As most psychiatrists I have often been dismissive of the “borderline” appelation. It seemed to be mostly a creation of the psychoanalysts eager to confirm their model separating the neuroses from the psychoses and justifying their initial lack of success with this category of patients.

However,over time,with considerable observation of these people in both my professional and personal life,I now understand better how close they can be to this “border”.In fact, much of the literature on this subject makes short shrift of the psychotic aspects involved.Yes,there is mention of the “brief psychotic episodes” in DSM5 and the psychopharmacologists recommend using atypical antipsychotic meds in some cases.But generally the psychotic aspects are minimized in favour of the “interpersonal sensitivity” and “emotional dysregulation”.

In fact,I believe that, in most cases, there is a wellspring of “paranoia’ lying under the surface which may well be responsible for much of the  symptomatology and it is usually not being addressed properly in treatment.So even the best of therapies like DBT(Dialectical Behavioural Therapy) may be ignoring the depth and instead focusing on surface symptoms such as emotional intensity and dysregulation.Although DBT has definite benefits for this form of psychopathology this feature may ,in fact,be limiting its effectiveness.

Now “paranoia’ itself is no easy matter to treat.The key to its detoxification is to be aware of the illusory character of its affect and thought content but again this is no simple task.However, awareness of its presence by both the patient and the people around them should be a vital tool in its management.A judicious and temporary use of low-dose anti-psychotics may be a viable option in some cases.Let us explore together where this new perspective can take us.