Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of “identity disturbance” was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
Highlights
Borderline personality disorder (BPD) is one of the most frequently used clinical diagnoses in both US and Europe
Conceptual, and empirical review [4], we have argued that the division of the borderline group into BPD and schizotypal personality disorder (SPD) was not entirely justified, and that the BPD category today is over-inclusive and both clinically and conceptually difficult to differentiate from the schizophrenia spectrum disorders
In a separate study [9], we have argued that the BPD criteria of “identity disturbance” and “chronic feelings of emptiness” are multi-layered phenomena which in their basic aspects of structural change of experience were both originally ascribed to the schizophrenia spectrum [10]
Summary
Borderline personality disorder (BPD) is one of the most frequently used clinical diagnoses in both US and Europe. The percentage of hospitalized patients diagnosed with personality disorders (PD) with DSM-II and ICD-8 was 1% and 4.6% in New York and London, respectively [3]. These dramatic changes in the proportion of diagnostic classes may reflect changes in incidence or help-seeking patterns but are most likely determined by altered diagnostic criteria and their clinical application. Conceptual, and empirical review [4], we have argued that the division of the borderline group into BPD and SPD was not entirely justified, and that the BPD category today is over-inclusive and both clinically and conceptually difficult to differentiate from the schizophrenia spectrum disorders. In a separate study [9], we have argued that the BPD criteria of “identity disturbance” and “chronic feelings of emptiness” are multi-layered phenomena which in their basic aspects of structural change of experience were both originally ascribed to the schizophrenia spectrum [10]
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