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Kestenbaum, C.J. (2012). Childhood Precursors of Personality Disorders: Evaluation and Treatment. Psychodyn. Psych., 40(1):111-130.
(2012). Psychodynamic Psychiatry, 40(1):111-130
Childhood Precursors of Personality Disorders: Evaluation and Treatment
Clarice J. Kestenbaum, M.D.
The term “borderline,” though originally confined to adult patients, began to be applied about a generation ago also to children, thanks in part to the work of Paulina Kernberg (1990), and, around the same period, Kenneth Robson (1983). In the chapter I had contributed to Robson's book I expressed my reservations about the term in relation to child psychiatry, drawing attention to the following problem:
… the seriously disturbed child who is not psychotic may be exhibiting the prodromata of a future major psychiatric disorder (i.e., Axis I), that may have constitutional underpinnings. It is better, in my opinion, to consider such a child as on the way to becoming schizophrenic, for example, or manic-depressive, rather than borderline … The importance of early assessment has preventive implications … and we might be able to identify the constitutionally vulnerable child and provide specific treatment modalities best suited to avert or ameliorate the condition. (Kestenbaum, 1983, p. 51)
In that chapter I presented seven children who were given the diagnosis “borderline” according to criteria developed by Vela, Gottlieb, and Gottlieb (1983), and whom I had personally evaluated later during the course of a 10- to 25-year follow-up. Of the seven, three of the patients in adult life were in the schizophrenic spectrum, two would be classified today as bipolar, one developed into antisocial personality disorder. The seventh had become a well-functioning psychoanalytic patient.
Currently, DSM-V (APA, in press) is under review. Dimensional models are now being developed; personality disorders may well serve as laboratories to test trait-based paradigms within a dimensional framework.
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