Initially, it was suggested that borderline personality disorder bordered on or overlapped with schizophrenia, non-schizophrenic psychoses, and neuroses such as anxiety disorders and depression. Because it coincided with so many other psychiatric diagnoses, it was commonly believed to be time-consuming, lacking in accuracy and validity, and only useful for patients who did not clearly fit into other diagnostic categories. The disorder was also thought to respond very poorly to treatment. Unfortunately, a large number of mental health professionals, seemingly unfamiliar with the current scientific literature, still feel this to be true.
However, many studies have now shown that borderline disorder has diagnostic validity and completeness. Some of these studies clearly indicate that the illness does not overlap with schizophrenia. Furthermore, the disorder appears to be a distinct diagnostic entity, although it frequently co-occurs with other mental disorders such as depression and bipolar II disorders, attention deficit hyperactivity disorder (ADHD), substance use disorders, post-traumatic stress disorder trauma (PTSD), and with several other personality disorders.
Finally, medications and specific forms of psychotherapy have been shown to be effective in treating BPD, thus offering substantial hope for those who suffer from it, and for their families and friends.
A brief historical review of major advances in our understanding and treatment of borderline disorder follows:
– Descriptions of individuals demonstrating the symptoms of borderline disorder were first mentioned in medical literature nearly 3,000 years ago.
– In 1938, American psychoanalyst Adolph Stern first described most of the symptoms that are now considered diagnostic criteria for BPD. He suggested possible causes of the illness, and what he believed to be the most effective form of psychotherapy for these patients. Finally, he named the disease, referring to patients with the symptoms he described as “the borderline group”.
– The psychoanalyst Robert Knight, in 1940, introduced the concepts of ego psychology in his description of the borderline disorder. Ego psychology deals with the mental functions that allow us to realistically perceive events, successfully integrate our thoughts and feelings, and develop effective responses to the life around us. He has suggested that people with borderline disorder have impairments in many of these functions, and he refers to them as “borderline states”.
– The next major contribution in the field was made by the psychoanalyst Otto Kernberg. In the 1960s, he proposed that mental disorders were determined by three distinct personality organizations: psychotics, neurotics, and “borderline personality”. Kernberg was a strong advocate of modified psychoanalytic therapy for those patients with BPD who are able to benefit from it.
– In 1968 American author and Professor Roy Grinker and his colleagues published the results of the first study performed on patients with borderline disorder, which he referred to as the “borderline syndrome”.
– The next big breakthrough came in 1975, when John Gunderson and Margaret Cantor published an article that synthesized the relevant published information about borderline disorder, and defined its main characteristics. Gunderson then published a specific research instrument to improve the accurate diagnosis of the disorder. This instrument allowed researchers around the world to verify the validity and integrity of the borderline. Subsequently, BPD first appeared in the DSM-III as a bona fide psychiatric diagnosis in 1980.
– In 1979, John Brinkley, Bernard Beitman, and Robert Friedel proposed that medications, specifically low-dose neuroleptics (now referred to as antipsychotic agents), are effective in reducing some of the symptoms of borderline disorder. Friedel’s research team published support for this proposal in 1986, in one of the first two placebo-controlled studies for any medication in patients with borderline disorder. A similar finding was reported in the same journal by Paul Soloff’s research team with a different medication in the same class. Since then, other controlled studies of similar agents have supported and extended the initial conclusion. In addition, medications from other classes have been reported to be effective in treating the symptoms of borderline disorder.
– In the 1980s, the first of a large number of neuroimaging, biochemical and genetic studies were published indicating that borderline disorder is associated with biological disturbances in areas of the brain related to the symptoms of the disease.
– In 1993, Marsha Linehan introduced dialectical behaviour therapy (DBT), a specific and now well-documented form of psychotherapy for patients with borderline disorder who are prone to self-injurious behaviour and who require and request frequent and short hospital stays. Since then, other forms of psychotherapy that are specifically designed for borderline disorder have been developed.
– Over the past decades, two advocacy groups have been founded, the Treatment and Research Advancements Association for Personality Disorder (TARA APD), and the National Education Alliance for Borderline Personality Disorder (NEA – BPD). The missions of these organizations are: to raise awareness of borderline disorder and its treatments; provide support to people suffering from illness, and their families and friends; to increase funding for dedicated federal and private research on the disorder, and to decrease the stigma associated with it.
– From about 2020 onwards it does seem as if all help and research on BPD has stopped with very little interest in renewing it. We made this site to try and encourage more research, more talk about BPD and one day I hope that this site will also be included in these BPD history posts.