Editing Borderline personality disorder (section)

==History==
[[File:Edvard Munch - Salomé.jpg|thumb|Devaluation in [[Edvard Munch]]'s ''Salome'' (1903). Idealization and devaluation of others in personal relations are common traits of BPD. The painter Edvard Munch depicted his new friend, the violinist [[Eva Mudocci]], in both ways within days. First as "a woman seen by a man in love", then as "a bloodthirsty and [[Human cannibalism|cannibalistic]] [[Salome]]".<ref name="Ed1990">{{cite book|title=Edvard Munch: the life of a person with borderline personality as seen through his art|date=1990|publisher=Lundbeck Pharma A/S|location=[Danmark]|isbn=978-87-983524-1-9|pages=34–35}}</ref> In modern times, Munch has been diagnosed as having had BPD.<ref>{{cite book|author-link=James F. Masterson|vauthors=Masterson JF|title=Search for the Real Self. Unmasking The Personality Disorders of Our Age|chapter=Chapter 12: The Creative Solution: Sartre, Munch, and Wolfe|pages=208–230, especially 212–213|publisher=Simon and Schuster|location=New York|date=1988|isbn=978-1-4516-6891-9}}</ref><ref>{{cite book|vauthors=Aarkrog T|title=Edvard Munch: the life of a person with borderline personality as seen through his art|publisher=Lundbeck Pharma A/S|location=Denmark|year=1990|isbn=978-87-983524-1-9}}</ref>]]
The coexistence of intense, divergent moods within an individual was recognized by [[Homer]], [[Hippocrates]], and [[Aretaeus of Cappadocia|Aretaeus]], the latter describing the vacillating presence of impulsive anger, [[melancholia]], and [[mania]] within a single person. The concept was revived by Swiss physician Théophile Bonet in 1684 who, using the term ''folie maniaco-mélancolique'',<ref>{{Harvnb|Millon|Grossman|Meagher|2004|p=172}}</ref> described the phenomenon of unstable moods that followed an unpredictable course. Other writers noted the same pattern, including the American psychiatrist Charles H. Hughes in 1884 and J. C. Rosse in 1890, who called the disorder "borderline insanity".<ref>{{cite journal|vauthors=Hughes CH|year=1884|title=Borderline psychiatric records – prodromal symptoms of psychical impairments|journal=Alienists & Neurology|volume=5|pages=85–90|oclc=773814725}}</ref> In 1921, [[Emil Kraepelin]] identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of BPD.<ref name="millon">{{Harvnb|Millon|1996|pp= 645–690}}</ref>

The idea that there were forms of disorder that were neither psychotic nor simply neurotic began to be discussed in psychoanalytic circles in the 1930s.<ref name="David W Jones history of borderline">{{cite journal|vauthors=Jones DW|title=A history of borderline: disorder at the heart of psychiatry|journal=Journal of Psychosocial Studies|date=1 August 2023|volume=16|issue=2|pages=117–134|doi=10.1332/147867323X16871713092130|s2cid=259893398|url=https://oro.open.ac.uk/90946/1/90946.pdf|access-date=25 September 2023|doi-access=free|archive-date=16 March 2024|archive-url=https://web.archive.org/web/20240316010907/https://oro.open.ac.uk/90946/1/90946.pdf|url-status=live}}</ref> The first formal definition of borderline disorder is widely acknowledged to have been written by [[Adolph Stern]] in 1938.<ref name="stern">{{cite journal|vauthors=Stern A|year=1938|title=Psychoanalytic investigation of and therapy in the borderline group of neuroses|journal=Psychoanalytic Quarterly|volume=7|issue=4|pages=467–489|doi=10.1080/21674086.1938.11925367}}</ref><ref name="alberto">{{cite journal|vauthors=Stefana A|year=2015|title=Adolph Stern, father of term 'borderline personality'|journal=Minerva Psichiatrica|volume=56|issue=2|pages=95}}</ref> He described a group of patients who he felt to be on the ''borderline'' between [[neurosis]] and [[psychosis]], who very often came from family backgrounds marked by trauma. He argued that such patients would often need more active support than that provided by classical psychoanalytic techniques.

The 1960s and 1970s saw a shift from thinking of the condition as [[Pseudoneurotic schizophrenia|borderline schizophrenia]] to thinking of it as a borderline affective disorder (mood disorder), on the fringes of bipolar disorder, [[cyclothymia]], and [[dysthymia]]. In the [[DSM-II]], stressing the intensity and variability of moods, it was called [[cyclothymic personality]] (affective personality).<ref name="DSM-IV-TR"/> While the term "borderline" was evolving to refer to a distinct category of disorder, psychoanalysts such as [[Otto Kernberg]] were using it to refer to a broad [[Spectrum disorder|spectrum]] of issues, describing an intermediate level of personality organization<ref name="millon"/> between neurosis and psychosis.<ref name="pmid3898174">{{cite journal|vauthors=Aronson TA|title=Historical perspectives on the borderline concept: a review and critique|journal=Psychiatry|volume=48|issue=3|pages=209–222|date=August 1985|pmid=3898174|doi=10.1080/00332747.1985.11024282}}</ref>

