Borderline--a diagnostic entity?

Abstract

In the last years, there has been considerable controversy as to whether the term "borderline" should be introduced into psychiatric diagnostic nomenclature to designate psychiatric disorders not classifiable as psychoses, neuroses or traditional forms of personality disorders. Whereas many psychiatrists, especially those who are psychodynamically oriented, have been using this term for a long time, the more phenomenologically oriented psychiatrists refuse to do so while pointing to its lack of clear-cut definitions and its confusing abundance of meanings. The definitions of the term "borderline" used in the various "borderline" -concepts are reviewed. Some authors (Knight, Kety et al.) consider "borderline schizophrenia" to be a subgroup of schizophrenic psychoses. Others (Klein, Stone) take "borderline" disorders as a heterogeneous group of psychiatric illness encompassing especially some atypical affective disorders. Thirdly the concepts of those authors who conceive "borderline" as a distinct diagnostic entity are reviewed: Kernberg's "Borderline personality organization", Grinker's "Borderline syndrome", Gunderson and Singer's "Borderline personality disorders", Spitzer and Endicott's "Borderline (unstable) personality disorder" and "Schizotypical personality". The "borderline" definitions of all concepts are examined as to whether they fulfil the requirements of a "useful" (according to Kendell) diagnostic category, i.e. whether they yield reliably defined diagnostic criteria, and whether they can be validated by genetic and biological studies, therapy response, and long-term studies. It is pointed out that attempts have been made to establish operationally defined diagnostic criteria for some of the "borderline" concepts, but that research aiming at their validation is still in an initial stage.