The Fate of Borderline Pathology in Dimensional Classification Systems: A Narrative Review

Area of Science:

• Psychiatry
• Clinical Psychology
• Personality Disorders

Background:

• Personality disorder classifications are shifting from categorical to dimensional models.
• This shift prompts re-evaluation of borderline personality disorder (BPD) nosological status and clinical utility.
• The borderline construct has evolved from early descriptions to operationalization in diagnostic manuals.

Purpose of the Study:

• To review the historical development and contemporary controversies surrounding the borderline personality disorder (BPD) construct.
• To examine arguments for and against retaining BPD as a distinct diagnosis.
• To integrate the concept of borderline pathology within a dimensional framework of personality functioning.

Main Methods:

• Narrative review of the literature on borderline personality disorder (BPD).
• Analysis of historical diagnostic revisions and contemporary research findings.
• Integration of the borderline construct with dimensional models of personality functioning, including the DSM-5 Alternative Model for Personality Disorders (AMPD).

Main Results:

• Arguments against BPD include lack of a distinct factor, capturing fluctuating symptoms, stigmatization, and non-specific treatments.
• Converging evidence suggests core borderline symptoms indicate general personality pathology and severity of functional impairment.
• Borderline pathology can be conceptualized as a dynamic dimension of dysfunction.

Conclusions:

• Retaining borderline pathology as a dimension supports PD assessment by marking overall dysfunction and guiding treatment.
• This dimensional approach offers continuity with existing clinical and research traditions.
• Conceptualizing BPD as a dimension aligns with the Level of Personality Functioning (LPF) in the AMPD.