Cognitive
Features
Mary
of Borderline
C. Zanarini, Ed.D., John G. Gunderson, and Frances R. Frankenburg, M.D.
Of 50 patients with borderline personality disorder, 1 00% reported disturbed but nonpsychotic thought, 40% (N=20) reported quasi-psychotic thought, and none reported true psychotic thought during the past 2 years; only 14% (N= 7) reported ever experiencing true psychotic thought. Disturbed and quasi-psychotic thought was significantly more common among these patients than among patients with other axis II disorders or schizophrenia and normal control subjects; however, true psychotic thought was significantly more
common
among
schizophrenic
patients.
While
disturbed thought was also common among axis II disorder and schizophrenic patients, quasi-psychotic thoughf was reported by only one of these subjects, suggesting that quasi-psychotic thought may be a marker for borderline personality disorder. (Am J Psychiatry 1990; 147:57-63)
S
tern (1) first introduced the term “borderline” SO years ago to describe patients who he thought manifested both neurotic and psychotic symptoms. Since that time, psychoanalytically oriented authors such as Knight (2), Frosch (3), Kernbeng (4), and Gunderson (5) have suggested that the tendency of bonderline patients to develop psychotic or psychotic-like symptoms when sufficiently stressed is a core feature of the disorder. Despite the widespread clinical acceptance of this observation and the intense research interest in this aspect of the phenomenology of bordenline personality disorder (6-30), the most chanactenistic and distinguishing cognitive features of the disorder are still unclear. There are three main reasons for this lack of clarity. First, most studies have failed to systematically assess the full range of cognitive features of the disorder. Some studies (13, 22, 25, 26, 28, 29), for example, have focused on the prevalence of chronic eccentnicities of thought associated with schizotypal personality disorder, while others (6, 7, 9-1 1) have focused on the
Received Dec. 27, 1988; revision receivedJune 26, 1989; July 13, 1989. From the Psychosocial Research Program, Hospital, and the Department of Psychiatry, Harvard School, Boston. Address reprint requests to Dr. Zanarini, Hospital, 1 15 Mill St., Belmont, MA 02173. Copyright © 1990 American Psychiatric Association.
Am
J
Psychiatry
147:1,
January
Personality
1990
accepted McLean Medical McLean
Disorder
M.D.,
prevalence of discrete psychotic episodes. Second, eithen formal comparison groups have not been used (6, 7, 24, 25) or they have usually been restricted to schizophrenic or depressed patients or general psychiatnic control subjects (8-20, 22, 27). Perhaps most important, only four studies (16, 21, 26, 29) have made
any
effort
to assess
the cognitive
distinctions
between
borderline personality disorder and a range of other DSM-III axis II disorders. Third, less than half of the studies (8, 13, 14, 21-26, 28-30) have presented the prevalence rates for each of the types of cognition they assessed. Most of the other studies (9-12, 15-20, 27) have presented mean scores or factor analytic results,
which tie light studied
delineate
between-group
on how characteristic really is. In addition,
differences
but shed
each cognitive interpretation
lit-
feature of the re-
suits of most of these earlier studies has been hampered by the tendency to use the terms “psychotic” or “psychotic-like” to describe all cognitive difficulties-a definition of psychosis that is far more encompassing than the clear-cut departure from consensual reality descnibed in DSM-III. The current study built upon these earlier studies in four important ways. First, diagnostic assessments were made by using semistructured interviews based on rigorous research criteria. Second, patients with personality disorders, schizophrenic patients, and normal control subjects were studied. Third, we investigated all of the types of cognition described in earlien studies. Fourth, the three main levels of cognition that we explored-disturbed thought, quasi-psychotic thought, and true psychotic thought-were systematically assessed by using clearly delineated clusters of symptoms.
