. The problem of stigma comes from partially trained mental health professionals, not the public.

I agree with Royce Lee. I have had patients who have been relieved once they learned that they have a particular diagnosis which fits their feelings and symptoms and they were more willing to go through DBT or other therapies.

We must listen to our patients, what they tell us and how they feel about being given information/diagnoses that often makes sense of what they are experiencing which understandably can be quite confusing at times.

Yes, this is true. If a patient is prone to having a very negative view of a disorder of "personality" then I think emphasizing a personality disorder diagnosis becomes a semantic exercise that is not helpful. In these cases, it may be more helpful to talk about traits or biological proclivities (impulsivity, mood swings, etc.). In general, I find that younger patients are very open to the BPD diagnosis. Sometimes older patients are confused. I am not sure, but I suspect it is the term "personality". I wonder if this term has different connotations for different generations.

I don`t agree with Royce Lee as far as the medication is concerned. When I worked in psychiatry I realized that patients with BPD got many drugs. There were no other patients who got as many drugs as BPD patients and for many of these drugs there was no proper indication.

Good point Stepfanie and I bet emprical studies would back you up. BPD patients often wind up on oddly complex cocktails of drugs but there are no indications for BPD itself.

The inappropriate use of medication may be an issue where the clinician is reluctant to make or share a diagnosis with the patient. Quite often patients receive inappropriate care because of lack of skills on part of the clinical team to deliver care to clients with personality disorder.

thanks to all for your contributions. i've used your opinions in a speech in the Spanish Congress on Personality Disorders. Barcelona.