Is It Time to Rethink Borderline Personality Disorder?
New research shows overlap between borderline and other personality disorders.
A running debate in abnormal psychology and psychiatry is whether there really is a diagnosable entity of borderline personality disorder. From the first proposal of this term to reflect, literally, the “border” between neurosisand psychosis, shifts in diagnostic thinking have focused on the deficits this disorder involves in emotion regulation, sense of self, and ability to negotiate boundaries with others. The American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition (DSM-5), published in 2013, retained the personality disorders as categorical types instead of, as was expected, using an empirically-based dimensional system. Borderline personality disorder would have remained an entity in this new system, but mental health professionals making diagnoses would also specify an individual’s ratings on a set of associated personality traits. Based on empirical approaches that regard personality as reflecting individual variations along central dimensions, or facets, critics of the categorical system had argued that this change was long overdue. The compromise reached with the DSM-5 was that a “beta” version of a dimensional rating system would be tested until it was clear that the diagnostic shift was indeed justified.
If you there are people in your life who have been diagnosed with this disorder, or if you yourself have received such a diagnosis, the idea that borderline isn’t a discrete entity but instead can range in magnitude and expression might resonate well with you. By its very nature, personality doesn’t easily fit into pigeonholed categories. Even the most respected framework for understanding personality, the Five Factor Model, doesn’t place people into groups based on a single trait. Although there’s a temptation to say that someone is “neurotic,” or “conscientious,” the proper application of the Five Factor Model defines an individual’s personality in terms of high and low scores on all five of its ratings scales. The even more refined version of the Five Factor Model uses a total of 30 scores (six “facets” of the five traits) to capture an individual’s personality with all of its nuances and subtleties. How, then, can it be realistic to group people with the maladaptive personalities associated with a personality disorder into clear-cut groups? It’s handy to have those terms, and clinicians have found the types to provide them with a lexicon they can use in their practice, but the question remains as to whether those terms have legitimacy.