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The carefully worked out structural diagnostic criteria differentiating the borderline conditions from neuroses and psychoses are reviewed: i.e., the presence of identity diffusion, the predominance of primitive defensive operations, particularly splitting, and the maintenance of reality testing. We are reminded of the particular difficulties in applying these criteria to adolescents whose tendency to engage in identity crises, to show striking superficial psychopathology, and to display multiple transient sexual trends may mask diagnoses of all kinds. These difficulties are beautifully clarified in six illustrative case histories. Kernberg reviews his distinction between "narcissistic personality" and "borderline personality organization," emphasizing that only the most severe narcissistic personalities present with overt borderline functioning. In the treatment of the borderline adolescent, Kernberg emphasizes the need for absence of either "moralistic" or "romanticizing" attitudes toward the patient, as well as the need to set firm criteria with both patient and family about the conditions for treatment. though recognizing the need at times for family evaluation and possible family treatment, he advises great caution against confusion of goals with this approach.