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January 1983

Borderline Personality

Author Affiliations

St Louis University School of Medicine St Louis, MO 63103

Arch Gen Psychiatry. 1983;40(1):107. doi:10.1001/archpsyc.1983.01790010113013

To the Editor.—  Dr Chessick's case report of the intensive and lengthy treatment of a patient with borderline personality (Archives 1982;39:413-419) highlights an important fact about the diagnosis and treatment of this disorder, and also merits comment.First, although DSM-III represents a major advance over previous editions, this patient did not initially have symptoms that suggested a borderline disorder, as defined in it.1 Thus, an unwary psychotherapist or analyst may well have been misled; indeed, several apparently were, according to Dr Chessick's report. The degree of this patient's disturbance became apparent only after intensive evaluation and treatment. This highlights the importance of not relying solely on a set of diagnostic criteria in DSM-III (however important) when evaluating the conditions of patients who might have preoedipal conflicts for intensive psychotherapy. The unfolding of the transference relationship seemed to be the real key to making the diagnosis. This patient, though clearly