Borderline or schizotypal: similarities and differences between a descriptive diagnosis and dynamic personality diagnostics.

In the clinical practise of a treatment centre of personality disorders
diagnosing is performed by a clinical interview and semi-structured interview
with which symptoms according to the DSM -IV are categorised. However, due to
the fact that symptoms of the decribed personality disorders are overlapping,
it is often very challenging to distinguish between the different personality
disorders (Stigler & Bijschoof, 2004; Kavoussi &Siever, 1992; Plakun & Muller,
1987; McGlashan, 1987). McGlashan, (1987) describes depersonalisation and
derealisation phenomena, paranoid idea's and feelings of depressoin in both
schizotypal- als borderline patients. Inappopriate anger and difficulties being
alone also proof not to differentiate (McGlashan, 1987). Kavoussi &Siever, 1992
en Plakun & Muller, 1987 decribe a number of significant similarities between
SPD and BPD. Kavoussi en Siever (1992) speak of percentages of 58% in overlap
of clinical symptoms. Furthermore, often there seem to be comorbidity, in which
both disorders are present in more of less extend (Joffe & Regan, 1988, Watson,
1998, Pfohl & Coryell & Zimmerman & Stangl, 1986). This makes differential
diagnotics more difficult and treatment indicating very complex.
Diagnostics with the usual tests, interviews and questionnaires seems to be
insufficient for this task. For accurate diagnostics, instruments with a more
multi-conceptual approach seem to be more adequate. The Developmental Profile
(Abraham *90, *05) is a diagnostic instrument with a psychodynamic background
with which relevant personality features can be displayed multidimensional
(qualitative). There is some evidence indicating that the habitual behavioural
patterns, which are characteristic for the SPD and the BPD, can be found in the
lower two Developmental levels in the Developmental Profile (Abraham et al,
1997, 1998). Specific characteristics of the SPD and BPD on the Developmental
Profile, however, are yet insufficiently determined (Samkalden &Trijsburg
2006).
The Developmental Profile Questionnaire (DPQ/OPV), the General Assesment of
Personality disorders (GAPD), the Assesment of DSM IV Personality Disorders
(ADP IV) and the Schizotipal Personality disorder Questionnaire (SPQ) can be
supportive in diagnosing the specific type of personality disorder, as well as
the level of functioning of the patient and severity of the personality
pathology, by which they can contribute to the exploration of personality
functioning of patients with a SPD or a BPD.

In this pilot study we explore and evaluate the similarities and differences
between patients with a DSM IV diagnosis of SPD or BPD on the Developmental
Profile, the Developmental Profile Questionnaire (DPQ/ OPV), the General
Assesment of Personality Disorders (GAPD) and the Schizotypal Personality
Questionnaire (SPQ). The criterium validity wille be calculated by determining
the correlation of the endpoints of the Developmental Profile and the SCID II
(SPD of BPD). The other goal of teh study is to contibute to the
differentiation of the specific diagnostic categories of SPD and BPD in
clinical practise.

Study design:
cross sectional explorative pilot study with a duration of 1 year.
Study population:
40 voluntary psychiatric participants between the age of 18 and 45 year with a
diagnosis of SPD or BPD, based on the SCID II (Structured Clinical Interview
for DSM-IV Axis II Personality Disorders; First et al., 1997; Weertman et al.,
2000). We divide the participants into two groups: 20 participants with a SPD
and 20 with a BPD.
Intervention:
All participants will be asked to participate in the Developmental Profile
interview, and the following questionnaires: the Developmental Profile
Questionnaire (DPQ/OPV), the General Assesment of Personality Disorders (GAPD)
and the Schizotypal Personality Questionnaire (SPQ). We will then evaluate the
similarities and differences in the scores.

There are no physical risks associated with the study. There are no risks
involved with side-effects or other undesirable consequences. In all cases
there will be informed consent from the participants. Before deciding to
participate in the study, the participant will receive adequate verbal and
written information about the study. And is told to terminate participantion in
the study at any time, if he/she wishes, without further consequenses of the
usual treatment or his/her fysical and mental health. The particpant is also
told to take a break as often as wished for and to inform the investigator
about the topics he/she does not want to talf about.
The participant is free to choose to receive the information collected from the
study. The patient is also free to share this information with his/her
doctor/psychologist and to add this to her/his current treatment.
Patient will be asked to participate in this study for half a day. To minimize
the burdening on the patients treatment, the study can be planned either on a
usual treatment day or on the participants day-off, according to the patients
wishes.
The interview and questionnaires are not damaging in any way and do not contain
questions of disturbing- of provocative nature. The risk of decomepnsation of
the psychiatric mental state is based on the broad experience with the
Developmental Profile (interview) and questionnaires, very small. The further
minimise this risk, the following precautions are taken:
The interviewing researcher will investigate the status mentalis of the
participant before, during and after (and half an hour later) the interview and
questionnaires. When the participant, at any moment, seem to be distressed,
the interview/questionnaires wil be stoppend (or not started at all)
immediately. On this moment the investigator wil discuss with the participant
what to do next: take a break, postpone or stop participation alltogether. The
desicion of the participant is alway leading in this. The investigator will
then provide the support needed by the participant and will do so under the to
supervison of a certicfied psychiatrist. When necassary, the intestigator will
contact the participant's own responsible doctor or psychologist to discust the
further support needed by the participant.
The participant is told that there is a possibility that he/she will notice
that the interview was confronting, at a later time that day. The participant
is explained that this is normal and that he/she is free and welcome to phone
the investigor on a special number during the coming few days with things
according to the interview/questionnaires. The investigator will then provide
the support needed by the participant . The partcipant will also recieve a
telephone number he/she can call during evenings, night and weekends in case an
emergency. The doctor on call will then provide the support needed by the
participant. The investigator will make an appointment with the participant to
phone/meet 2-3 days after the interview, to reflect on the participants
feelings about participating in the study and investigate and provide any
support needed by the participant.