Where Did "Borderline" Even Come From?

Why focus on Borderline? In clinical practice, borderline personality disorder is common, as the pain these individuals experience often leads them to treatment. Outside of clinical practice, every time I open social media, there’s a hot topic of “borderline-this” or “borderline-that.” It’s one of the most researched of all the personality disorders, yet there is a high level of misinformation online about borderline. Not too long ago, there was intense stigma regarding borderline personality disorder. Currently, the stigma seems to have lessened, but it still exists. It’s hard to squash a stigma that’s been around for almost a century.

Stigma and Borderline in the Media

Because of the unstable nature of borderline types, it can be a good fit for dramatic TV shows and movies. But such theatrical depictions actually eclipse what borderline looks like in reality. Can you think of any classic movies or shows that portray a character with borderline personality disorder? If so, the character you’re thinking about is quite likely the villain of the story, maybe even murderous or psychopathic. That is NOT your average borderline case. There’s an episode in Daredevil … maybe season 3 episode 5, and they worked really hard to try to have a character named Dex portray borderline personality disorder. But he ended up killing his coach because his coach pulled him out of a game. Dex saw a therapist when he was a child, and the therapist wrote down “borderline personality disorder” and then later, “psychopathic tendencies.” While the writers put in some good effort, they missed the mark. It’s a great example of the exaggerated and dramatized portrayal of borderline in the media. Individuals with borderline are more apt to harm themselves, not others. Remember the Personalities that Kill episode/blog? Borderline individuals are at medium risk, not high.

Okay, so what if you just quickly Google “characters with borderline personality disorder?” The Hulk comes up a lot. Why? Because he has two “personalities?” He doesn’t remember what happens when he becomes the Hulk, so this fits much better with dissociative identity disorder and not borderline. Is it because he’s angry? Anger is part of many personalities. The Hulk does not likely meet criteria for borderline personality disorder. I also saw Elsa come up a lot. But based on what? There’s no push-pull in her relationships. She withdraws to protect herself and others (Schizoid type maybe?), and she’s not fearful of being alone. My hypothesis is that characters viewed as “crazy” are likely to be labeled borderline, and this absolutely contributes to the stigma around this condition.

History of Borderline

To understand the history of where the psychological term “borderline” came from, we have to look back to the time when the psychological field split patients into two categories: psychotic (out of touch with reality, needing hospitalization) and neurotic (too rigid and anxious, needing outpatient treatment). Psychotic diagnoses would include schizophrenia, hallucinations, and delusions. Neurotic diagnoses would include obsessive compulsive conditions and those with high anxiety.* But, alas, not all people fit into one of these categories. Some patients were outside of psychotic or neurotic categories- somewhere in the “Borderland,” - since they were bordering on both categories. They also didn’t respond to the standard treatment for either psychoticism or neuroticism. The Borderland space eventually became understood as a borderline organizational level of personality (Kernberg) somewhere around 1967. Kernberg viewed psychotic and neurotic to be on a continuum, calling the space in between: “borderline.” From that time until 1980 when the DSM-III was published, there was significant controversy about the term borderline. Some in the psychological field wanted to create a categorical diagnosis to capture the movement of borderline organization, and some were adamantly against it. Obviously, and unfortunately, the categorical diagnosis of borderline won out and was published in the DSM-III (1980), and it is the same concept we use today. Some professionals still oppose using borderline as a diagnostic category, but the widespread acceptance of such has overshadowed the history of the term.

*In our episode on Psychodynamic Personality Classifications (as Ice Cream Flavors), you can read or listen (5:17) to learn more about this original classification system.

All of this history leads me to…. How can we actually capture a dynamic movement and put it in a box? It’s a hindrance that has resulted in chaotic information regarding what we currently understand borderline personality disorder to be. In the earlier days of this disorder, it was essentially a “trash can diagnosis,” - a label to describe the numerous patients whose acuity was too severe to be in outpatient treatment, but too high functioning to be psychiatrically hospitalized. The unfortunate irony in not “belonging” to a category is that at the core of the borderline condition is fear of rejection. The name itself thus reinforces the symptoms of this disorder. Further, the essence of borderline means that there’s movement. For example, patients can be in reality at breakfast time and out of reality from lunch to dinner time. Borderline patients have constantly shifting presentations. The varying display of borderline symptoms has likely led to a lot of the misinformation that’s out there, especially on social media.

My own preference to view borderline as an organizational level and not a category puts me on the losing side of the “borderline battle.” However, the DSM-5-TR does include a proposed dimensional model for the future, placing personality disorders on a severity continuum versus a static, categorical box. This gives me hope. Because there are many things that don’t fit in boxes, least of these, people.