A comparison of thought and perception disorders in borderline personality disorder and schizophrenia: psychotic experiences as a reaction to impaired social functioning.

Francesco Oliva,Marinella Dalmotto,Pier Maria Furlan,Elvezio Pirfo,Rocco Luigi Picci

doi:10.1186/s12888-014-0239-2

Francesco Oliva, Marinella Dalmotto + Show 3 more

Open Access

https://doi.org/10.1186/s12888-014-0239-2

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Journal: BMC Psychiatry	Publication Date: Oct 3, 2014
Citations: 62	License type: CC BY 4.0

Affiliation: University of Turin, ASL Roma

Abstract

BackgroundAlthough previous studies suggest a high frequency of psychotic symptoms in DSM-IV Borderline Personality Disorder (BPD) there is currently no consensus on their prevalence and characteristics (type, frequency, duration, location etc.). Similarly, there are few papers addressing psychotic reactivity, the crucial aspect of BPD included in the ninth criterion for DSM-IV BPD, which remained unchanged in DSM-IV-TR and DSM-5. The purposes of the present study were to compare thought and perception disorders in patients with DSM-IV BPD and schizophrenia (SC), investigating their relationship with social functioning.MethodsThought and perception disorders and social functioning over the previous two years were assessed by the Diagnostic Interview for Borderline Revised (DIB-R) and Personal and Social Performance scale (PSP) respectively in outpatients with DSM-IV BPD (n = 28) or DSM-IV SC (n = 28).ResultsQuasi-psychotic thought (i.e. transient, circumscribed and atypical psychotic experiences) was more frequent in BPD (BPD = 82.1%, SC = 50%, p = 0.024); whereas true psychotic thought (i.e. Schneiderian first-rank, prolonged, widespread and bizarre psychotic symptoms) was more frequent in SC (SC = 100%, BPD = 46.4%, p < 0.001). However both types of psychotic features were prevalent in both groups. Non-delusional paranoia (e.g. undue suspiciousness and ideas of references) was ubiquitous but was more severe in BPD than SC patients (U(54) = 203.5, p = 0.001). In the BPD group there was a strong negative correlation between personal and social functioning and non-delusional paranoia (τ(28) = 0.544, p = 0.002) and level of personal and social functioning was a significant predictor of the severity of non-delusional paranoia only in the BPD group (β = −0.16, t(23) = 2.90, p = 0.008).ConclusionsBPD patients reported less severe psychotic experiences with more frequent quasi-psychotic thought, less frequent true psychotic thought and more severe non-delusional paranoia than SC patients. Interpersonal functioning seems to predict non-delusional paranoia in BPD, which would validate the “stress-related paranoid ideation”, included in the ninth diagnostic criterion for DSM-IV and DSM-5 BPD. PBD patients had higher scores on the psychotic experiences subscale that support the use of a dimensional assessment of the severity of thought and perception disorders, for example the Clinician-Rated Dimensions of Psychosis Symptom Severity introduced in DSM-5, Section III.

Highlights

Previous studies suggest a high frequency of psychotic symptoms in DSM-IV Borderline Personality Disorder (BPD) there is currently no consensus on their prevalence and characteristics
This was consistent with both DSM-III (Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.) [13] and DSM-III-R [14], which reported that in BPD transient psychotic symptoms may occur during periods of extreme stress; none of the eight criteria for DSM-III/ DSM-III-R BPD referred to psychotic features and instead the classification of concurrent psychotic symptoms was covered by Axis I psychotic disorders
In order to assess whether the transition from DSM-III to DSM-IV led to changes in reports of thought and perception disorders in BPD and whether this psychopathology is a reaction to interpersonal functioning, the aims of the present study were (1) to describe perception and thought disorders in a group of outpatients with DSM-IV BPD, comparing their symptoms with those of outpatients with DSM-IV SC; and (2) to explore relationship between these symptoms and function searching for possible correlations between perception and thought disorders and personal and social functioning in both groups and subsequently estimating the extent to which level of personal and social functioning predicts perception and thought disorders in both groups

Summary

Introduction

Previous studies suggest a high frequency of psychotic symptoms in DSM-IV Borderline Personality Disorder (BPD) there is currently no consensus on their prevalence and characteristics (type, frequency, duration, location etc.). Zanarini and colleagues [21] conducted an in-depth evaluation of the cognitive features of BPD comparing three clinical groups (BPD, n = 50; other personality disorders, n = 55; schizophrenia, n = 32) with healthy controls (n = 46) They used the Diagnostic Interview for Borderline Revised (DIB-R) [22] to assess psychopathology over the previous two years and the Structured Clinical Interview for DSM-III (SCID) [23] to evaluate lifetime psychotic episodes. These findings [21] confirmed the predicted specificity of true psychotic thought for SC and extended previous reports of the prevalence of transient psychotic-like symptoms in BPD, suggesting that quasi-psychotic thought was a highly discriminant sign and “virtually pathognonomic” for BPD

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