Borderline Diagnosis in Projective Assessment

There are two broad alternative understandings of the diagnosis borderline: a clearly delineated category and a vague, approximately defined location on a continuum of psychopathology. In this article, I review publications on projective testing of borderlines to help determine which way of using the diagnosis is more helpful. The data show that although borderlines can be distinguished as a group from neurotics and schizophrenics, the differences are small, and there is considerable overlap among these diagnostic groups. No specific psychological mechanisms have been identified that typify borderlines and are not also found among neurotics, schizophrenics, or both. The borderline diagnosis does not appear to be internally homogeneous; variability among borderlines appears to be as great as or greater than differences between borderlines on the one hand and neurotics and/or schizophrenics on the other. These findings imply that borderline pathology cannot be exclusively attributed to trauma from any particular period of development and that no specifically focused therapeutic approach is appropriate for most borderlines. Theoretical and technical approaches helpful for borderlines are also helpful for at least some neurotics and psychotics, and vice versa.