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Which patients does one mean – that is the first question we have to ask when confronted with the subject of borderline personality disorders and their treatment. Indeed, to diagnose a patient as borderline is neither easy nor without risk. An obvious risk is misunderstanding. Does one mean the traditional borderline schizophrenia, already singled out by Kraepelin and Bleuler at the turn of the century and still accepted as such by writers like Searles in the United States and Rosenfeld in Europe; or the borderline condition identified by Grinker, Kernberg and a host of other psychoanalytic and non-psychoanalytic workers throughout the world today? And what about the DSM III, the diagnosis of personality disorder recognized by the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association? I am not going to attempt a reconciliation of the various views on the subject today. I will, instead, describe the patients I grossly identify as borderline, and on the basis of some pathognomonic characteristics define indications and a strategy for treatment as those might concern a psychoanalyst.
I like to conceptualize borderline pathology in terms of five aspects of human functioningo, if you wish, personality; namely, affective disposition, impulse control, personal identity, interpersonal relationships and reality testing. These five parameters of personality are dynamically interconnected and, naturally, overlapping. Let us consider them briefly.
In the area of affects, there is a great lability, an emotional instability that runs the gamut of dysphoric affects. The borderline is an angry individual. Characterized by oral demandingness, which often has a paranoid