![]() ![]() The term was later expanded in the late 1960s and 1970s by Otto Kernberg 15 this diagnosis was used in empirical studies conducted by Grinker and Werble. 14 He used it to refer to a group of patients whose conditions worsened during therapy and who showed masochistic behaviour and psychic rigidity, indicating a protective mechanism against any perceived changes in the environment or within the individual. The term “borderline” was first described by the psychoanalyst Adolf Stern in 1938. What is the origin of the term “borderline personality disorder”? Recent research, which was the focus of our review, was generally of high quality and used sophisticated assessment and measurement strategies to differentiate the disorder from other psychiatric disorders. ![]() We based our review primarily on findings from a relatively small body of experimental studies that used the very similar DSM-III 12 and DSM-IV 13 definitions of borderline personality disorder and its symptoms. A summary of the evidence used in this review is found in Box 1. In this article, we focus on the current diagnostic criteria for borderline personality disorder, as presented in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), 11 and how these criteria can be used to differentiate it from other disorders that may share symptoms. 8, 9 One large, well-conducted 10-year prospective study found that 93% of those with borderline personality disorder had at least a 2-year period of remission, but only 50% also attained good psychosocial functioning. Retrospective studies have shown that symptoms resolve over time, with 75% of patients at 15-year follow-up and 92% of patients at 27-year follow-up no longer having the disorder. 7 The incidence of suicide attempts among patients with borderline personality disorder is highest among those in their twenties, but mortality peaks in the thirties, with a 10% lifetime rate of completed suicide. More than 500 000 such visits to emergency departments occur each year in the United States. Patients with borderline personality disorder are frequently encountered in the emergency department, where they present following threatened suicide or a suicide attempt. 6 Unfortunately, a large proportion of patients with the disorder are not identified in practice. 4 Women account for 70% of patients with this disorder in clinical settings, 5 and the most common age at first presentation is in late adolescence. 3 These values are higher than would be expected given a prevalence of about 1% in the general population. It is a common presentation in both psychiatric and general practice, with accurately diagnosed cases seen in 10% of psychiatric outpatients, 20% of psychiatric inpatients 1, 2 and 6% of family medicine patients. Borderline personality disorder can be a difficult diagnosis because of similarities to other conditions, particularly mood disorders. ![]()
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