Borderline Personality Disorder

I know the basics of Borderline Personality Disorder, but why is it called that? Doesn’t the word “borderline” imply something beyond that border. If someone were referred to as borderline schizophrenic for example (I realize the two disorders have nothing to do with eachother), that would make more sense, or borderline diabetic. But with Borderline Personality Disorder, it seems to be just borderline. What does that word refer to?

I understand that the borderline in Borderline Personality Disorder refers to borderline neurosis/psychosis. At least this is what my psychopathology lecturer described it as.

The term is based in history and is no longer meaningful. It causes a lot of confusion when people hear it. The best thing to do is to read about the signs, symptoms, and etiology. Don’t get stuck on the word ‘borderline’ – many people use the term BPD.

My reading is that it’s a messy diagnostic category.

http://www.clinical-supervision.com/Borderline.htm
*The concept of Borderline Personality Organisation (BPO) arose in the 1950’s to account for clients who could neither be classified as neurotic nor as psychotic. Though Knight (1953) introduced the term within this context, it was Stern (1938) who first coined the term, categorizing clients who had previously been described as ‘as-if personalities’, ‘latent schizophrenics’, ‘pseudopsychopathic schizophrenics’, ‘pseudoneurotic schizophrenics’, ‘sub-clinical schizophrenics’ and ‘occult schizophrenics’.

The difficulty in labelling this clinical entity is echoed by the controversy and disagreement inherent in it’s definition. Different theoretical orientations propose different diagnostic criteria. Thus one encounters behavioural, symptomatic, psychodynamic formulations and psychological test findings forming the basis of diagnostic categorisation of the Borderline Personality Organisation. *

“Borderline” is a complete misnomer that has its origins in attempting to place the behaviors on a continuum of normal->psychotic behavior because, at the time, they didn’t no how else to define them. People with BPD seem nuttier than neurotics but not completely detached from reality like psychotics. Borderline Personality Disorder can’t be defined on an axis of severity because it’s difference from other disorders is qualitative not quantitative. One of the defining symptoms of BPD is highly unstable relationships characterized by rapid fluctuation between idealizing and devaluing others. IIRC, according to object relations theory, the origins of the problem are in the “rapprochement” phase of development when the child is seperating from the parents and is ambivalent about the desire to feel autonomy vs. the desire to feel secure. Problems here get amplified into the love/hate instability of people with BPD.

A good read on understanding Borderline PD is The Search For The Real Self by Masterson.

When I worked in psych, often (very often!) the difficult patients with any personality disorder (those who cut on themselves, those who split the staff (said different things to different staff), those who said they had different personalities, etc.) were all called ‘borderline’ by the staff. This was obviously lazy and wrong.

I found the ‘true’ borderline PD patients to be fascinating. You could sit with one and talk for hours (they love attention!) and sort out all their problems (not solve them) and even get them to admit crystal clear insight into their behavior. But the next minute they’d be right back in their disorder.
That’s what is meant by the psychotic borderline. They are neurotic to beat-all with usually a depressed mood to boot, but can accurately evaluate reality (non-psychotic), and then the next moment they are one-sandwich short of a picnic (gross impairment of reality testing=psychotic).

Oops…this wasn’t the borderline personality that I came across in a book (briefly browse through though). Is this an example of a borderline personality disorder - Girl want attention from guy, girl made up problems and delibrately create troubles to make guy give her some attention, couldn’t stand it if the guy is like about to leave her for anything (even just to go down…). Strange thing is the girl will be entirely all right and happy until the guy makes sign to leave…