Co-occurrence of borderline and schizotypal personality disorders: a scoping review

Abstract

Background

The historical concept of borderline conditions refers to the pathology on the border between neurosis and psychosis. In DSM-III the conditions were divided into specific but also somewhat overlapping diagnostic criteria for Borderline Personality Disorder (BPD) and Schizotypal Personality Disorder (SPD). This phenomenological overlap, which results in co-occurrence of the two diagnoses, remains a clinical challenge to this day.

Methods

To address this issue we examined the co-occurrence of SPD and BPD according to the established DSM-IV/-5 diagnostic criteria. A literature search was conducted including studies that employed a structured interview with defined BPD and SPD criteria.

Results

Studies from 20 samples were included (i.e. 15 patients, 3 community and 2 forensic samples). For patients diagnosed primarily with BPD, 1–27% also met the criteria for SPD and for patients diagnosed primarily with SPD, 5 – 33% showed co-occurrence with BPD. In the forensic samples, co-occurrence for primary BPD was 10% and 67 – 82% for primary SPD. In the community samples, co-occurrence for primary BPD was 29% and 50% for primary SPD. The pattern of co-occurrence across community samples was particularly heterogeneous.

Conclusion

The identified co-occurrences for BPD and SPD were considerably sample-dependent, and samples and measurements were generally too heterogeneous for a precise meta-analysis. Forensic and community samples generally showed higher co-occurrences, but these findings were characterized by potential methodological limitations.

Keywords:

• Borderline conditions
• schizotypal personality disorder
• psychotic-like symptoms
• borderline personality disorder
• co-occurrence

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The first author received funding form Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University and Psychiatry Region Zealand, Denmark. The other authors did not receive grant from funding agencies.