Defining Terms

Sometimes people ask me the meaning and origin of borderline. It describes a middle ground between neurosis and psychosis.

Those Freudian terms are a little out of vogue. To review, a neurosis is a mental disturbance of lesser seriousness. Fear of flying, for example, might be a neurosis. Or oversensitivity, or a need for control over your children’s lives. I always think of Woody Allen visiting his psychiatrist for years, lying on the couch complaining about his parents and his relationships. Chronic anxiety is neurotic.

The psychotic person, in contrast, loses touch with reality. Hallucinations and hearing voices come into play. Sociopaths like Hannibal Lecter are psychotic.

Psychoanalyst Adolph Stern coined the term borderline personality disorder in 1938 to describe a syndrome that seemed worse than a neurosis but not quite a psychosis. People with BPD can function in the workplace and seem normal much of the time. They rarely have psychotic breaks. On the other hand, their chaotic personal relationships and depression can destroy their lives. Sometimes they seem to distort reality, almost in a psychotic manner. If it’s a neurosis, it’s a debilitating one.

Dr. Joel Paris defines the disorder in this way:

Although we no longer believe that patients with BPD have an underlying psychosis, the name “borderline” has stuck. A much more descriptive label would be “emotionally unstable personality disorder.” The central feature of BPD is instability, affecting patients in many sectors of their lives.

Thus, borderline patients show a wide range of impulsive behaviors, particularly those that are self destructive. They are highly unstable emotionally, and develop wide mood swings in response to stressful events. Finally, BPD may be complicated by brief psychotic episodes.

Most often, borderline patients present to psychiatrists with repetitive suicidal attempts. We often see these patients in the emergency room, coming in with an overdose or a slashed wrist following a disappointment or a quarrel.

Interpersonal relationships in BPD are particularly unstable. Typically, borderline patients have serious problems with boundaries. They become quickly involved with people, and quickly disappointed with them. They make great demands on other people, and easily become frightened of being abandoned by them. Their emotional life is a kind of rollercoaster.

As Dr. Paris implies, the term is highly controversial and often considered a misnomer. The average person has no idea what borderline indicates. In addition, the disorder has accrued so many negative connotations that many believe the term should be abandoned just to start fresh, without the stigma.

Dr. Paris proposed a new name. Do you have any suggestions?

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