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

Abstract

Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of the alternative model for personality disorders (AMPD) in DSM-5 Section III, a dimensional approach was proposed, which potentially holds promise for better future differentiation between BPD and SPD. The present study sought to examine the psychopathology using the AMPD model. A total of 105 patients were interviewed, 25 were excluded according to exclusion criteria, and the final sample comprised 80 patients who fulfilled the DSM-5 criteria for BPD (n = 35), SPD (n = 25), and comorbid BPD þ SPD (n = 20), respectively. All patients were administered The Structured Clinical Interview for DSM-5 alternative model for personality disorders Modules I and II. One-way analysis of variance tests with planned contrasts were used. Results showed that for AMPD Criterion A, the BPD þ SPD group had the most severe impairment of personality functioning, except for Identity, where the SPD group showed the most severe impairment. For AMPD Criterion B, the domain of Detachment and the facet of Eccentricity from the Psychoticism domain were most prominent for the SPD group relative to the 2 other groups. The differentiating between BPD and SPD manifestations of cognitive/perceptual disturbances does not seem resolved by the Psychoticism domain, which covers broader aspects of psychopathology. Future research should further investigate the construct of Psychoticism, especially to differentiate nonpsychotic symptoms (e.g., dissociation) and address thought disorder.

In search of hidden threats: A scoping review on paranoid presentations in personality disorders

“…Some evidence exists on the link between BPD and ideas of reference: prevalence rates of BPD patients suffering from ideas of reference across studies ranged from 43% to 61.7%. These rates are lower than those found in STPD or comorbid STPD/BPD patients but still higher than in other PDs (Meisner et al, 2021;Zanarini et al, 2013). Yet, correlations between BPD and ideas of reference were overall weak in our sourcesranging from .08 (Hummelen et al, 2012) to .21 (with the total number of BPD symptoms; Widiger et al, 1986)and ideas of reference were suboptimal in predicting BPD diagnosis (Sens = .49; Spec = .64; PPV = .70; NPV = .42; Widiger et al, 1986).…”

“…Consistently, levels of this dimension in STPD patients were higher than in conventional clinical cut-offs (Meisner et al, 2021). Two neuroimaging studies (Dickey et al, 2007;Nakamura et al, 2005) Yet, it has to be noted that correlations between STPD and doubts about others' intentions varied consistently across studies (r range = .19-.41; Bach et al, 2017;Falkum et al, 2009;Hummelen et al, 2012) and that some sources suggested only acceptable predictive power or prototypicality of doubts about others' intentions for the diagnosis of STPD (Hummelen et al, 2012;Livesley et al, 1987;Pfohl et al, 1986).…”

“…Moreover, this paranoid dimension showed an overall acceptable to high ability to predict the diagnosis of STPD (Hummelen et al, 2012; Pfohl et al, 1986; Widiger et al, 1986). The prevalence of patients with ideas of reference ranged from 64% in a STPD sample to 85% in a sample of comorbid BPD/STPD patients (Dickey et al, 2005; Meisner et al, 2021). By the same token, Nakamura et al (2005) and Dickey et al (2007) observed that some neuroanatomical alterations were linked to ideas of reference in STPD patients (i.e., reduced density of the right uncinate fasciculus but not right hippocampal volumes), and such alterations were similar to those of low‐schizotypy individuals (Chan et al, 2019).…”

“…OCPD and MDD individuals (Morey et al, 2003), as well as healthy controls (Morey et al, 2003;Wang et al, 2006), being second only to STPD patients (with or without comorbid BPD) (Meisner et al, 2021).…”

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

“…This complex composition of Criterion B trait facets has largely been supported by meta-analytic evidence (Watters et al, 2019), whereas specific findings suggest that the portrayal of borderline PD could be further improved by including features of psychoticism (e.g., perceptual dysregulation) and detachment (e.g., suspiciousness). However, this insinuates that all of the five Criterion B domains may well apply to borderline PD (Bach, Sellbom, et al, 2016; Evans & Simms, 2018; Meisner et al, 2021; Sellbom et al, 2014). Thus, although most clinicians do not treat their patients at a diagnostic level (i.e., categorical diagnosis), but rather at a symptom level (i.e., individual problems), it seems obvious to use individual trait profiles when formulating individualized treatment for patients with borderline PD.…”