Over the past decade there has been plenty of good news for people with borderline personality disorder. First, the acute symptoms of the disorder, characterized by marked emotional dysregulation, suicidality, self-harm, and impulsivity—long believed to be chronic in nature—have been shown to remit naturally without treatment, with patients experiencing substantial reduction in symptoms far earlier than previously assumed (1). Second, carefully crafted psychotherapeutic treatments have been developed and have been shown in randomized controlled trials to be more effective than treatment as usual at relieving acute symptoms such as self-harm and suicide attempts. The new treatments, which are not widely available, are an unlikely cause for the apparent change in prognosis over the past two decades. The change may have been because general psychiatric treatment, or treatment as usual, delivered by well-meaning mental health professionals was actually harmful and has now improved or is no longer so easily available (2). No treatment trials have reported on negative outcomes, so the specialist treatments may primarily minimize harmful interventions, perhaps by carefully formulating the patient's problems according to a focused theory and offering crisis planning to prevent uncoordinated care.