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Raphael-Leff, J. (1984). Pathological Play in Borderline and Narcissistic Personalities: By Irving Steingart. New York: S. P. Medical and Scientific Books. 1983. Pp. 139.. Int. J. Psycho-Anal., 65:495-497.

(1984). International Journal of Psycho-Analysis, 65:495-497

Pathological Play in Borderline and Narcissistic Personalities: By Irving Steingart. New York: S. P. Medical and Scientific Books. 1983. Pp. 139.

Review by:
Joan Raphael-Leff

The term 'borderline', first used by Adolph Stern in 1938, has become increasingly popular over the past 45 years, with consequent broadening and blurring of diagnostic boundaries. Whereas Freud's broad nosological classification grouped patients into two global categories of Neurotic or Psychotic distinguished by degree of 'break with reality', with the development of Ego Psychology, psychoanalysts began isolating a third intermediate group of patients. At first defined in terms of presence of patients. At first defined in terms of presence or absence of neurotic/psychotic features, more recently, borderline patients have gradually become delineated by various clinicians in terms of a stable pathological organization, differing on a variety of attributes such as degree of ego organization, quality of object relations, nature of defensive operations, structural characteristics and transference manifestations.

However, little agreement exists among psychoanalysts as to the specific nature of these patients designated as borderline, or even whether the term describes a discrete diagnostic entity or a position along a pathological continuum.

It would appear that the issue has been further complicated by recent changes in psychiatric classification in the USA leading to the adoption of the DSM-III (Diagnostic & Statistical Manual, equivalent to the I.C.D. used in Europe). Over the last decade, the category of 'schizophrenia', previously a 'catch-all' diagnosis, has been rapidly shrinking to West European proportions.

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