The borderline patient: update on the diagnosis, theory, and treatment from a psychodynamic perspective

This paper presents an overview regarding the borderline patient including historical background, diagnosis, developmental theory, prognosis, and psychotherapy, all from a psychodynamic perspective. The overview is succinct, current, and practical; it is comprehensive although certainly not all-inclusive. Five clinical vignettes are presented, reflecting various aspects of borderline patients. These vignettes are used to illustrate phenomena elaborated later in the paper. Regarding diagnosis, an approach based on ego strengths and ego weaknesses is detailed. This "ego-psychological diagnostic approach" leans on the ideas of Kernberg, but simplifies and occasionally modifies his work, in addition to including aspects of the borderline patient not stressed by him. It provides a simple, integrated summary of current psychodynamic diagnostic thinking. The paper compares and contrasts two of the most useful developmental theories regarding the borderline patient, those of Kernberg and Adler. The clinical usefulness of the two theories is noted, as is their relationship to etiology. Relying on the work of Stone, there is a brief section on prognosis, followed by an even briefer discussion of referral yield. The paper concludes with a discussion of psychotherapy. A continuum of psychodynamically related psychotherapies is detailed, then related to borderline individuals.