Which clinical history findings are characteristic of borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

In contrast to borderline personality disorder (BPD) in adulthood, BPD in childhood has not been consistently and clearly categorized.

In the 1940s and 1950s, several researchers categorized this disorder in children in the realm of childhood psychoses or schizophrenia. [15, 23] Clinical observations included fluctuations in ego states, primitive regressions, disturbed interpersonal relationships, and severe anxiety.

Anna Freud described children with deep levels of regression, massive developmental arrests, withdrawal of libido from the object world and displacement onto the body or self, inability to receive comfort from others, and numerous specific ego deficits. [24]

In 1982, Pine developed a working nosology of borderline syndromes in children. [3] These clinical subgroupings remain highly relevant.

Patients with BPD may have failures in developmental lines associated with major ego functions or central aspects of object relationships. They are often unable to soothe themselves adequately, demonstrating overemotionality and maladaptive attempts at self-soothing. They also may have an unstable sense of self that manifests as maladaptive attempts to fulfill their needs by means of suicide threats, self-harm, and angry behavior.

BPD has historically been considered to be on the border between psychosis and neurosis. The following findings are characteristic:

  • BPD is characterized by marked instability in functioning, affect, mood, interpersonal relationships, and, at times, reality testing

  • Patients with BPD may manifest overwhelming anger when in a state of crisis

  • Psychotic symptoms, when present, are short-lived, circumscribed, or accompanied by good reality testing

  • Individuals with personality disorders are frequently dissatisfied with their marked and sustained impairment in social, occupational, or academic functioning


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