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Meissner, W.W. (1983). Notes on the Levels of Differentiation Within Borderline Conditions. Psychoanal. Rev., 70:179-209.

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(1983). Psychoanalytic Review, 70:179-209

Notes on the Levels of Differentiation Within Borderline Conditions

W. W. Meissner, M.D. Author Information

Introduction

Despite the luminously clarifying descriptions of the borderline syndrome provided in recent years by Kernberg (1967, 1968, 1970, 1971, 1975a), there is still considerable confusion and ambiguity regarding the definition and diagnosis of the borderline condition. More often than not the borderline terminology is used in a general way to refer to patients who manifest basically neurotic symptomatology, but who somehow also convey an impression of more serious psychopathology. Such patients may manifest transient psychotic fragmentation, pathological narcissistic phenomena, character distortions, quasi-addictions and addictions, massive and bizarre as well as multiple symptoms, a history of behavior disorders and difficult interpersonal relationships, and a pattern of atypical reactions early in the experience of therapy, including extreme rigidity, the emergence of early archaic material, the manifestation of primitive transference reactions, and frequently enough a rapid if not euphoric improvement (Stone, 1954). There is a lack of diagnostic precision and a failure to differentiate the borderline syndrome from closely related forms of pathology, such as the schizoid personality, latent psychosis, psychotic character, etc. (Blum, 1972).

Guze (1975) has noted that there is little agreement on borderline phenomenology. Current descriptions include a wide range of clinical features without adequate data on the frequency of their occurrence, either by themselves or in combination with other features—a feature that is required to determine whether we are dealing with a syndrome or not. Establishing the diagnosis requires systematic data on the natural history of the disorder and its delimitation from other conditions.

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