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In his presentation, “Toward a Psychobiological Theory of the Borderline Personality Disorder,” Michael Stone proposed a psychobiological model of the borderline conditions that explored the role of a hyperirritability of the nervous system that may either antedate parent-child interactions or stand apart from traditional developmental stages. He suggested that one pathway toward this hyperirritability is the traumatic effect of abuse, which may alter the neuroregulatory response systems in ways that cannot be accounted for in classical psychoanalytic developmental models. Stone traced the history of the borderline diagnosis including various dynamic hypotheses; he stated that impulsivity, a “red thread” through most definitions of the borderline case, may be understood as the behavioral manifestation of some underlying predisposition to action-oriented responses. Borderlines behave impulsively; often they gave evidence of inordinate irritability of the nervous system. The irritability appears as the neurophysiological precursors of impulsivity. Pre- and post-natal factors may individually or in concert set in motion lasting deformations of CNS circuitry that substantially increase the reactivity (irritability) of the system such that it remains perpetually nearer some neurophysiological boiling point. These factors bring about quick, poorly modulated, wildly oscillating, and unpredictable responses to many stimuli. In place of stability and reasoned responses, one sees extreme dependence upon the interpersonal events of the immediate past and wild oscillations in attitude. Stone concluded that reduction of irritability should often take precedence over other therapeutic goals, especially at the outset, in one's work with borderline patients.
Thomas McGlashan presented “Longitudinal Perspectives on Patients with Borderline Personality Disorders.” Data were collected from patients discharged from the Chestnut Lodge Hospital in Rockville, Maryland over a 25-year period