The identification and labeling of patients as "borderline" first arose during the era when psychiatry was dominated by the psychoanalytic paradigm.

The concept of BPD, and the signs and symptoms sufficient for a diagnosis of BPD, did not substantively change between the 1980 DSM-III and the updated and revised DSM-IV-TR release in 2000 [9].

According to the DSM-IV-TR, the diagnosis of BPD is attained by a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following [10]: The introduction of operationalized diagnoses for BPD and other disorders based on observable criteria in the 1980 DSM-III was considered a significant advancement in the field.

Independent of a theory of causality, the cluster of symptoms and behaviors that characterize borderline personality became more widely recognized, as did the symptoms now known to characterize BPD, such as dramatic fluctuations from confidence to despair, markedly unstable self-image, rapid changes in mood, intense fears of abandonment and rejection, and propensity for suicidal ideation and self-harm.

In 1978, Gunderson and Kolb described these characteristics that now define BPD and were instrumental in the inclusion of BPD as a formal psychiatric classification in the 1980 DSM-III [7,8].

Research of BPD during the 13 years between the DSM-IV-TR and the DSM-5 clarified the understanding of BPD and prompted revisions to the diagnosis [4].

The greatest overall change between the DSM-IV and the DSM-5 has been the elimination of the multi-axial classification system, whereby BPD and other personality disorders were assigned a separate axis (Axis II). The distinction between Axis I and Axis II disorders in earlier DSM editions received little empirical validation and increasingly became disputed in light of evolving research and clinical evidence.However, the concept of and diagnostic criteria for BPD during and after the 2000 DSM-IV-TR became increasingly criticized on several grounds.For example, the description of BPD was non-specific.Providers working with patients with BPD also require an understanding of the concept and diagnostic criteria in the fifth edition of the (DSM-5) and how these changes substantially depart from earlier DSM editions [4].Such education on BPD can lead to greater provider confidence, more positive attitudes toward these patients, improvements in therapeutic progress in patients, and lower stress levels in providers [5].Perhaps the greatest barrier to effective care of the patient with BPD is the extent of stigma and negative attitudes toward patients with the disorder.