After standardized criteria were developed by [[John G. Gunderson|John Gunderson]]<ref>{{cite journal|vauthors=Gunderson JG, Kolb JE, Austin V|title=The diagnostic interview for borderline patients|journal=The American Journal of Psychiatry|volume=138|issue=7|pages=896–903|date=July 1981|pmid=7258348|doi=10.1176/ajp.138.7.896}}</ref> to distinguish it from mood disorders and other Axis I disorders, BPD became a personality disorder diagnosis in 1980 with the publication of the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-III]].<ref name="PToverview">{{cite web|vauthors=Oldham JM|date=July 2004|url=http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0|title=Borderline Personality Disorder: An Overview|work=Psychiatric Times|volume=XXI|issue=8|url-status=live|archive-url=https://web.archive.org/web/20131021180803/http://www.psychiatrictimes.com/articles/borderline-personality-disorder-overview-0|archive-date=21 October 2013}}</ref> The diagnosis was distinguished from sub-syndromal schizophrenia, which was termed "schizotypal personality disorder".<ref name=pmid3898174/> The DSM-IV Axis II Work Group of the American Psychiatric Association finally decided on the name "borderline personality disorder", which is still in use by the DSM-5.<ref name="DSM53"/> However, the term "borderline" has been described as uniquely inadequate for describing the symptoms characteristic of this disorder.<ref>{{cite book|vauthors=Stone MH|year=2005|chapter=Borderline Personality Disorder: History of the Concept|veditors=Zanarini MC|title=Borderline personality disorder|pages=1–18|publisher=Taylor & Francis|location=Boca Raton, Florida|isbn=978-0-8247-2928-8}}</ref>

Psychodynamic theorists have historically offered the most comprehensive theoretical models of BPD. Gunderson stressed the patient's fundamental interpersonal hypersensitivity, which he viewed as partially genetic.<ref>{{Cite journal|last1=Gunderson|first1=John G.|last2=Lyons-Ruth|first2=Karlen|date=February 2008|title=BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model|journal=Journal of Personality Disorders|volume=22|issue=1|pages=22–41|doi=10.1521/pedi.2008.22.1.22|issn=0885-579X|pmc=2596628|pmid=18312121}}</ref> Kernberg sees the disorder as one involving disturbed [[Object relations theory|object relations]], marked by an excess of aggression and use of primitive defenses, such as splitting, projection, and projective identification.<ref>{{Cite journal|last1=Kernberg|first1=Otto F.|last2=Michels|first2=Robert|date=May 2009|title=Borderline Personality Disorder|url=https://psychiatryonline.org/doi/10.1176/appi.ajp.2009.09020263|journal=American Journal of Psychiatry|volume=166|issue=5|pages=505–508|doi=10.1176/appi.ajp.2009.09020263|pmid=19411373|issn=0002-953X}}</ref> Gerald Adler, writing from a [[self psychology]] perspective, viewed the disorder as resulting from the failure of evocative memory and characterized by an intolerance of aloneness.<ref>{{Cite journal|last1=Adler|first1=G.|last2=Buie|first2=D. H.|year=1979|title=Aloneness and borderline psychopathology: the possible relevance of child development issues|url=https://pubmed.ncbi.nlm.nih.gov/457345/|journal=The International Journal of Psycho-Analysis|volume=60|issue=1|pages=83–96|issn=0020-7578|pmid=457345}}</ref> [[James F. Masterson|Masterson]] hypothesized that the disorder resulted from core developmental problems with [[Margaret Mahler|separation-individuation]].<ref>{{Cite journal|last=LENZENWEGER|first=MARK F.|date=October 2001|title=The Personality Disorders: A New Look at the Developmental Self and Object Relations Approach|url=https://psychiatryonline.org/doi/10.1176/appi.ajp.158.10.1755-a|journal=American Journal of Psychiatry|volume=158|issue=10|pages=1755–a|doi=10.1176/appi.ajp.158.10.1755-a|issn=0002-953X}}</ref> More recently, Mark L. Ruffalo has advanced the hypothesis that BPD is fundamentally a disorder of paradox or self-contradiction.<ref>{{Cite journal|last=Ruffalo|first=Mark L.|year=2025|title=Heads I win, tails you lose: Interpersonal aspects of borderline personality disorder|url=https://pubmed.ncbi.nlm.nih.gov/40063356/|journal=Bulletin of the Menninger Clinic|volume=89|issue=1|pages=52–69|doi=10.1521/bumc.2025.89.1.52|issn=1943-2828|pmid=40063356}}</ref>

===Etymology===
Earlier versions of the DSM—before the multiaxial diagnosis system—classified most people with mental health problems into two categories: the [[Psychosis|psychotics]] and the [[Neurosis|neurotics]]. Clinicians noted a certain class of neurotics who, when in crisis, appeared to straddle the borderline into psychosis.<ref>{{cite book|vauthors=Moll T|title=Mental Health Primer|isbn=978-1-7205-1057-4|page=43|date=29 May 2018|publisher=CreateSpace Independent Publishing Platform}}</ref> The term "borderline personality disorder" was coined in American psychiatry in the 1960s. It became the preferred term over a number of competing names, such as "emotionally unstable character disorder" and "borderline schizophrenia" during the 1970s.<ref>{{cite book|title=Psychopharmacology Bulletin|date=1966|publisher=The Clearinghouse|page=555|url=https://books.google.com/books?id=_kOnSecueiYC&pg=PA555|access-date=5 June 2020|archive-date=4 December 2020|archive-url=https://web.archive.org/web/20201204232024/https://books.google.com/books?id=_kOnSecueiYC&pg=PA555|url-status=live}}</ref><ref>{{cite journal|vauthors=Spitzer RL, Endicott J, Gibbon M|title=Crossing the border into borderline personality and borderline schizophrenia. The development of criteria|journal=Archives of General Psychiatry|volume=36|issue=1|pages=17–24|date=January 1979|pmid=760694|doi=10.1001/archpsyc.1979.01780010023001}}</ref> Borderline personality disorder was included in DSM-III (1980) despite not being universally recognized as a valid diagnosis.<ref>Harold Merskey, ''Psychiatric Illness: Diagnosis, Management and Treatment for General Practitioners and Students'', Baillière Tindall (1980), p. 415. "Borderline personality disorder is a very controversial and confusing American term, best avoided.</ref>