CLINICAL-STUDY OF THE RELATION OF BORDERLINE PERSONALITY-DISORDER TO BRIQUETS SYNDROME (HYSTERIA), SOMATIZATION DISORDER, ANTISOCIAL PERSONALITY-DISORDER, AND SUBSTANCE-ABUSE DISORDERS

Objective: The criteria for borderline personality disorder seem to se lect patients with very high rates of Briquet's syndrome (hysteria), s omatization disorder, antisocial personality disorder, and substance a buse disorders. This study was undertaken to determine whether systema tic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distingui sh it from these other disorders. Method: Eighty-seven white female pa tients (75 in St. Louis and 12 in Milan, Italy) who had borderline per sonality disorder according to both th DSM-III-R criteria and the Revi sed Diagnostic Interview for Borderlines were further examined with th e DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determ ine their patterns of psychiatric comorbidity. Results: Every patient had at least one additional DSM diagnosis. Patients in St. Louis and M ilan averaged five and four additional diagnoses, respectively. Eighty -four percent of the patients in St. Louis met criteria for either som atization disorder, Briquet's syndrome, antisocial personality disorde r, or substance abuse disorders. Patterns of comorbidity for panic (51 %), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies. Conclusions: Th e data indicate that the boundaries for the borderline condition are n ot specific and identify a high percentage of patients with these othe r disorders. Furthermore, the comorbidity profiles closely resemble th e psychiatric profiles of patients with these disorders. If the border line syndrome is meant to include all of these disorders, its usefulne ss as a diagnosis is limited. Until the fundamental features of border line personality disorder that distinguish it from the others are iden tified, it is recommended that clinicians carefully assess patients fo r these other diagnoses. Efforts should be made to change the borderli ne personality disorder criteria by shifting away from overlap with th e criteria for the other disorders.