Borderline or Schizotypal? Differential Psychodynamic Assessment in Severe Personality Disorders

Abstract

Considerable overlap in symptoms between patients with borderline personality disorder (BPD) and schizotypal personality disorder (STPD) complicates personality diagnostics. Yet very little is known about the level of psychodynamic functioning of both personality disorders. Psychodynamic assessment procedures may specify personality characteristics relevant for differential diagnosis and treatment planning. In this cross-sectional study we explored the differences and similarities in level of personality functioning and psychodynamic features of patients with severe BPD or STPD. In total, 25 patients with BPD and 13 patients with STPD were compared regarding their level of personality functioning (General Assessment of Personality Disorder), current quasipsychotic features (Schizotypal Personality Questionnaire), and psychodynamic functioning [Developmental Profile (DP) interview and Developmental Profile Inventory (DPI) questionnaire]. Both groups of patients showed equally severe impairments in the level of personality functioning and the presence of current quasipsychotic features. As assessed by the DP interview, significant differential psychodynamic patterns were found on the primitive levels of functioning. Moreover, subjects with BPD had significantly higher scores on the adaptive developmental levels. However, the self-questionnaire DPI was not able to elucidate all of these differences. In conclusion, our study found significant differences in psychodynamic functioning between patients with BPD and STPD as assessed with the DP interview. In complicated diagnostic cases, personality assessment by psychodynamic interviewing can enhance subtle but essential differentiation between BPD and STPD.

Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder

“… 28 Another study also found higher scores for the cognitive-perceptual, interpersonal , and disorganization clusters in patients with BPD and hallucinations than those without them. 49 , 51 The link between schizotypy and hallucinations is consistent with the findings of Sommer et al, who investigated a population with auditory verbal hallucinations without psychiatric diagnoses. 54 …”

“…Association with schizotypy has also been found in patients with other personality disorders, especially schizotypal personality disorder. 49 , 51 , 55 In 23 patients with BPD (no difference between presence/absence of hallucinations) and 12 patients with schizotypal personality disorder, no differences were found between scores on the three clusters of schizotypy. 51 A comorbid schizotypal personality disorder was be found in 7% of the BPD patients.…”

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

“…Patients with BPD and SPD are generally considered to have severe PDs (Hopwood et al, 2006; Millon, 1990). Studies have shown large co-occurrence between BPD and SPD (Meisner et al, 2020; Trull et al, 2012), which has important implications for diagnosis and clinical management (Van Riel et al, 2017). The AMPD hybrid model for BPD and SPD defines the threshold for a PD diagnosis by at least moderate impairment of personality functioning (Criterion A) as manifested by characteristic difficulties in two or more of the four areas of personality functioning (Identity, Self-Direction, Empathy, and Intimacy).…”

The Relationship Among Mentalization, Mindfulness, Working Memory, and Schizotypal Personality Traits in the General Population

“…Previous studies indicated that the regulative function of mindfulness and mentalization play a critical role in borderline personality organization ( Marszal and Górska, 2015 ), and our results extend this model to schizotypy. Despite the symptom-level overlap, a notable difference between borderline personality and schizotypy may be the developmental disturbance of emotion regulation in individuals with borderline features, extending to interpersonal relationships, attachment, and identity coherence ( Van Riel et al, 2017 ).…”