What is Borderline Personality Disorder (BPD)?

Description of the Disorder
The essential features or criteria fall under four main headings with instability being the consistent feature:*

1. Instability of interpersonal relationship

  • Inability to be alone, sense of panic when alone
  • Extreme dependency
  • Fear of abandonment, seperation, or rejection
  • Manipulation of others
  • Devaluation of self or others

  • 2. Self-image is unstable

    3. Affect is labile (reactivity of mood) 4. Behavior is impulsive and unstable These features are a guideline when conceptualizing the Borderline Personality, the principal thing to be cognizant of is that these features occur rapidly, without warning, and are pervasive.  The person with BPD can change right in front of your eyes.
    History of the Term
    When Adolf Stern first coined the term "border line" in 1938 he used it to describe outpatients that did not fall into the standard classification system used in the psychiatric profession (Stern, 1986).  The practice during this time was to label behavior as normal, neurotic, or psychotic (Linehan, 1993; Stone, 1993).  Neurotic patients were considered to have a less severe illness and responded well to classical psychoanalysis (Freud).  The “border line” patient, although, not as severe as the psychotic, did not respond well to psychoanalysis and their behavior did not met classification standards for a neurotic or psychotic diagnosis (Stone, 1986).  This term became the catchall term within the psychoanalytic community to describe patients that did not meet established diagnostic criteria (Linehan, 1993).  Many contributors helped develop the current label and view of the borderline patient.  Stern labeled and a conceptualized this type of patient using10 descriptors the patients behavior.  In 1942, Helene Deutsch describes an “as-if” group of patients that also failed to fit into established categories; her theory about these patients led to the “pathology of internalized object-relations.  Melitta Schmideberg, 1947, described a group of borderlines that were more schizoid or narcissistic as being “stable in their instability” which is the nature of the disorder. Kernberg’s definition relied on reality-testing and identity diffusion: “borderline personality organization is that characteristic level of functioning where the sense of identity is weak… yet the capacity to test reality is preserved…”(Stone, 1993, p. 219).  This definition lead to Gunderson and Singer’s development of a six-item criterion set that was observable and could be better delineated from other disorders (Stone, 1986).  The use of the term “borderline” grew with the psychoanalytic movement, evolving to describe both a disturbance or severity in personality functioning and the structure of personality organization. It wasn’t until 1980 when the DSM-III was published that the concept of BPD became an official diagnostic disorder with it’s own set of criteria (Linehan, 1993).  The definition used in the DSM-III/R and DSM-IV is roughly founded on Gunderson’s idea of using a set of criterion to define the borderline.  (see Stone, 1986 or Linehan, 1993 for complete history).

    Features of BPD

    *This list was adapted using the Diagnostic Interview for Borderlines, Revised (DIB-R) and the DSM-IV ( APA, 2001; llama central, 2001).
    **The example given was chosen for its brevity and so it should be mentioned that unlike Maxine, not every story has a successful conclusion (Paris, 1999).  When self-mutilation is involved often times the result is death (Stone, 1993).
    ***Antisocial Personality Disorder is the acception to this rule, it can only be diagnosed after the age of 18