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Symptoms & Diagnosis

Is Borderline Personality Disorder a ‘Real’ Diagnosis?

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Only relatively recently has Borderline Personality Disorder (BPD) been accepted by clinicians, therapists, and even insurance companies as a valid psychiatric diagnosis. Awareness of the disorder and acceptance of the diagnosis has increased immensely in the past three decades, though the original term was coined in the 1930s by psychologist Adolph Stern. Stern wanted to classify a set of patients for whom there was no pre-existing psychiatric definition.

According to an article by Stern, published in the Psychoanalytic Quarterly in 1938, “It is well known that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that this border line group of patients is extremely difficult to handle effectively by any psychotherapeutic method.” It is clear that the term “border line,” in this context, merely referred to patients whom Stern believed did not meet a set of criteria that would plainly indicate a specific diagnosis. However, it would take more than 40 years for the psychiatric community to seriously consider and codify the diagnostic criteria for Borderline Personality Disorder.

BPD Diagnosis Initially Dismissed

The initial lack of diagnostic precision in determining the exact behavior and symptoms associated with BPD, combined with the fact that the disorder overlapped with a number of other psychiatric disorders, led many to question the validity of the diagnosis. A large portion of the psychiatric community dismissed Borderline Personality Disorder as a “catch-all” diagnosis lacking in any scientific validity and only appropriate for those patients who didn’t clearly fall into another category.

Throughout the middle of the past century, advances were made in the understanding of the disorder, but it was not until 1980 that BPD was afforded status as a bona fide psychiatric diagnosis when it appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This was due in large part to the commitment and perseverance of psychotherapists who documented, analyzed, and synthesized their combined knowledge on the disorder and defined the major characteristics and symptoms of BPD to be able to make a more accurate diagnosis.

BPD Diagnosis Led to Research

The validation of the Borderline Personality Disorder diagnosis has resulted in greater understanding and increased research into the disorder. A major advance in the treatment of BPD is the advent of Dialectical Behavior Therapy (DBT), introduced by Dr. Marsha Linehan in the 1990s. DBT was created specifically to treat BPD, but it has been successful in treating a variety of disorders. Effective BPD treatment incorporates DBT along with a wide range of holistic and multi-disciplinary therapeutic practices, such as Eye Movement Desensitization and Reprocessing (EMDR), yoga, and art therapy.

In addition to increased options for patients and their families, the validation of BPD as a diagnosis has allowed for the establishment of  advocacy organizations such as the National Education Alliance for Borderline Personality Disorder (NEA-BPD), whose mission is “to raise public awareness, provide education, promote research on Borderline Personality Disorder, and enhance the quality of life of those affected by this serious mental illness.”

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