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Excessive comorbidity within personality disorders and other psychiatric disorders is a perennial problem in psychiatric diagnosis and treatment. Questions of etiology, disorder hierarchies, and treatment decisions are problems clinicians face on a daily basis.

This review summarizes the current body of knowledge about borderline personality disorder (BPD). Each section describes the development of BPD’s knowledge base in the 33 years since the diagnosis became part of the American Psychiatric Association’s standard diagnostic classification system.

Despite long-recognized and significant shortcomings, the criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV. A new approach to the diagnosis of personality disorders was developed for DSM-5, however, which can be found in Section III. The DSM-5 Section III approach provides a clear conceptual basis for all personality disorder pathology and an efficient assessment approach with considerable clinical utility.