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Patients with conditions in the intermediate range of severity often show adequate capacity to test reality but poor ego integration. To many, a modified psychoanalytic method is often applied. These patients are not easily classified within the standard nomenclature. The term “borderline” has been applied, in an illdefined manner at first; more recently, Kernberg has outlined, in more precise terms, the characteristics of this group from a psychostructural viewpoint. Genetic factors are important in this group also: a family history positive for mental illness is frequently noted. Amenability to analytic therapy is also related to the characterologic subtype, which carries prognostic implications as well. A multidimensional diagnostic approach is therefore crucial in this range of patients. A triaxial model is proposed and described, stressing (a) traditional diagnosis from the standpoint of genetic predisposition, (b) psychostructural diagnosis, and (c) characterological subtype. This method may help resolve confusion about diagnosis in the borderline realm and may lead to more accurate selection of treatment strategy.
Because of recent advances in genetics, computer technique, and psychopharmacology, many concepts in traditional psychiatric nosology are coming under question. Although our taxonomy