Hi Aileen, I agree completely. It’s the metaphorical elephant in the room! So obvious, the only conclusion is clinicians are sometimes wilfully blind to the history of patients, and instead devote their practise to symptoms seen as character flaws.

I’m reminded of a quote from Bessel Van Der Kolk’s book the Body Keeps Score — to paraphrase ‘I still reguarly get scientic papers to review that say things like “it’s been hypothesised that borderline patients may have histories of childhood trauma”. When does a hypothesis become a scientifically established fact?’ He goes on to say ‘unless you understand the language of trauma and abuse you cannot understand BPD.’

In the interest of scientific accuracy however, other researchers disagree to an extent e.g. Peter Fonagy argue it’s related to early failed mother-infant bonding , Marsha Linehan BioSocial theory says it’s biological vulnerability, and an invalidating environment together; others like John Gunderson and Mary Zarahini, while acknowledging the overlap, have said BPD and CPTSD are separate diagnoses; but you can indeed have both.

Nevertheless, BPD is just a pejorative label that does more harm than good — no one has come up with a better name as of yet.