L: DSM-III and DSM-III-R schizotypal symptoms in borderline personality disorder. Compr Psychiatry

The frequency of DSM-III and DSM-III-R schizotypal personality disorder (SPD) symptoms and diagnosis was explored in 39 inpatients classified as borderline by the Diagnostic Interview for Borderlines (DIB) and 19 inpatient major depressive disorder (MDD) controls. Most SPD symptoms in all groups, except the nondepressed borderlines, derived from social-interpersonal items. By DSM-III, 24 borderlines (62%) but only six controls (32%) had cognitive-perceptual SPD symptoms (P =.03), whereas by DSM-III-R only 14 borderlines (36%) and seven controls (37%) had such symptoms. Of the 24 borderlines showing cognitive-perceptual symptoms, 16 also had MDD, a significant difference from the non-MDD borderlines (P =.04). This difference disappears in DSM-III-R. The results suggest that some SPD symptoms in borderlines may be related to a concurrent affective episode. 0 1990 by W. B. Saunders Company. T HE QUESTION OF COMORBIDITY of borderline personality disorder (BPD) with other diagnoses has repercussions not only for the diagnostic process but also for treatment particularly pharmacologic treatment. ’ Although Spitzer et a1.2 attempted to separate out “unstable ” borderlines from schizotypal borderlines, this creation of a borderline diagnostic category has raised much criticism. Many patients with BPD have symptoms of or meet criteria for other axis II diagnoses uch as schizotypal personality disorder (SPD) or histrionic personality disorder.3 In addition, some patients with BPD have symptoms of or meet criteria for axis I disorders uch as major affective disorder.4 Spitzer et al. reported 54 % comorbidity of BPD and SPD. ’ George and Solo@ reported that 46 % (22 of 48) of borderlines identified by the Diagnostic Interview for Borderlines (DIB)6 met either SPD alone (N = 4) or both SPD and BPD (N = 18). Among a group of 41 patients with either BPD or SPD, Jacobsberg et al., ’ using DSM-III, reported that 39 % of the subjects met the criteria for both diagnoses. Other investigators8V13 reported concurrent SPD diagnoses among BPD patients in the range of 22 % to 75%. A concurrent diagnosis of major depressive episode has repeatedly been found in more than 50 % of subjects who meet eithe