Table 1 Brief summary of the history of BPD conceptualizations

Bleuler (1911) [12]

“If we examine some individuals more closely, we often tend to suspect the presence of simple schizophrenia without, however, being able to make a definite diagnosis at the given time; but very often, after days or years, our suspicions can be confirmed. Thus, there is no doubt that many simple schizophrenics are at large whose symptoms are not sufficiently pronounced to permit the recognition of mental disorder. If one observes the relatives of our patients, one often finds in them peculiarities which are qualitatively identical with those of the patients themselves, so that the disease appears to be only a quantitative increase of the anomalies seen in the parents and siblings. Such mild cases are often considered to be “nervous” or “degenerated” individuals, etc. But if we follow the anamnesis of those who are admitted to the hospital in later years because of an exacerbation of their difficulties, a criminal charge, a pathological drinking bout or some such episode, we can usually find throughout the entire past history of the individual mildly pathological symptoms which in the light of their recent illness unquestionably have to be considered as schizophrenic. There is also a latent schizophrenia, and I am convinced that this is the most frequent form, although admittedly these people hardly ever come for treatment. It is not necessary to give a detailed description of the various manifestations of latent schizophrenia. In this form, we can see in mice all the symptoms and all the combinations of symptoms which are present in the manifest types of the disease. Irritable, odd, moody, withdrawn or exaggeratedly punctual people arouse, among other things, the suspicion of being schizophrenic. Often one discovers a concealed catatonic or paranoid symptom and exacerbations occurring in later life demonstrate that every form of this disease may take a latent course”

Freud (1913) [13]

“Often enough, when one sees a case of neurosis with hysterical or obsessional symptoms, mild in character and of short duration, a doubt which must not be overlooked arises as to whether the case may not be one of insipient dementia praecox and may not sooner or later develop well-marked signs of this disease”

Stern (1938) [14]

“It is well known that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that this border line group of patients is extremely difficult to handle effectively by any psychotherapeutic method”

Zilboorg

(1941) [4]

“The less advanced cases have been noted, but not seriously considered. When of recent years such cases engaged the attention of the clinician, they were usually approached with the euphemistic labels of borderline cases, incipient schizophrenias, schizoid personalities, mixed manic-depressive psychoses, schizoid manics or psychopathic personalities”

Hoch and Polatin

(1949) [15]

“Some psychiatrists concede that the clinical and psychodynamic structure of these cases differs from the neuroses –although retaining a great deal of resemblance to the neurotic disturbances–and call them "borderline cases. …Again, others are struck by the similarity of the mental changes and personality structure to schizophrenia and will diagnose them as schizophrenics. The writers would like to emphasize that this group of patients is not small”

Knight (1953) [3]

“Patients with borderline states were falling apart on the couch”

Kernberg (1967) [5]

“The ego pathology differs from that found in the neuroses and the less severe characterological illnesses on the one hand, and the psychoses on the other. These patients must be considered to occupy a borderline area between neurosis and psychosis. The term borderline personality organization, rather than “borderline states” or other terms, more accurately describes these patients who do have a specific, stable, pathological personality organization; their personality organization is not a transitory state fluctuating between neurosis and psychosis”

Moore and Fine (1968) [7]

“A descriptive term referring to a group of conditions which manifest both neurotic and psychotic phenomena without fitting unequivocally into either diagnostic category”

Grinker and co-workers (1968) [8]

“This book contains the first reported results of a lengthy research program on hospitalized borderline patients whose ego-functions were studied through multiple observations on their daily behaviors. In general, the informal diagnostic term of borderline as well as several synonyms in our nosological classification has long been used without standard definition as a convenient term with which to label cases of clinical unclarity. In this first systematic investigation of the phenomena clinically observed for at least several decades as borderline, we have attempted to understand what the term really denotes, define its characteristics, and determine whether it encompasses subgroups or categories”

Gunderson and Singer (1975) [9]

“This review of the descriptive literature on borderline patients indicates that accounts of such patients vary depending upon who is describing them, in what context, how the samples are selected, and what data are collected. The authors identify six features that provide a rational means for diagnosing borderline patients during an initial interview: the presence of intense affect, usually depressive or hostile; a history of impulsive behavior; a certain social adaptiveness; brief psychotic experiences; loose thinking in unstructured situations; and relationships that vacillate between transient superficiality and intense dependency. Reliable identification of these patients will permit better treatment planning and clinical research”

Spitzer and co-workers (1979) [11]

“Although there is a large psychiatric literature on various "borderline" conditions, there has been no agreement as to the definition of the concept. A review of the literature reviewed two

major uses of the term: Borderline Schizophrenia and Borderline Personality. Two item sets were developed to provide diagnostic criteria for the two concepts. High sensitivity and specificity were demonstrated for both item sets using data describing 808 borderline and 808 control patients. These criteria will be used in the forthcoming DSM-III classification for the categories of Borderline Personality Disorder and Schizotypal Personality Disorder”