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One of the persistent problems in dealing with the borderline syndromes has been their inadequate discrimination from the psychoses. This has been a difficulty not only conceptually (Meissner, 1978a) and theoretically (), but also clinically. The present discussion will attempt to delineate the clinical discrimination between the functional psychoses and the borderline syndromes. Such discrimination serves as the basis for different treatment approaches and for different prognostic implications.
Significant difficulties are posed in the discrimination between psychotic and borderline disorders in view of the fact that the diagnostic precision regarding both of them is wanting. There is no universal agreement as to the diagnostic characteristics that would define either the psychoses or the borderline syndromes. Historically, it has only been progressively over time that the borderline syndromes have been clarified and gradually distinguished from more clearly psychotic forms of pathology. Early workers in this area tended to see the borderline syndromes much more in terms of their relationship to the psychoses. It was only gradually that the view of the borderline syndromes as representing relatively persistent and stable forms of character pathology was progressively defined and established.
An additional problem in this regard is the fact that the borderline syndromes are characterized by varying degrees of susceptibility to regression. These transient regressive “borderline states” are equivalent to short-term transient psychotic regressions that look very much like psychotic episodes. The question then arises whether clinically these states represent the breakthrough of underlying psychotic processes