Borderline personality disorder: Some current nosologic problems

Abstract

The disagreement about the borderline concept among clinicians may historically be seen as a consequence of the dichotomy between psychoanalysis and clinical descriptive psychiatry. The validity of the concept is analyzed by applying the criteria of Robins and Guze. Kernberg's borderline personality organization is conceived as a sophisticated analytic metapsychologic concept, which has only weakly been empirically validated, in contrast to the borderline personality disorder (BPD) of DSM-III. There is a considerable overlap between BPD and other DSM-III diagnoses. In family studies BPD is separated from schizophrenia, but with uncertainty from affective disorders. BPD patients tend to have a poor prognosis in short-term follow-up studies but a more favorable one in the long run. Studies of biologic markers have not substantially validated BPD. The literature on psychotherapeutic treatment of BPD is heterogeneous and without solid outcome studies. Although neuroleptics are conceived as “drugs of choice”, there have been few controlled clinicals trials. Hence, the BPD as a nosologic entity needs further validation.

Key Words:

• Borderline personality disorder
• Nosologic entity
• Review