Toward a validation of the concept of borderline schizophrenia

Abstract

The concept of borderline schizophrenia has survived in DSM-III under the term schizotypal personality disorder. First-generation studies of borderline schizophrenia have focused on phenomenological criteria for delineation of the syndrome. Four diagnostic systems have been published but no external validation is offered, hence, their use is limited. Two published studies give prevalence rates of 12.7% and 24.5% among first-degree relatives of schizophrenics. A second generation of studies focusing on biologic dysfunctions already described in schizophrenic populations but targeting high-risk individuals, like the first-degree relatives of schizophrenics, will provide external validation for the diagnosis of Borderline Schizophrenia. Six areas for study are suggested: biochemical, brain morphology, psychophysiological, electroencepholographic, neuroendocrine, and neuromuscular. A clinicobiologic dissection would provide the biologic underpinning for the diagnosis of borderline schizophrenia. To date, only platelet and plasma MAO levels among first-degree relatives have been studied. The heuristic value of this model is discussed.