Borderline Personality Disorder

   Borderline personality disorder (BPD) is important because it became a highly popular diagnosis after the 1980s, applied almost exclusively to young women who previously would have been called "hysterical."

   Beginning of "borderline personality disorder" (1938). New York psychoanalyst Adolph Stern (1879–1958) described in the Psychoanalytic Quarterly "a large group of patients [who] fit frankly neither into the psychotic nor into the psychoneurotic group. . . . This border line group of patients is extremely difficult to handle effectively by any psychotherapeutic method" (p. 467). Highly narcissistic and insecure, these patients "are constantly being deeply insulted and injured by trifling remarks made by people with whom they come into contact, and occasionally develop mild paranoid ideas" (p. 471). His description involved 10 characteristics that might or might not be present and was quite nonspecific.

   "Borderline personality" becomes specified (1967–1968). In 1967, Menninger Foundation psychoanalyst Otto F. Kernberg (1928–) specified in the Journal of the American Psychoanalytic Association the psychopathology of what he called "borderline personality organization," which he believed to be a stable character structure and not "a transitory state fluctuating between neurosis and psychosis." He offered a list of operational criteria, any two or three of which would suffice to make the diagnosis. They included anxiety, "polysymptomatic neurosis," and "manifest sexual deviation." Giving rise to this pattern of personality organization were various "aspects of ego weakness," including inability to tolerate anxiety, to control impulses, or to sublimate one’s drives in other ways.

   In 1968, Chicago neurologist and psychoanalyst Roy R. Grinker, Senior (1900–1993) and colleagues attempted to characterize borderline patients in a quantitative analysis. They admitted to hospital a number of young adults with uncertain psychiatric diagnoses, performed a long battery of tests on them, and observed them closely for 2 weeks. After a factor analysis of the data, the investigators concluded that borderline patients had defects in their affective relations centering about angry explosions, inconsistent self-identity, and depressions characterized by loneliness rather than guilt.

   They subdivided these patients into four categories, including those who are impulsively angry, those whose personal relations with others vacillate, those who show little spontaneity and prefer to withdraw, and those who have anxiety mixed with a "childlike, clinging depression." Grinker’s monograph The Borderline Syndrome (1968) put BPD on the map.

   Borderline personality disorder: Gunderson defines (from 1978). In an article in 1978 in the American Journal of Psychiatry, John G. Gunderson (1942–) and Jonathan E. Kolb (1943–), both at McLean Hospital, defined BPD as involving low achievement, impulsivity, manipulative suicidal gestures, heightened affectivity, mild psychotic experiences, high socialization (intolerance of being alone), and disturbed close relationships. Later, Gunderson served on the advisory committee of DSM-III-R for personality disorders and in 1984 wrote the influential manual Borderline Personality Disorder.

   Borderline personality disorder enters DSM-III (1980). The definition in the Manual reflected recent scholarship, characterizing BPD by "instability in a variety of areas, including interpersonal behavior, mood, and self-image. . . . Frequently there is impulsive and unpredictable behavior that is potentially physically selfdamaging. . . . There may be problems tolerating being alone, and chronic feelings of emptiness or boredom" (p. 321).