Borderline Personality Disorder is associated with high degrees of mental health service engagement due to distress, and is classically described as being strongly associated with trauma, specifically childhood sexual abuse. This is despite low prevalence of trauma histories, as well as studies suggesting a paucity of evidence for trauma as a primary contributory factor. This article aims to outline the literature regarding the debate and advocates for reformulation of the condition as a condition with a biological origin and a multifactorial presentation.