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BPD from "Borderline Personality Disorder Demystified" book

Borderline Personality Disorder from "Borderline Personality Disorder Demystified" book by Robert O. Friedel, MD

The term borderline personality disorder came into official use in 1980, when it was included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). However, the symptoms of the disorder have been recognized for almost three thousand years. Some of these appear in the writings of Homer, Hippocrates, and Aretaeus (renowned for his symptomatic description of diseases and his diagnostic skills). Then highlighted new medical description in 1684, brings to at the early decades of the twentieth century, towards 1921, to 1923 bla bla bla bla.

From "wastebasket diagnosis" due to lacked validity and integrity, it was only used because people with these symptoms did not fit into any existing diagnostic classification. For all this time, terms like "border-line psychosis", "pre-schizophrenia", "pseudoneurotic schizophrenia" and "latent schizophrenia" emerged in attempts to accurately classify this group of patients.

The Psychoanalytic Origins of Borderline Disorder

Adolph Stern and the Border Line Group – In 1938, Stern listed ten characteristics of his border line group:

1) Narcissism

2) Psychic bleeding

3) Inordinate hypersensitivity

4) Psychic and body rigidity—"the rigid personality"

5) Negative therapeutic reactions

6) Constitutionally rooted feelings of inferiority, deeply embedded in the personality of the patients

7) Masochism

8) A state of deep organic insecurity or anxiety

9) The use of projection mechanism

10) Difficulties in reality thinking, particularly in personal relationships

Robert Knight and Borderline States – In 1940s, Knight introduced concepts from the field of ego psychology into Stern's psychoanalytic conceptual framework of borderline disorder. Ego psychology addresses those mental processes that enable us to integrate and deal effectively with our thoughts, feelings, and responses to the events of everyday life. These are called ego functions.

The symptoms aka the ego dysfunctions described as "borderline states":

1) Emotional regulation

2) Rational thinking

3) Integration of feelings, impulses, and thoughts

4) Realistic planning

5) Successful adaptation to the world around us

6) Involvement in mature relationships

7) Effectively subduing and rechanneling the energy from primitive and basic impulses

Otto Kernberg and Borderline Personality Organization – In 1960s, he suggested using a model of mental illness, which was determined by three distinct personality types:

1) Psychotic personality organization: consist of individuals predisposed to psychotic disorders such as schizophrenia

2) Neurotic personality organization: consist of individuals predisposed to less severe mental illnesses such as anxiety and depressive neuroses

3) Borderline personality organization: consist of individuals who fell between the first two types and how the symptoms that we now refer to as borderline personality disorder

Goy Grinker and the Borderline Syndrome – In 1968, he and his colleagues published the result of the first empirical research involving people with borderline disorder. From their data, they concluded that specific impairments of ego function differentiate the "borderline syndrome", as they named it, from other mental disturbances. These ego dysfunctions were manifested in four behavioral characteristics that best identify patients with the disorder:

1) A predominant emotional state of expressed anger

2) A defect in emotional relationships

3) Impairments in self-identity

4) Depressive loneliness

John Gunderson and Borderline Patients/Borderline Personality Disorder – In 1975, his major contribution to the field of borderline disorder when he published with Margaret Singer, a critically important articled called "Defining Borderline Patients: An Overview." Followed up by a large empirical research study led by Robert Spitzer. Brings to provided the initial scientific rationale in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published in 1980.

Four behavioral domains of borderline disorder:

1) Poorly regulated emotions

2) Impulsivity

3) Impaired perception and reasoning

4) Markedly disturbed relationship

Diagnostic criteria of Borderline Personality Disorder

This table lists the symptoms of borderline disorder as described in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, 5th edition (DSM-5 dikemaskini), published in 2013. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as included by five (or more) of the following criteria:

1) Frantic efforts to avoid real or impaired abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5 (below)

2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) Identity disturbance: markedly and persistently unstable self-image or sense of self

4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5

5) Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria (dissatisfaction, anxiety and restlessness), irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7) Chronic feelings of emptiness

8) Inappropriate, intense anger of difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9) Transient, stress-related paranoid ideation or severe dissociative symptoms