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Friedman, H.J. (1995). Borderline Personality Disorder: Etiology And Treatment. Edited by Joel Paris. Washington, DC: Amer. Psychiat. Press, 1993, 420 pp., $46.50.. J. Amer. Psychoanal. Assn., 43:276-281.

(1995). Journal of the American Psychoanalytic Association, 43:276-281

Borderline Personality Disorder: Etiology And Treatment. Edited by Joel Paris. Washington, DC: Amer. Psychiat. Press, 1993, 420 pp., $46.50.

Review by:
Henry J. Friedman, M.D.

The concept of a type of psychopathology, eventually to become known as borderline personality disorder, grew out of the influence of the psychoanalytic method on the treatment of patients in the 1960s. Retrospectively, it can be seen that these individuals responded adversely to the experience of intimacy and limited gratification that characterized psychoanalytic technique, even when applied to analytic psychotherapy during that decade. Not atypically, such patients would respond to an intensive psychotherapy with mounting tension (frequently focused on a combination of life dissatisfactions, a sense of enraged worthlessness, and an overriding sense of the therapist's importance), without much, if any, comprehension of analytic psychotherapy as a mutual effort to understand the patient's inner life. The influence of psychoanalytic thinking in the evolution of a new psychiatric diagnostic category represents a high point in the interplay of psychoanalysis and psychiatry. Indeed, it is difficult for any therapist attempting to treat patients who meet the current criteria for the BPD diagnosis to ignore the transference-countertransference aspects of the treatment relationship; these patients, with their overwhelming, dramatic, and demanding involvement in any therapeutic endeavor (or their dramatic refusal to engage) generate dynamics at a rate of intensity that far outstrips the slower-going, uncovering process involved in the treatment of well-defended neurotic patients. While analysts such as Abend, Porder, and Willick (1983) have described psychoanalysis with borderline patients, it is probable that the patients they describe would not be considered as meeting the current diagnostic criteria for BPD.

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