Borderline Personality Organization & Disorder

Of all the personality disorders, there’s only one that shows up in both the DSM-5 clusters and ICD-11: Borderline Personality Disorder.

Borderline behavior (as defined in the DSM-5 diagnostic criteria outlined in the next lesson) is considered a general marker of personality dysfunction.

That means that even those with other personality disorders tend to express borderline patterns when they are extremely impaired — these behaviors are therefore used as a marker not just of the type of dysfunction an individual may be experiencing, but also extremity of the patient experience.

The term “borderline” originated from another old school concept: that there is a spectrum of mental illness that ranged from “neurotic” to “psychotic”.

Neurotic individuals have a clear, well-organized and consistent sense of self, the capacity for intimate and trusting relationships with others, and good “reality testing” — an ability to distinguish between what is real and what is not.

Psychotic individuals are at the opposite end of the spectrum — they have a disorganized, fragmented sense of self and poor reality testing, meaning they might hallucinate (hear or see things others don’t) and maintain delusions (believe things others don’t).

Borderlines are…well…on the border between neurotic and psychotic. Their sense of self and others is fragmented and disorganized — leading to instability in relationships, identity, emotions and behaviors — but not quite to the same extent as someone who is psychotic. Their reality testing may also suffer under stress — leading to temporary dissociation from reality and feelings of paranoia.

While this construct is not as widely used today, we think it’s important to be aware of how these categories and ideas developed. It also highlights the importance of the concept of “Borderline Personality” to understanding all personality disorders and difficulties.

In the next few pages, we’ll discuss the diagnostic criteria for Borderline, the model for interpersonal hypersensitivity that drives these criteria, and some relevant facts and figures about the condition.