The Problematic History of Borderline Personality Disorder

The history of Borderline Personality Disorder (BPD) has been a rather controversial one. Let’s take a trip down memory lane to understand what ‘borderline’ means and the significance it holds in psychiatry and the way the world perceives psychiatry.

The term ‘borderline personality’ was coined in the USA, 1938 by Adolph Stern. He used this term or categorization to relate patients who ‘fit frankly neither into the psychotic nor into the psychoneurotic group’ and introduced the term ‘borderline’

The term ‘borderline personality’ was proposed in the United States by Adolph Stern in 1938 (most other personality disorders were first described in Europe). Stern described a group of patients who ‘fit frankly neither into the psychotic nor into the psychoneurotic group’ and introduced the term ‘borderline’ to describe what he observed because it ‘bordered’ on other conditions.

Otto Kernberg (1975) used the term “borderline personality organisation” to describe a continuous pattern of functioning and behaviour characterised by instability and indicating a disordered psychological self-organization.

Diagnoses are determined through classification and categorization. BPD is now described through an arrangement of human behaviour that categorises similar persons into deficient typologies. A personality disorder diagnosis proclaims the deficiency to be a permanent trait of the individual rather than a temporary situation.

When a doctor uses this model and criteria to make a diagnosis of BPD, for example, the ability to categorise resulting from this information might impact how individuals perceive themselves in comparison to social standards. According to Foucault (1982), the client may internalise the issue discourse and learn to view themselves as inadequate, with that deficit being a basic quality.

The aetiology of BPD is a well researched topic, and even BPD sceptics have embraced a causal model that lists childhood trauma as a risk factor for BPD. The general population tends to believe that BPD is a reasonable and unavoidable outcome of a stressor, when in fact it is a diagnosis dependent on the mere judgment of a clinician. 

It is critical to note here that a BPD diagnosis is placed within the mainstream Western discourse on identity, a definition of selfhood that emphasises autonomy and goal-directed conduct. These qualities are directly related to societal ideals of self-sufficiency through employment. Personality and identity must be conceived of as generally stable, intrinsic elements of oneself that emerge via actions, characteristics, and other external manifestations in order for members of society to be self-sufficient and goal-directed. In conventional treatment, doctors decode and interpret these symptoms in connection to their departure from societal norms for conduct.

Self-injury and suicide conduct, for example, are viewed as pathological activities that undermine the cherished sense of selfhood. The self-directed injury, which challenges the mainstream narrative of goal-directed conduct, is viewed as an incapacity to be an agentic, goal-directed individual. Some forms of self-harm, such as overworking at one’s workplace to the point of inflicting physical illnesses, disregard of interpersonal connections, and sleep deprivation, are not considered abnormal since they are consistent with societal norms, such as sacrificing one’s needs or wants for a greater good. 

However, because the self-directed character of self-injury cannot be reconciled with other societal standards, self-injury is regarded as a sign of severe illness; the individual must be viewed as disordered for such an activity to make sense.

Studies of BPD provide grounds to reconsider these prevalent notions of abnormal conduct and the assumed stability of identity. We also know that BPD symptoms fade with time, so that “after roughly 10 years, as many as half of the patients no longer exhibit a pattern of behaviour that satisfies complete criteria” for BPD (American Psychiatric Association 2013).

Another study found that after six years, 73 percent of an adult cohort were in remission from symptoms, undermining the notion that personality is mostly consistent. Furthermore, many BPD characteristics, such as unstable relationships, irresponsibility, and dramatic emotional swings, are considered normal throughout youth but undesirable in maturity.

Feminist opponents of BPD give an alternate viewpoint, typically considering the diagnosis of BPD as pathologizing women’s responses to gendered violence and oppression. According to Shaw and Proctor (2005), diagnosis is a kind of social control:“[BPD] can be applied to women who fail to live up to their gender role because they express anger and aggression. Conversely, the diagnosis is also given to women who conform ‘too strongly,’ by internalizing anger, and expressing this through self-focused behavior such as self-injury” . They demonstrate how BPD diagnosis creates a double bind: women with BPD who engage in non-typically feminine behaviors—self-injury, numerous sexual partners, outward displays of anger—are cast in the archetype of the overemotional hysterical woman.

To sum it up, I believe that it is safe to say that Borderline Personality Disorder is one of the list of disorders or conditions that is wrongly attributed to a certain group of people, typically women, queer, neurodivergent and other margnialized people, to categorize whatever psychiatrists do not seem or wish to understand.

We are what we consume and this applies to the circumstances we have to endure and the ideas we grow up with; our nurturing shapes how we perceive, react, and behave. Initially, the diagnosis of BPD was assigned mostly to individuals whose experiences and behavior was shaped by patriarchal, oppressive, abusive, and non-inclusive instances as well as to individuals whose experiences could not be understood through Western viewpoint of Psychology. 

As we progress further as a society, we still see many individuals being wrongly diagnosed with BPD as long as they fit the traditional definition of it and their circumstantial experiences are overlooked, but we have also progressed further enough to recognize a misdiagnosis and have the capability to refute it.

Women are being empowered to take the forefront in their narrative and change the world of Psychology by making it more inclusive, less harsh, and more understanding of what it means to be a woman in the current world.

Experiences of people from marginalized communities are also being decoded and interpreted rightly by studying the society and its impact rather than only the individual’s response to it.

As psychology becomes more holistic in its view, women, queer and neurodivergent folks  choose what connects to them and what doesn’t, thus demanding that therapy also step away from misogynistic ideas of view people. 

Article by 

Riya Singh,

Writer at PFP