We call on the American Psychiatric Association to remove borderline personality disorder (BPD) as a diagnostic category from the DSM and develop an evidence-informed transition that protects access to assessment, treatment, and support.
We also request a formal public response to the Royal College of Psychiatrists’ August 2026 acknowledgment of avoidable harm experienced by adult survivors of childhood sexual abuse, and an examination of comparable harms in U.S. mental healthcare. (rcpsych.ac.uk)
Why we are calling for change
Trauma survivors deserve compassionate care that takes their distress, circumstances, and accounts of abuse seriously. Instead, the American Psychiatric Association has created a personality disorder diagnosis that invalidates and individual's experience of abuse, pathologizes the female response to trauma in particular, and stigmatizes individuals to the point that the may receive inadequate care or no care at all both within the mental health and medical systems.
Our concern is that the BPD classification can locate difficulties within a person’s personality while insufficiently accounting for trauma, ongoing danger, developmental experiences, and social context. Its interpretation and use warrant scrutiny, including whether the label contributes to stigma, dismissal of disclosures, exclusion from services, or inadequate assessment of other explanations.
Borderline personality disorder was formally introduced into the DSM-III in 1980, largely through clinical observation, expert consensus, and emerging descriptive research rather than evidence establishing a distinct, biologically or etiologically validated disorder. Its inclusion was influenced by earlier psychoanalytic concepts of borderline personality organization and the diagnostic criteria proposed by John Gunderson and colleagues.
Since that time, much of the research has started with the assumption that BPD is an empirically valid diagnosis. Researchers have studied people who meet the established criteria, examined what symptoms they share, and developed assessment tools to identify those symptoms.
But there is a fundamental problem: Demonstrating that people share a particular collection of symptoms does not prove that those symptoms represent a separate psychiatric disorder.
For example, researchers can select nine symptoms, decide that five are required for a diagnosis, and then study people who meet that definition. They may find similarities among those individuals, but that does not independently establish that the original grouping represents a distinct disorder rather than symptoms arising from trauma, other psychiatric conditions, or overlapping psychological processes.
In other words, much of the research has examined how well BPD fits the definition researchers created, rather than independently establishing whether that definition corresponds to a distinct disorder.
This does not mean that people diagnosed with BPD are not experiencing genuine psychological difficulties. It means that the scientific validity of the diagnostic category itself is a separate question and one that remains debated.
The DSM 5's own Field Trials cast doubt on the reliability, validity, and clinical usefulness of the borderline personality disorder construct. The disorder is highly heterogeneous and there are 256 different qualifying symptom combinations that can achieve the diagnostic threshold. The 9 diagnostic criteria are descriptive, vague, and poorly operationalized. Although standardized tools have been created to help identify these traits more objectively, they are rarely used in clinical practice and therefor the poor results found in the DSM Field Trials are even more suspect when considering how clinicians diagnose the disorder. In addition, longitudinal research published in World Psychiatry in 2024 indicated that 56% of diagnosed patients did not meet criteria for the BPD label two years after diagnosis.
We advocate removal because we believe assessment and care should more accurately describe people’s needs and circumstances, with fewer opportunities for stigmatizing interpretation.
We ask the APA to:
1. Commit to removing BPD as a diagnostic category, through a transparent process that publicly evaluates the evidence and consequences of the proposed change.
2. Convene a review with meaningful survivor participation, including people harmed by the diagnosis and people who have found it helpful, alongside clinicians, researchers, and patient-rights advocates.
3. Examine the diagnosis’s scientific foundations and clinical effects, including validity, criterion interpretation, reliability in routine practice, diagnostic bias, overlap with other conditions, and consequences for access to care and credibility.
4. Evaluate alternative approaches, including recognition of ICD-11 complex PTSD where its criteria are met, dimensional assessment, and individualized formulations that incorporate trauma and context. People should receive a thorough reassessment rather than an automatic replacement diagnosis.
5. Protect continuity of care and coverage. Diagnostic reform must preserve access to effective treatments, including DBT and trauma-focused therapies when appropriate, based on individual needs, evidence, and informed preferences.
6. Publish a response, review timetable, and transition recommendations, including guidance for reassessment and addressing inaccurate or stigmatizing records.
Our request concerns the classification of suffering and the responsibilities of institutions. People’s difficulties and need for support must remain fully recognized throughout any change.
By signing, we support removal of BPD from the DSM, transparent diagnostic accountability, and continued access to effective, respectful care.
Initiative for Psychiatric Diagnostic Accountability — IPDA
www.diagnosticaccountability.org