How the Term 'Borderline' in BPD Came About

A history of the misleading term 'borderline'

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Many wonder how the term borderline came to describe borderline personality disorder. Let's learn more about the origin of this term, and why its use is debated by some experts today. 

The History of the Term "Borderline" in Borderline Personality Disorder

The term "borderline" was first introduced in the United States in 1938. It was a term used by early psychiatrists to describe people who were thought to be on the "border" between diagnoses, mostly psychosis and neurosis.

At the time, people with neurosis were believed to be treatable, whereas people with psychoses were deemed untreatable.

Then, in the 1970s, a deeper understanding of borderline personality disorder began to emerge. People with BPD were described as being very emotional, needy, difficult, at risk for suicide, and to have an overall unstable level of functioning. 

Soon, a pattern of symptoms began to emerge to describe those with borderline personality disorder. These included: 

  • rapid shifts from periods of confidence to total despair 
  • unstable self-image
  • rapidly fluctuating mood swings
  • fear of abandonment
  • strong tendency for both self-harm and suicidal thinking

In 1980, BPD became an official personality disorder in the Diagnostic and Statistical Manual of Mental Disorders III, or DSM-III.

Borderline Personality Disorder Today

Today, far more is known about BPD. The term "neurosis" is no longer used in our diagnostic system, and BPD is no longer thought of as being a psychotic disorder.

Now BPD is recognized as a disorder characterized by intense emotional experiences and instability in relationships and behavior that begins in early adulthood and manifests itself in multiple contexts (for example, at home and at work).

In addition, experts have recognized that there is a strong genetic component to BPD—meaning it can run in families.

 

According to the DSM-5, in order to be diagnosed with BPD, a person must meet these criteria:

  • Have an impairment in either identity (sense of self) or self-direction (for example, life goals).
  • Have an impairment in interpersonal functioning with either empathy (unable to recognize feelings of others) or intimacy (intense, unstable and conflicted relationships).

In addition, a person must have the following pathological personality traits:

  • Negative Affectivity: characterized by frequent mood changes, anxiousness, fear of rejection, feeling down frequently, and suicidal thoughts and behavior
  • Disinhibition: characterized by impulsivity and risk-taking (for example, spending sprees, sex)
  • Antagonism: characterized by hostility (for example, anger in response to a minor insult)

The Ongoing Debate of Borderline Personality Disorder

The term borderline is still debated by some people. Many experts are now calling for BPD to be renamed, because they believe the term "borderline" is outdated. Some believe that BPD should not be classified as a personality disorder, but rather as a mood disorder, or an identity disorder.

Suggestions for the new name have included:

  • Emotion Dysregulation Disorder 
  • Unstable Personality Disorder
  • Impulse Spectrum Disorder
  • Complex Posttraumatic Stress Disorder

What Does This Mean for Me If I Have BPD?

It's important to not get too hung up on the term "borderline." The term is old and may be changed in the future. Instead, focus on working with your doctor or therapist in receiving the proper therapy so you can get healthy. 

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bernstein DP et al. Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system. J Pers Disord. 2007 Oct;21(5):536-51.

Borderline Personality Disorder: Treatment and Management. NICE Clinical Guidelines, No. 78.National Collaborating Centre for Mental Health (UK). Leicester (UK): British Psychological Society; 2009.

Gunderson JG. Borderline Personality Disorder: Ontogeny of a Diagnosis. Am J Psychiatry. 2009 May;166(5):530-39.

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