Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders.

OBJECTIVE: The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders. METHOD: Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity. RESULTS: Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, 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: The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the criteria for the other disorders.

The simulation of neurologic disease.

Conversion symptoms are defined as symptoms that suggest neurologic disease but have no explanation after appropriate evaluation including physical examination, laboratory studies, and appropriate radiographic and other imaging studies. Conversion symptoms are more common in young women as compared with other groups. Conversion symptoms may be seen in essentially all psychiatric illness categories and are especially common in Briquet's syndrome and antisocial personality disorder. They are also seen in patients with neurologic disorders, including seizure disorder, central nervous system tumor, head injury, and multiple sclerosis. Family members of patients with conversion symptoms have a heterogeneous mixture of psychiatric illnesses parallel to the heterogeneous conditions seen in the probands. Psychosocial stressors and compensation factors, including monetary and legal aspects, appear to play important roles in many cases of conversion symptoms. Most individual conversion symptoms resolve, but the individual patient may experience other conversion symptoms as well as experience difficulty as a result of comorbid psychiatric illness.

Pfeiffer syndrome: a syndrome of acrocephalosyndactyly.

The authors present a case of Pfeiffer syndrome, which differs from the classic description. Treatment consisted of surgical correction of the unusual digital deformity. The literature is reviewed in regard to acrocephalosyndactyly and related congenital disorders and deformities.

Simple schizophrenia: revisited.

Simple schizophrenia is no longer a part of official American classification schemes, but is a diagnosis still used in other parts of the world. Long considered a traditional schizophrenic subtype, in time the concept became unclear, was used infrequently, and exhibited poor reliability and doubtful descriptive validity. We reviewed charts of 52 patients diagnosed with simple schizophrenia. Our findings confirm the descriptive heterogeneity and diagnostic imprecision of simple schizophrenia.

Simple schizophrenia: past, present, and future.

The diagnostic category called simple schizophrenia has disappeared from official American nosology but has been retained in ICD-9. The diagnosis has a long history, was one of the traditional schizophrenic subtypes identified by Bleuler, and was later accepted by Kraepelin. The authors provide a historical overview of the concept, review its modern successors, and provide recommendations for its inclusion in DSM-IV as a proposed diagnostic category needing further study.