Building structure for the borderline construct

This article overviews the development of the borderline personality disorder construct. In the past 25 years, the borderline personality diagnosis has grown remarkably in clinical usage even as its construct has undergone dramatic shifts in the process. It originated as a type of intrapsychic personality organization that reflected psychoanalytic observations and the hope for long-term curative therapies. It was transformed by descriptive observations into a syndrome whose boundaries with first schizophrenia and then affective disorders became the subject of intense study. More recently, it is recognized as a specific type of personality disorder that communicates substantial information about pathogenesis and that helps guide clinical planning and prognostication. The context dependency of the borderline patient's presentation explains why the diagnosis can often elude recognition.