The History of BPD

G. Pacana

1/22/20243 min read

history of BPD
history of BPD

The term borderline was coined to describe patients who were diagnosed to be on the borderline between a neurotic and psychotic disorder.

The history of borderline personality disorder is a long and complex one dating back to 1938. The American psychiatrist Adolf Stern is believed to have first used the term borderline to describe a group of young female patients with a history of trauma who did not respond well to traditional psychoanalysis. Stern believed that these patients were more than simply neurotic and not altogether psychotic, but somewhere in between. It is commonly felt that the “borderline” label is misleading and stigmatizes the disorder.

The following is a brief timeline for the progression of the disorder that we have come to know as borderline personality disorder:

In 1938, the American psychoanalyst Adolph Stern published one of the most important articles to appear on borderline disorder, then or since. In it, he described in detail most of the symptoms that are now considered diagnostic criteria for the disorder. He correctly suggested the likely causes of the disorder and listed the fundamental principles of what he believed to be the most effective form of psychotherapy for these patients, many of which are currently in use. Finally, he named the disorder by referring to patients with the symptoms he described as “the borderline group.”

The psychoanalyst Robert Knight, in the 1940s, introduced the concepts of ego psychology into his description of borderline disorder. Ego psychology deals with mental functions that enable us to realistically perceive events, successfully integrate our thoughts and feelings and develop effective responses to life around us. He suggested that people with borderline disorder have impairments in many of these functions, and he referred 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: psychotic; neurotic and “borderline personality.” Kernberg has been a strong proponent of modified psychoanalytic therapy for those patients with borderline disorder who can benefit from it.

In 1968, Roy Grinker and his colleagues published the results of the first research conducted on patients with borderline disorder, which he referred to as the “borderline syndrome.”

The next major advance occurred in 1975 when John Gunderson and Margaret Singer published a seminal and widely read article that synthesized the relevant, published information on borderline disorder, and proposed its major characteristics. Gunderson then published a specific research instrument to enhance the accurate diagnosis of borderline disorder. This instrument enabled researchers all over the world to verify the validity and integrity of borderline disorder. Subsequently, borderline personality disorder first appeared in DSM-III as a bona fide psychiatric diagnosis in 1980.

In 1979, John Brinkley, Bernard Beitman and Robert Friedel provided anecdotal evidence that medications, specifically low doses of 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 of any medication in subjects 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 original finding. In addition, medications in other classes have been reported to have efficacy 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 those brain areas related to the symptoms of the disorder.

In 1991, Marsha Linehan introduced Dialectical Behavior Therapy (DBT), a specific and now well-documented form of psychotherapy for patients with borderline disorder prone to increased anger, and self-injurious behavior and who require and request frequent, brief hospitalizations. Since then, other forms of psychotherapy have been developed that are specifically designed for borderline disorder.

1994: DSM-IV is published, defining further the symptoms of BPD required for diagnosis.

2008: The U.S. House of Representatives declares May as the National Borderline Personality Disorder Awareness Month.

Over the years a variety of alternative names have been suggested for BPD. These include Emotional Regulation Disorder, Emotional Dysregulation Disorder, Emotional Intensity Disorder, Emotionally Unstable Personality Disorder, Emotion-Impulse Regulation Disorder, and Impulsive Personality Disorder.

None of these names stuck and the disorder is still largely referred to by both patients and clinicians as BPD or borderline personality disorder.



Source: Borderline Personality Disorder Demystified, Robert O Friedel, M.D