The term Borderline, like the disorder it describes, is subject to constant lively discussion in the mental health community. The noted BPD researcher Dr Hagop Akiskal has called it “an adjective in search of a noun.” The name was introduced by the first psychoanalysts, who noted that certain patients actually got worse, not better, during the course of traditional Freudian ‘talk therapy’. Contrary to Freud’s hypotheses, these patients did not heal when past traumas were uncovered, but rather, the revelations led to brief flares of what appeared to be psychotic behaviour. These patients were thus seen as standing on the ‘border’ of neurosis (classed as a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, hypochondria) but not a radical loss of touch with reality.) and psychosis (classed as an abnormal condition of the mind that results in difficulties determining what is real and what is not real) so sane and insane or a calm mind and a crazy one, the two poles of mental illness as understood at that time: a psyche caught halfway between neurotic control and psychotic regression. Other, even less useful terms that have been historically used include “Ambulatory Schizophrenics”, “Neurasthenics” or “Hysterical Neurotics.”
Today it is believed that this misnomer was due to an incomplete understanding of the function of early trauma, the ego defence mechanisms, and attachment issues which are the hallmark of personality disorders. The term “Personality Disorder” itself has evolved from earlier terms such as “Character Disorder.”
Even in contemporary times, the position occupied by personality disorders is not well understood by a public conditioned by movies to view all mental health disorders as variants of schizophrenia. Modern therapeutic strategies focus on retraining the Borderline sufferer in healthier coping skills (although the debate over the therapeutic usefulness of processing early traumatic memories continues to this day).
Unfortunately for the sake of clarity, the original label “Borderline” has stuck. Even more confusing: BPD is often mistaken for the acronym for Bipolar Disorder, or BP (manic depression) — in fact, some researchers and clinicians consider BPD to be an affective mood disorder, a sub-diagnosis of Bipolar Disorder!
There is no easy acceptance here, it is all kind of confusing and that is even before you bring in the newer title of EUPD (emotionally unstable personality disorder) into the mix! But that is a post for another day.