Five year follow-up comparison of borderline and schizophrenic patients

Abstract

HE TERM BORDERLINE is prevalent in clinical parlance and is often used to suggest a definitive diagnosis rather than a marginal or confusing diagnosis. Whether a specific category should be established for borderline patients in psychiatric nosology is an unsettled question, but borderline is discussed in the literature as though these patients are readily distinguishable in their psychopathologic manifestations, past history, course and outcome when compared to psychotic patients on the one hand, and neurotic or personality disorders on the other. This must, of course, be established by empiric investigation including systematic clinical assessments and the simultaneous evaluation of comparative diagnostic groups. Such studies are conspicuously absent in the literature. In a recent literature review, Gunderson and Singer1 identified certain clinical features which seem to be shared by borderline patients notably: a) superficial social skills and work adjustment; b) impulsivity; c) a variety of intense affects; d) brief ego dystonic psychotic experiences and; e) intense and unstable interpersonal relationships often disrupted by hostility. Since previous investigations of the borderline syndrome have not included systematic comparisons with other diagnostic groups, it cannot be said to what extent these characteristic clinical features are also distinguishing features. In an earlier report we contrasted hospitalized schizophrenic patients with hospitalized borderline patients,2 Having used psychotic symptoms as diagnostic criteria, we compared the patients on a variety of nonpsychotic symptoms, prognostic and outcome measures. There was considerable similarity in the nonpsychotic aspects of the clinical picture, but when dissociative symptoms were present they were more severe in the borderline patients. Affective symptoms were common in both groups, but the borderline patients had more difficulty with anger and less with anxiety than did the schizophrenic patients. The borderline patients had chaotic interpersonal lives (despite superficial adjustment), Surprisingly, we found these two diagnostic groups virtually identical in a battery of past history and prognostic variables. Assessment of two-year outcome in four areas (length of hospitalization, social contact, employment record, and symptom