Response

The paper by Porter et al ^{Reference Porter, Edwards, Head and Smith1} effectively demolishes complex emotional needs as a synonym for personality disorder but it was a straw creation inviting to be knocked down. The term was not a comprehensive one; it really only applied to emotionally unstable or borderline personality disorder, and this accounts for less than a quarter of all with the generic diagnosis of personality disorder. ^{Reference Winsper, Bilgin, Thompson, Marwaha, Chanen and Singh2} For most it is completely inappropriate. If you asked someone like Margaret Thatcher if she has complex emotional needs, the reply would be, ‘your question is meaningless and silly; my emotional needs are none of your business and are certainly not complex’.

The fundamental problem here is not the name but its underlying meaning. People instinctively create social categories, which helps them to learn about others’ thoughts, benefits and interaction. Unfortunately, this categorisation may often be associated with prejudice, stereotyping and discrimination. However, not naming, or renaming. a category does not stop the categorisation nor its accompanying negative features. The advantage of a spectrum of diagnosis with no categories, as in the ICD-11 diagnostic system, ^{Reference Tyrer, Mulder, Kim and Crawford3} is that it nullifies prejudice, promotes inclusion and, in the case of personality problems, aids adjustment with a range of interventions for all levels of severity. ^{Reference Mulder, Murray and Rucklidge4,Reference Tyrer5} If we are all in the same boat we must look after each other to keep balance. Rather than trying to change the language of personality descriptions we may need to focus on reducing the social significance that people ascribe to the description by making them conceptually rich and part of a diverse spectrum of human behaviours.

The wish by many to rid the world of the diagnosis of personality disorder because of stigma and implied untreatability is pointless. It is a very common problem ^{Reference Winsper, Bilgin, Thompson, Marwaha, Chanen and Singh2} and has more successful treatments than many other conditions. ^{Reference Choi-Kain, Albert and Gunderson6} Unfortunately, the campaign to get rid of the term has had the paradoxical effect of promoting stigma. Nobody can deny that many with personality problems have been a boon to civilisation and we cannot wish them away with verbal gymnastics. Ludwig van Beethoven probably had severe personality disorder; he was irritable, angry, impulsive, markedly obsessional, lived in squalor and had a nomadic existence with no close relationships. ^{Reference Tyrer5} Yet, this detachment from society led him to inspired musical composition. The initial four bars of his famous fifth symphony say loudly ‘I have personality disorder’. Let us, all with one voice, sing ‘We have personality disorder’, and celebrate our diversity.