The term borderline has seen wide variations in its definition since its first use approximately fifty years ago. It has referred, variously, to: (1) borderline personality disorder,(2) a borderlinepsychostructural organization, in a psychoanalytic sense, (3) borderline affective disorder, and (4) borderline schizophrenia.
The conceptualization of borderline personality disorder first as a variant of schizophrenia and later as an affective disorder variant provided additional impetus for various medication trials.
Schizophrenia is a final common pathway of a variety of pathological conditions. The borderline, however, is not an incipient or early schizophrenic although among the wide variety of its symptom-complexes are included withdrawal, depression and schizoid personalities. Although their object-relations are primitive, they still are able to maintain some ties with other people.
Modell thinks that borderline indicates a structural diagnosis rather than a syndrome with specific symptoms. Among the qualities of the borderline he includes: (1) subtle disorder in sense of reality; (2) strained quality of identifications and sense of identity; (3) relations based on primary identification instead of love, with identity borrowed from the partner; (4) primitive destructive fantasies; (5) temporary and limited regressions; (6) wish for omnipotent protectors and enormous dependence on external objects, but at the same time intense fear of closeness. On the positive side the borderline is relatively stable and does not develop overt schizophrenic breakdowns. According to Modell the borderline is an example of developmental arrest because of deficient mothering.
Kernberg (1967) has presented the results of his therapeutic encounters with a large number of borderline cases. His general conclusions are: (1) the borderline represents a specific and stable form of pathological ego-structure; (2) the presenting symptoms do not differentiate the syndrome; (3) transient psychotic episodes occur as a reaction to severe stress, alcohol and drugs, or in therapy as a transference psychosis; (4) these patients otherwise maintain reality-testing and have intact formal organization of thought processes; (5) borderline cases are easily differentiated from psychoses but not so easily differentiated from neuroses.
