DISCRIMINANT COGNITIVE-AFFECTIVE FEATURES OF THE BORDERLINE DISORDERS (RORSCHACH, SUBTYPES, DIAGNOSIS, PHENOMENOLOGY, PERSONALITY)

Abstract

Diagnostic and descriptive distinctions between schizophrenic and borderline patients, and between putative subtypes of borderlines, are recognized as a continuing difficulty. The possibility of using cognitive-affective schemas operationalized as responses to projective probes has not yet been adequately explored. The following study was designed to address the possible role of these functional attributes of personality as they appear on the Rorschach and to assess their potential diagnostic significance.;The Rorschach protocols of 16 schizophrenic and 40 borderline patients were gathered, and the borderline patients were further divided into Frozen/Inhibited (N = 23) and Florid/Infantile (N = 17) subgroups. Each response in each protocol was scored by independent sets of blind raters for formal determinants, object relational content, and quality of thought disorder. A multidimensional, multivariate strategy was employed to examine both the discriminative validity and the descriptive differences between the diagnostic groups and the borderline subtypes.;The results of earlier studies that sought to differentiate schizophrenics from borderlines were confirmed in this sample by only a limited number of formal determinants and scaled ratings. When the borderlines were considered as two separate subgroups, however, group distinctions were strongly confirmed. Each of the borderline subgroups could be differentiated by sets of findings derived from the instruments used, though the characteristic patterns found did not confirm predictions generated from the literature. From the mean diagnostic group scores on all three types of instruments, a composite set of five, optimally descriptive variables was chosen, and discriminant equations were calculated. Accurate classification of group membership was obtained on average 81% of the time among the schizophrenics, 53% of the time among the Frozen/Inhibited borderlines, and 77% of the time among the Florid/Infantile borderlines.;Though differing from previous findings in the literature, and limited to this sample, the results from this study demonstrate that: (1) a valid definition of a cognitive-affective schema can be derived by projective methods; (2) the Rorschach when properly employed can be a powerful tool for assessing pathological phenomenology; and (3) the borderline personality disorder can only be investigated effectively when phenomenological differences between subgroups are taken into account.