Advances in the understanding and treatment of borderline personality disorder are highlighted in several features. The Treatment in Psychiatry article by Gabbard and Horowitz (CME, p. 517) presents a hypothetical patient with borderline personality disorder in whom a transference interpretation by the therapist evokes anger similar to the kind it aimed to address. A strong therapeutic alliance is a key ingredient in therapy, and the timing of transference interpretations can be important. Many effective dynamic interventions proceed from mentalizing and clarifying cognitions to changing attitudes and altering maladaptive interpersonal relations. Along the way, transference interpretations may provide a crucible of mutual observation in which to negotiate attitudinal change and strengthen the alliance. The Clinical Case Conference by Goodman et al. (p. 522) examines the psychotherapy of a specific patient with many of the central features of borderline personality disorder. She was a participant in a study of the neurobiology of response to treatment. Details of the 1 year of dialectical behavior therapy highlight important facets of psychotherapy and illustrate the gains made. The patient’s hyperemotional responses are juxtaposed with her physiologic hyperreactivity and the neurobiologic underpinnings of borderline personality disorder. Gunderson (p. 530) gives a chronological account of the transformation of the syndrome, initially conceptualized as borderline schizophrenia. Borderline personality disorder eventually gained its own diagnostic criteria, but over time questions have been raised about overlap with other conditions, such as bipolar disorder. In the 1970s, treatment consisted of psychoanalytic psychotherapy, and inconsistent responses to medications slowed the search for biological origins. Pragmatic, multimodal treatment approaches, such as dialectical behavior therapy and mentalization-based treatment, emerged in the 1990s. The current decade has revealed significant genetic influences and an improved prognosis. In an editorial on p. 509, Dr. John Oldham summarizes the advances in understanding and treating borderline personality disorder. In their editorial on p. 505, Drs. Otto Kernberg and Robert Michels identify aspects of diagnosis, etiology, and treatment that need further study.