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This volume presents an up-to-date survey of thinking about borderline personality, as well as revealing some of the difficulties inherent in its treatment. The book includes sections on diagnosis, concepts, and treatment. Most of the contributors are from north of the border (Canada) with a few southern (United States) experts mixed in. The level of competence is high and well maintained throughout. The result is a serviceable overview of a generous segment of current thinking about borderline disorders.
Problems arise in the scope and depth of its coverage, specifically the confinement of its focus to the DSM-III category. No less a figure than Stanley Lesse (1986) commented a few years ago that “in too many institutions, we are training a generation of psychiatrists that has a bookkeeping attitude toward psychiatric diagnoses… The rigidities and limitations of DSM-III accentuate this trend” (p. 9). To which Karasu (1986) added:
The limitation of such instruments pertain to their insufficient ability to take into account the human, complex personal qualities and characteristics of patients as individuals. They highlight the gap between the art and science of diagnosis, or between the interests of the clinician and the researcher. Essentially DSM is a research-oriented instrument, which requires that there be a minimum of false positive diagnoses in order to obtain a homogeneous sample and to keep any distortion or dilution of statistical data at the lowest possible level. In contrast, clinical practice must insist on a minimum of false negative diagnoses. (p. 333)
This tension pervades the discussions in this volume but does not surface until the final discussion, and then only briefly. But this orientation reflects the current situation in the sector on which this volume reports. I would be tempted to retitle the book, “A Partial Handbook of DSM-III-(R) Borderline Disorders.” The section on diagnosis reports on empirical research that has achieved increased reliabil