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Borderline or Schizotypal? Differential Psychodynamic Assessment in Severe Personality Disorders

VAN RIEL, LAURA MSc, MD; INGENHOVEN, THEO J.M. PhD; VAN DAM, QUIN D. PhD; POLAK, MARIKE G. PhD; VOLLEMA, MEINTE G. PhD; WILLEMS, ANNE E. MSc; BERGHUIS, HAN PhD; VAN MEGEN, HAROLD PhD

Journal of Psychiatric Practice: March 2017 - Volume 23 - Issue 2 - p 101–113
doi: 10.1097/PRA.0000000000000225
Articles

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.

VAN RIEL: Novarum Centre for Eating Disorders and Obesity, Arkin Institute of Mental Health, Amsterdam, The Netherlands

INGENHOVEN: Centre for Psychotherapy, Pro Persona, Lunteren, The Netherlands

VAN DAM: Centre for Psychology and Psychotherapy Q.D. van Dam, Leiden, The Netherlands

POLAK: Institute of Psychology, Erasmus University Rotterdam, The Netherlands

VOLLEMA: Centre for Psychology, De Binnenkijk, Centre for psychotherapy, diagnostics and supervision, Ermelo, The Netherlands

WILLEMS: Research Centre GZZ Centraal, Amersfoort, The Netherlands

BERGHUIS: Institute of Mental Health, Pro Persona, Tiel, The Netherlands

VAN MEGEN: Institute of Mental Health GGZ Centraal, Ermelo, The Netherlands

Funded by Institute of Mental Health GGZ Centraal and the Developmental Profile Foundation, The Netherlands.

The authors declare no conflicts of interest.

Please send correspondence to: Laura van Riel, MSc, MD, Novarum Centre for Eating Disorders and Obesity, Arkin Institute of Mental Health, Jacob Obrechtstraat 92, 1071 KR Amsterdam, The Netherlands (e-mail: laura.van.riel@novarum.nl).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.