Borderline Personality Disorder (BPD) is a mental health condition that affects how people feel, think and relate to others. It’s known for emotional instability, intense relationships and a fragile sense of self. But it wasn’t always understood this way.
The history of BPD is long, complex and often misunderstood. Over time, the way people talk about and treat BPD has changed a lot. From early confusion to modern understanding, let’s take a look at how perceptions of BPD have evolved.
Table of Contents:
The history of BPD: From the 19th century to today
The 1800s: Confusion and misunderstanding
Mental health has always been tricky to define. Before science and medicine got involved, people often explained mental illness through religion or superstition. Behaviours we now link with BPD were once seen as signs of madness, possession or weak character.
In the 1800s, doctors began to notice a group of people who didn’t quite fit into existing mental health diagnoses. They weren’t psychotic, but they weren’t emotionally stable either. These patients often showed mood swings, anger, fear of abandonment and impulsive behaviour. But there was no name for it yet.
Some called it “hysteria”, especially in women. Others saw it as a form of neurosis. The people affected were often misunderstood, mislabelled and mistreated.
The 1930s: The introduction of the term “borderline”
The term “borderline” was first used in the 1930s by a psychiatrist called Adolf Stern. He noticed a group of patients who didn’t fit neatly into categories. They seemed to be on the “borderline” between neurosis and psychosis.
This was a big step, but still very vague. Stern saw them as difficult patients, often emotional, dramatic and hard to treat. His view was shaped by the psychoanalytic ideas of the time, which focused heavily on childhood experiences and the unconscious mind.
At this point, BPD wasn’t a diagnosis. It was more of a catch-all term for people who didn’t respond to typical therapy.
Mid-20th century: Psychoanalysis and the “difficult” patient
In the mid-20th century, psychoanalysis was the dominant model in psychiatry. Therapists like Otto Kernberg and Margaret Mahler developed theories around personality disorders. They tried to explain BPD using ideas like “splitting”, where people see others as all good or all bad, with no middle ground.
These ideas helped to shape how BPD was understood. Kernberg in particular saw BPD as a disorder of identity and emotional regulation. He described patients as having unstable relationships, low self-esteem and fear of abandonment.
Therapists often found these patients frustrating. They were seen as manipulative, attention-seeking or resistant to treatment. Sadly, these negative labels stuck around for a long time.
1980: BPD becomes an official diagnosis
It wasn’t until 1980 that BPD was officially recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the handbook used by mental health professionals in the US.
This was a major turning point. BPD was now a “real” diagnosis with set criteria. These included unstable moods, intense relationships, impulsive behaviour, fear of abandonment and identity issues.
Still, there was debate. Some thought BPD was just a mix of other disorders. Others questioned whether it was a disorder at all. And the stigma remained.
Many people with BPD continued to be seen as “difficult”. Some doctors avoided working with them altogether. Others misdiagnosed them with depression, bipolar disorder or schizophrenia.
Women and stigma
It’s important to talk about gender here. Around 75% of people diagnosed with BPD are women, which may be because they’re more likely to seek help or are unfairly labeled for showing emotion. Some experts think men are underdiagnosed, as their symptoms—like anger or risky behavior—can be mistaken for other problems such as substance abuse.
The 1990s: New therapies, new hope
In the 1990s, things began to change. A psychologist named Marsha Linehan developed a therapy called Dialectical Behaviour Therapy (DBT). This was designed specifically for people with BPD.
DBT focused on skills like mindfulness, distress tolerance and emotional regulation. It offered hope to people who had been told they were untreatable.
Linehan also opened up about her own struggles with mental illness. This helped to break down stigma and humanise the condition.
Since then, other therapies have been developed too, like Mentalisation-Based Treatment (MBT) and Schema Therapy. These have shown real results in helping people manage symptoms and improve their lives.
The 2000s: Changing the conversation
In the 2000s and beyond, the conversation around BPD has continued to shift. More people with lived experience have spoken out. Books, blogs, documentaries and social media have all played a role.
People with BPD are no longer seen as “difficult” or beyond help. They are recognised as people who have often faced trauma, especially in early life. Abuse, neglect and unstable relationships in childhood are all linked to BPD.
This doesn’t mean everyone with BPD has had a hard childhood. But understanding these links has helped to build empathy.
The focus has moved from blame to understanding. From labels to support. From hopelessness to recovery.
How we treat BPD today
Today, BPD is seen as a serious but treatable condition. It still carries stigma, but attitudes are improving.
More mental health professionals are trained to recognise and treat BPD. People with the diagnosis are more empowered to speak out, seek help and manage their symptoms.
That said, challenges remain. Waiting times for therapy can be long. Services aren’t always joined up. Some clinicians still hold outdated views. And stigma hasn’t disappeared completely.
But the picture is far more hopeful than it once was.
A word on labels
People with BPD have different views on the label. Some find it helpful for understanding their struggles and getting support, while others feel it’s limiting or stigmatizing. For instance, some people prefer using terms like EUPD (Emotionally Unstable Personality Disorder) or EID (Emotional Intensity Disorder). There’s no right answer—what matters most is that people get the support they need without judgement.
What we’ve learnt
Looking back, the history of BPD shows how far we’ve come — and how far we still need to go.
We’ve moved from confusion and fear to understanding and support. We’ve recognised that BPD is not about being “bad” or “manipulative”. It’s about deep emotional pain, often rooted in early life.
We’ve learned that with the right help, people with BPD can and do recover. They can build healthy relationships, manage emotions and lead fulfilling lives.
And we’ve learned that listening to people with lived experience is key. They are not just patients. They are experts in their own right.
Final thoughts: The history of BPD
Borderline Personality Disorder has had a tough history. Misunderstood, stigmatised and feared for decades, it was once seen as a lost cause.
But today, things look brighter. Science, therapy and human stories have helped to shift perceptions. People with BPD are finding their voice — and being heard.
If you or someone you know is living with BPD, know that help is out there. Recovery is possible. And most of all, you’re not alone.
