Assessment of formal thought disorder in personality disorders

Abstract

Early formulations of the borderline syndromes included thought disorder as a primary symptom of these pathologies (Bleuler, 1911). More recently, the DMS-III (American Psychological Association, 1980) has separated the borderline syndromes into borderline personality disorder (BPD) and schizotypal personality disorder (SPD). Many researchers, however, have demonstrated a large overlap between the two diagnoses (George & Soloff, 1986; Spitzer, Endicott, & Gibbon, 1979; Widiger, Trull, Hurt, Clarkin, & Frances, 1987). This has led to disagreement as to whether borderline personality disorder and schizotypal personality disorder are two separate personality organizations or should be unified. It has also been suggested that personality disorders should be viewed dimensionally rather than categorically (Widiger et al., 1987). Formal thought disorder, measured by the Thought Disorder Index (TDI; Johnston & Holzman, 1979), appears to be characteristic of patients with borderline syndromes. Studies have demonstrated qualitative differences in thought disorder between schizophrenic and manic patients (Solovay, Shenton & Holzman, 1987). In a study designed to measure formal thought disorder in BPD and SPD patients, Edell (1987b) found no quantitative differences between the two groups using the Thought Disorder Index (Johnston & Holzman, 1979).;The present study included patients with Structured Interview for DSM-III-R Personality (SIDP-R; Pfohl, Blum, Zimmerman, & Stangl, 1989) diagnoses of DPB, SPD and other Axis II diagnoses. Thought disorder was assessed using the Thought Disorder Index (Johnston & Holzman, 1979) in an effort to examine quantitative and qualitative differences between the groups. It was hypothesized that there would be differences in the thought disorder displayed by the BPD patients and by the SPD patients. Additionally, the number of borderline symptoms and the number of schizotypal symptoms were examined in relation to thought disorder. Results indicated that thought disorder was non-significantly greater in subjects with a schizotypal diagnosis than in subjects with a borderline diagnosis. Future research might investigate the role of depression and the patient's state at the time of Rorschach administration.