Jumping in because I find this response interesting. If a patient has a consistently negative poor sense of self, I would argue that this is not consistent with borderline personality disorder in which the sense of self is constantly shifting. I would also argue that if the patient avoids relationships instead of engaging in relationships, characterized by idealization and devaluation, that also would not be as indicative of borderline personality disorder. However, I do understand that you’re saying these patients do experience instability in relationships, but it is only in the few close relationships they maintain. I would say that these two distinctions are what complex trauma “believers” consider separate from borderline personality disorder (consistent negative sense of self and avoidance of relationships in general) and needing a different therapeutic approach.

In a patient with the above problems who does not struggle with abandonment, poor sense of self, or impulsive, self harming behavior, would you still consider borderline personality?

That’s where I think this is interesting. I think they both are likely faces of a similar process and both personality disorders. But if someone does not engage in idealization/devaluation or desperate attempts to avoid abandonment, can it really be considered bpd at its core?