History of the Borderline Diagnosis

The borderline diagnosis was first described by Alfred Stern in 1938. However, “borderline personality disorder” (BPD) did not enter the official nomenclature of American psychiatry until 1980. Between these two time points, psychoanalysts and psychiatrists carefully described aspects of borderline psychopathology, particularly cognitive symptoms. Two of the most careful and influential descriptions of the borderline diagnosis in the 1960s and 1970s were those of Otto Kernberg, who described the broad concept of borderline personality organization (BPO), and John Gunderson, who described the affective, cognitive, impulsive, and interpersonal symptoms of BPD. After 1980, BPD was often described as being a subthreshold variant of various diagnostic spectrums (e.g., mood disorders, impulsive disorders, trauma disorders) that were in vogue at that time. However, BPD is now commonly accepted as a well-validated disorder with a characteristic symptom profile that distinguishes it from other disorders, including other personality disorders.