Before it became “borderline personality disorder” in 1980, the condition went by several names, including “pseudoneurotic schizophrenia,” “borderline states,” and “borderline personality organization.” The word “borderline” itself dates back to 1938, but it took over four decades of debate before psychiatry settled on the diagnosis we recognize today.
Why It Was Called “Borderline”
The term “borderline” originally had nothing to do with personality. In the early 20th century, psychiatry divided serious mental illness into two broad camps: neurosis (anxiety, depression, obsessive symptoms) and psychosis (loss of contact with reality, as in schizophrenia). Some patients didn’t fit neatly into either category. They had intense emotional symptoms that looked neurotic on the surface, but their thinking and behavior sometimes veered toward the chaotic, unstable patterns clinicians associated with psychosis. These patients seemed to live on the border between the two, and that’s where the name came from.
Psychoanalyst Adolph Stern is widely credited with first using the term “borderline” in a clinical paper in 1938. He was describing a group of patients who didn’t respond well to traditional psychoanalysis and whose symptoms didn’t match the established categories. The label stuck, but for decades it remained vague, more of a clinical shorthand for “we’re not sure what this is” than a formal diagnosis.
Pseudoneurotic Schizophrenia
In the 1940s, psychiatrists Paul Hoch and Phillip Polatin coined the term “pseudoneurotic schizophrenia.” They were describing patients who showed up with prominent anxiety symptoms that initially looked neurotic but, on closer examination, seemed to mask an underlying psychotic process. These patients had the core features of schizophrenia, in their view, but the neurotic symptoms dominated the clinical picture.
This diagnosis captured many of the same patients who would later be diagnosed with BPD. The overlap was so significant that by the late 1960s, “pseudoneurotic schizophrenia” had become almost synonymous with “borderline states.” The key assumption at the time was that these patients had a form of schizophrenia. That assumption would eventually be overturned, but for roughly two decades, many people who would now receive a BPD diagnosis were instead classified as having a variant of schizophrenia.
Kernberg’s Borderline Personality Organization
The pivotal shift came in 1967, when psychoanalyst Otto Kernberg published his influential paper on “borderline personality organization,” or BPO. This was the first time the word “personality” entered the picture. Kernberg argued that these patients weren’t on a spectrum of schizophrenia at all. Instead, they had a distinct way of organizing their personality that sat between higher-level neurotic functioning and lower-level psychotic functioning. Their grip on reality was preserved, unlike in psychosis, but their sense of identity was unstable and their relationships were marked by intense, shifting emotions and characteristic defense mechanisms like splitting (seeing people as all good or all bad).
Kernberg’s framework was broader than today’s BPD diagnosis. He saw borderline personality organization as cutting across many categories, appearing not just in what we’d now call BPD but also in people with narcissistic and antisocial personality patterns, addiction, chronic depression, and some forms of histrionic behavior. His concept was less a single diagnosis and more a level of personality functioning that could show up in many forms. Still, his work was crucial because it completely decoupled the “borderline” concept from schizophrenia and psychosis, reframing it as a personality condition.
How BPD Entered the DSM in 1980
When the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was published in 1980, “borderline personality disorder” appeared as an official diagnosis for the first time. The criteria focused primarily on mood instability and behavioral patterns: unstable relationships, impulsivity, intense anger, chronic feelings of emptiness, fear of abandonment, and identity disturbance. This was a deliberate move to separate BPD from anything related to schizophrenia.
The schizophrenia-adjacent patients who had previously been lumped into the borderline category were given a different label: schizotypal personality disorder. That diagnosis captured the odd thinking patterns and perceptual distortions that had once been considered part of the borderline picture. With this split, psychiatry formally acknowledged that the old “borderline” umbrella had been covering at least two meaningfully different conditions.
Why the Name Has Been Controversial
The name “borderline personality disorder” is a leftover from a theory that no longer applies. Nobody in modern psychiatry thinks of BPD as sitting on the border between neurosis and psychosis. The condition is now understood as a pattern of emotional dysregulation, unstable self-image, and difficulty in relationships, rooted in a combination of temperament, brain development, and often early adverse experiences. The name doesn’t describe any of that.
This mismatch has led to ongoing calls to rename the condition. Some clinicians and advocacy groups have proposed alternatives like “emotional dysregulation disorder” or “emotionally unstable personality disorder,” the latter being the term used in the World Health Organization’s International Classification of Diseases (ICD-10) for years. Critics argue that the word “borderline” is meaningless to patients, carries stigma, and implies the person is on the edge of something worse rather than having a specific, treatable condition. Despite these arguments, the DSM has retained the name through multiple revisions, largely because it’s so deeply embedded in clinical practice, insurance coding, and research literature.