History of the Term 'Borderline' in Borderline Personality Disorder

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Borderline personality disorder (BPD) is a personality disorder marked by mood instability, impulsivity, fear of abandonment, and problems with self-image. In 1980, BPD became an official personality disorder in the "Diagnostic and Statistical Manual of Mental Disorders, Third Edition" (DSM-III).

Many wonder how the term "borderline" came to describe BPD. Let's learn more about the origin of this term and why its use has been debated through the years.

History of "Borderline" in Borderline Personality Disorder

The term "borderline" was first introduced in 1938 by American psychoanalyst Adolph Stern. He used it to describe a group of patients that did not improve with therapy and whose symptoms did not fit into either the psychosis or neurosis classifications.

At that time, people with neuroses were believed to be treatable, whereas psychoses were thought to be untreatable.

The term was then used to describe people who seemed to exhibit a type of "borderline schizophrenia."

By the 1970s, a deeper understanding of BPD began to emerge. Psychoanalyst Otto Kernberg used "borderline" to describe a personality organization between psychosis and neurosis.

People with borderline personality organization were described as having primitive psychological defenses, which are defense mechanisms to avoid anxiety and are the first to happen developmentally. Examples include splitting, or assigning "good" or "bad" qualities to everything, as well as projective identification or projection, or assigning your negative qualities onto someone else.

The personality organization was marked by instability and issues with one's sense of identity. Soon, a pattern of symptoms began to emerge to describe those with BPD, including: 

  • Unstable self-image: Identity disturbance; can include changes in what they want to do with their lives and what they are interested in
  • Rapidly fluctuating mood swings: Can range from anxiety and anger to intense dysphoria
  • Fear of abandonment: Can cause them to cut off people who they fear will abandon them or attach themselves closely to others; may lead to self-harm or suicidal behaviors
  • Strong tendency for both self-harm and suicidal thinking: Thoughts or acting on harming oneself; could manifest, fore example, in cutting or self-sabotage

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Borderline Personality Disorder Today

Today far more is known about BPD. It's now recognized as a disorder characterized by intense emotional experiences and instability in relationships with behavior that begins in early adulthood and showing up in multiple contexts—for example, at home and at work. In addition, experts have recognized that there is a strong genetic component to BPD.

BPD in the DSM-5

According to the DSM-5, in order to be diagnosed with BPD, a person must meet certain criteria. These include the following:

  • A pervasive pattern of instability in interpersonal relationships, self image, and emotions
  • Frantic efforts to avoid real or imagined abandonment
  • Impulsivity that is self-damaging
  • Recurrent suicidal behavior or self-harm
  • Chronic feelings of emptiness
  • Inappropriate, intense anger
  • Transient stress related to alterations in reality

Someone with BPD may not experience every symptom. However, according to the DSM-5, a person will exhibit five out of the nine specific criteria listed to receive a diagnosis.

BPD can impact every aspect of your life and leave you feeling out of control. You can experience intense emotions—including depression, anxiety, and anger—that can be difficult to manage. You may question who you are and doubt your self-worth. It might be hard to keep a job or be in a stable relationship.

Living with BPD can be really difficult and feel isolating. However, there is treatment available to help manage these symptoms.

The Ongoing Debate 

The term "borderline" has been debated through the years. Many experts have called for BPD to be renamed because they believe the term "borderline" is outdated and potentially stigmatizing. Some believe that BPD should not be classified as a personality disorder, but rather as a mood disorder or an identity disorder.

A 2007 survey also revealed that out of 96 personality disorder experts who completed the survey, only 31.3% wanted to keep the name "borderline personality disorder" in the DSM-5.

Suggestions for the new name have included:

  • Emotional Intensity Disorder
  • Emotional Dysregulation Disorder 
  • Dyslymbia

What Does This Mean for You If You 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 a doctor or therapist in receiving the proper therapy and getting all your questions answered so that you can manage your symptoms. 

BPD is often misdiagnosed because symptoms overlap with other conditions, including bipolar disorder, depression, and post-traumatic stress disorder (PTSD). Thus, the word borderline might more adequately describe the fact that it sits on the border of many other conditions, blurring their distinctions.

Borderline Personality Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

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A Word From Verywell

While the term "borderline" may be a misnomer in BPD, research has uncovered a great deal about the condition since the 1970s. Rest assured that there is treatment available to manage symptoms of BPD, including psychotherapy and medication.

If you or a loved one might be have BPD, don't put off reaching out to a mental health professional. They can help you set up a treatment plan that's right for you.

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