A diagnosis of borderline personality disorder (BPD) has become a way of excluding women from mental health care or detaining them for long periods in hospital. Three times as many women as men are given this diagnosis, and it pathologises the way that women behave in extremis when they are powerless and tramatised. Some undoubtedly have symptoms of chronic PTSD resulting from trauma, but crucially bipolar disorder, autism and PMDD are missed, and the mental health system traumatises further. Supported by many, both patients and professionals, a BPD diagnosis it is even more vehemently rejected by others, because of the associated stigma. Self-harm is a way that we try to cope with extreme emotions and is commonly used to (too) quickly make a diagnosis of BPD or EUPD. ‘Attempted suicide’ has not been an offence since 1961 but the police have become more involved in prosecution through ill-judged and unevidenced interventions such as Serenity Integrated Monitoring (SIM). Unpicking exactly how women reach this point, finding better and more compassionate ways of understanding and helping them with their lives including effective psychological therapy, is essential.