For more than four decades, people whose suffering centred on their ways of relating have been told they have a disordered personality. The evidence no longer supports this framing. We propose an alternative: Relational Sensitivity, a name that points to the actual locus of difficulty, opens the door to humane therapy, and gives back the dignity the old name took away.
The Relational Sensitivity Project is a coalition of researchers, clinicians, and people with lived experience campaigning for the World Health Organization to retire the "borderline pattern specifier" from the ICD-11 and replace it with a category that names the phenomenon for what it is: a painful sensitivity to relationships.
What follows is the argument for this change, the evidence that supports it, and an opportunity to add your name to our proposal for change.
The specific amendment we are asking the WHO to make.
Review the proposal →The evidence supporting our proposed amendment.
Examine the evidence →What our reform clarifies—about personality, about borderline, and about adjacent diagnoses.
Explore the utility →Add your name to the petition that will be delivered to the WHO ahead of the next maintenance cycle.
Sign the petition →The ICD-11 was the right structural move. It correctly retired ten incoherent categories and replaced them with a dimensional severity-plus-traits model. But it left "borderline pattern" inside that model as a political compromise—and in doing so undermined its own logic.
The reform we are seeking is narrow and contains three changes:
1. Remove BPD from the personality disorder section. Specifically, delete the "borderline pattern" specifier (6D11.5) from ICD-11 chapter 6D11. It does not describe a personality disorder. It does not belong there.
2. Add Relational Sensitivity Disorder as a separate diagnosis—not a subtype of personality disorder, not a specifier, not a modifier. A standalone category defined by maladaptive ways of relating to oneself and others (see box on the right).
3. Clarify what "personality disorder" denotes. Personality disorder remains in ICD-11 largely unchanged in structure, but perhaps clarified to make clear what the term should denote: relatively stable and maladaptive traits that are present, to some extent, in every human being.
Defined by the relational symptoms unique to borderline:
Our proposal is based on both conceptual and empirical evidence. To illustrate, we start from first principles and address the most fundamental questions on this topic: namely, (1) what is personality; (2) on that basis, what is a "personality pathology"; and (3) what does borderline indicate: a personality pathology or something else entirely? We address each question in turn below.
For over a century, the idea of personality has been defined by two criteria: breadth and stability. Breadth refers to the fact that personality spans many dimensions of human experience, including ways of thinking (open and creative versus conventional), feeling (volatile versus even-tempered), behaving (impulsive versus restrained), and relating (introverted versus extroverted, agreeable versus disagreeable). Stability refers to the fact that these broad tendencies remain relatively consistent across time and context.
On the above definition of "personality", a "disorder of personality" must by logical necessity involve a broad, stable, and maladaptive way of being. This definition carries at least two important implications. First, any way of being that is broad and stable (e.g., persistent sadness that affects many areas of life) is by definition a personality trait problem. Second, almost every person on the planet carries at least one such personality trait problem, because they are likely to have at least one aspect of themselves that negatively affects many areas of their life in a stable way. In this way, the correct way to frame personality pathology is in terms of degree ("how much personality pathology does each of us have") not kind ("does a particular patient have a putative disorder of personality").
Borderline pathology does not meet either criterion of personality pathology: it is neither broad nor stable. First, most "borderline" symptoms cluster within emotional and relational dimensions, such as neuroticism (the tendency to experience negative and unstable emotions) and antagonism (the tendency to be disagreeable). Second, most "borderline" symptoms remit substantially over time (with some exceptions, like chronic feelings of emptiness, which are increasingly acknowledged to be transdiagnostic problems not unique to BPD).
Based on all of the above, "borderline personality disorder" is neither "borderline" nor a "personality disorder". Instead, "borderline" pathology appears to be mainly about a general sensitivity in how a person feels that is particularly pronounced within the context of close relationships. Importantly, this is supported not only by the content of the "borderline" symptoms themselves, but by decades of developmental research (suggesting that the "borderline" pattern takes shape within early relationships), clinical research (suggesting that the most effective treatments are themselves relational), and qualitative research (suggesting that both clinicians and people with lived experience prefer a relational framing of "borderline personality" problems). In that sense, borderline personality disorder is best understood as a relational sensitivity disorder.
What "borderline pathology" actually describes: sensitivity to relational signals, with downstream instability in mood, identity, and behaviour.
What "personality pathology" actually describes: relatively stable and maladaptive traits that constrain adaptation to various life settings.
The reform matters for more than borderline alone. Once borderline is removed from the personality disorder section, several questions that have long been tangled together begin to come clear. We clarify four such questions below.
The idea of a personality "pathology" becomes more clear because it is readily defined as any tendency that becomes stably and broadly maladaptive over time. As explored previously, this idea is important for understanding all human beings because every single one of us has at least one personality trait that is rigid and maladaptive in some way (and thus every single one of us could benefit from psychotherapy). The idea of "personality pathology" then should not be stigmatised but should be acknowledged as an intrinsic aspect of all human beings.
For more than forty years, research has repeatedly shown that "borderline difficulties" develop in the context of early relationships (that may be either mildly invalidating or severely traumatic), that the underlying mechanisms that fuel and sustain them are themselves relational (for instance, failures in understanding oneself and others), and that their treatment centers on building a meaningful therapeutic relationship. Finally, both clinicians and patients have repeatedly expressed that these problems are not about "personality" but rather about "ways of relating". The name relational sensitivity captures the thread running through all of these findings: an emotional intensity organised around self-other relationships.
For at least three decades, clinicians have argued about whether borderline is really a form of complex PTSD. The overlap between them is large and the boundary is hard to draw. Many people meet the criteria for borderline without the trauma history that complex PTSD requires, and many people with complex PTSD meet the criteria for borderline. Seeing borderline as a relational sensitivity resolves a lot of this ambiguity: Both are difficulties in how a person experiences themselves and others in close relationships, but what separates them is where these difficulties come from. Complex PTSD points to an identifiable trauma, while relational sensitivity allows for a vulnerability that may have no single traumatic origin. The two diagnoses can then sit alongside each other and describe patients, rather than competing over the same ones.
Clinicians have long noticed that borderline features make almost every other condition harder to treat. For instance, a patient with depression may be sensitive to interpersonal rejection and thus fail to progress with treatment because they read the therapist's neutral remarks as criticism. Likewise, a patient with a psychotic disorder may struggle to progress with therapy because they are paranoid of their therapist. Conceptualising borderline difficulties as relational difficulties resolves a lot of these conceptual ambiguities: every mental disorder could be accompanied by comorbid relational problems, and the relational sensitivity diagnosis can help clinicians anticipate and work with (rather than around) the relational problems that impede psychological treatments.
This petition will be submitted to the WHO Department of Mental Health and Substance Use ahead of the next ICD-11 maintenance cycle.
We are gathering endorsements from clinicians, researchers, carers, people with lived experience, and members of the public who recognise that the current label has run its course.
You do not need credentials to sign. The patients whose lives are shaped by this diagnosis are its most authoritative witnesses.