The large number of clinical and therapeutic unsolved questions about borderline patients cannot be ever completely encompassed and resolved. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-III and following editions of the manual have well described the clinical features of these patients within the diagnostic categories of Borderline and Schizotypal Personality Disorder without succeeding in defining the nature of these conditions, their developmental feature, their course and prognosis. Within “borderline patients”, heterogeneous patients are still included who show slow, chronic evolutions towards different psychotic or non-psychotic conditions, and very different relational and social outcomes after many decades, if their lives are not broken by suicide and premature death. The author attempts to revise the controversial question of borderline patients from a public mental health service perspective; in these settings, borderline patients require continued attention and needs for many years, choosing their ideal therapists. Their treatment is often a difficult challenge for all caregivers involved in the treatment, and the therapeutic results are often very different. With the aim of a better planning of treatment, the author suggests reevaluating Grinker sub-typification, revised on the basis of new psychopathologically defined typologies of personality disturbances. Four “borderline types” are defined: two whose outcome is the development of major mood or psychotic disorders, and two personality configurations, more stable in their evolution unless personal or social negative events do not lead them to regressive behaviour. Several fundamental indications about the long-term psychotherapeutic relations with these patients in the Italian public services are outlined.
