Historical perspectives on the borderline concept: a review and critique

Considerable confusion and disagreement remains in the psychiatric literature over the meaning of the term borderline. Over the last ten years a veritable explosion of books and articles on the subject have espoused overlapping and at times contradictory ideas on entirely different levels of discourse: biological, genetic, pharmacological, objective-descriptive, ego psychology theory, object relations theory, separation-individuation theory, and so on. Together, they seem both bewildering and irreconcilable. Despite DSM III's efforts to impose conceptual clarity, the situation remains a semantic mess. "Borderline" still means different things to different people and still tends to be a wastebasket diagnosis. No definition has been entirely satisfactory. This article is a preliminary effort at synthesis and explication of how and why psychiatry has arrived at this state of affairs.