METHOD As part of a larger study of the validity of borderline personality disorder (3 1-34), 108 outpatients whose therapists felt that they met the DSM-III criteria for an axis II disorder had been recruited. Each of these patients was in treatment at one of three clinics in a metropolitan area. As part of an earlier study (35), two other groups of subjects had been recruited: 32 patients with definite clinical diagnoses of schizophrenia and 46 normal control subjects who had no history of serious psychiatric disturbance and who had no
57
BORDERLINE
PERSONALITY
DISORDER
knowledge of the purpose of the current study. Half of the schizophrenic subjects were outpatients at one of the three clinics we have mentioned, and half were inpatients at a hospital in a neighboring community. All of the normal control subjects were employees of these four institutions. All subjects gave written informed consent and were screened to determine that they 1 ) were between the ages of 18 and 40 years, 2) had normal or greater intelligence, and 3) had no history on current symptoms of an organic condition known to mimic on confound psychiatric symptoms. One of us (M.C.Z.), blind to the clinical diagnosis, then evaluated the diagnostic status of each patient with a personality disorder by administering three research instruments: 1) the Revised Diagnostic Interview for Borderlines (DIBR) (36), a semistructured interview that can reliably distinguish clinically diagnosed borderline patients from those with other axis II disorders, 2) the Diagnostic Interview for Personality Disorders (37), a semistructured interview that reliably assesses the presence of the 1 1 axis II disorders described in DSM-III, and 3) the Structured Clinical Interview for DSM-III (SCID) (38), a structured interview for 20 of the most common DSM-III axis I disorders. The DIB-R and the SCID were also administered by the same rater, blind to clinical diagnosis, to each schizophrenic subject and in nonblind fashion to each normal control subject. Of the 108 patients with axis II disorders, SO met both the DIB and the DSM-III criteria for borderline personality disorder as assessed by the DIB-R and the Diagnostic Interview for Personality Disorders; they were included in the borderline group. Fifty-five others did not meet the study criteria for borderline personality disorder but did meet the DSM-III criteria for some other type of axis II disorder as assessed by the Diagnostic Interview for Personality Disorders; they were included in the other personality disorder group. The three remaining patients with axis II disorders were excluded from further study, two because they met the DSM-III criteria for a concomitant psychotic disorder and one who did not meet the DSM-III cnitenia for any axis II disorder as assessed by the Diagnostic Interview for Personality Disorders. All 32 schizophrenic patients met the DSM-III criteria for schizophrenia as assessed by the SCID. In addition, no schizophrenic or normal control subject met the study criteria for borderline personality disorder as assessed
frequently recurring is it rated as present (e.g., the patient has had episodes of depersonalization off and on for most of the past 2 years). In addition, delusions and hallucinatitrns that are judged to be transient (of less than 2 days’ duration), circumscribed (affecting only one on two areas of the patient’s life), on atypical of psychotic disorders (possibly reality-based on totally fantastic in content) are rated as quasi-psychotic expeniences. In contrast, delusions and hallucinations that are judged to be prolonged (duration of 2 days on more), widespread (affecting many areas of the patient’s life), on bizarre on stereotypic of psychotic disorders (Schneidenian first-rank symptoms or other gross departures from reality) are rated as true psychotic experiences. The psychosis section of the SCID, which consists of 10 items that are also contained in the DIB-R, explicitly rates only true psychotic experiences. Each expenience that was rated as a true psychotic episode was further rated as to whether it was related to substance abuse on depression or was of another functional nature (i.e., characteristic of a major psychotic disorder). Between-group comparisons involving categorical data were computed using the chi-square statistic conrected for continuity (df= 1 for all comparisons). Between-group comparisons involving continuous data were computed using analysis of variance. The Bonfenroni correction for multiple comparisons was used where applicable.
by our
for an “anxious” cluster (avoidant, dependent, compulsive, or passive-aggressive) personality disorder. (These percentages add to more than 100% because some subjects met the criteria for disorders in more than one cluster.) Table 1 shows the percentage of those in each group who reported disturbed cognitive experiences. (Exact chi-squane values for each of the comparisons in this and the subsequent tables can be obtained from the first author.) As shown in table 1, a significantly higher percentage of the borderline patients than of those in each of the other three groups reported experiencing
research
instruments.
The cognitive status of each subject was evaluated by using two sets of items: 1) the cognition section of the DIB-R, which inquires about cognitive functioning in the past 2 years, and 2) the psychosis section of the SCID, which inquires about lifetime cognitive functioning. The cognition section of the DIB-R explicitly rates 27 types of cognition not associated with substance abuse. Twelve items are used to rate the presence of disturbed but nonpsychotic thought, and 15 items are used to rate the presence of psychotic thought. Only when disturbed thought is chronic or
58
RESULTS There were no significant differences in mean±SD age between the borderline subjects (29.2±6.4 years) and the other personality disorder (28.1 ±7.2), schizophrenic (26.2±5.4), and normal control (30.3 ±5.6) subjects. There was also no significant difference in the percentages of female subjects among the borderline subjects (66.0%, N=33) and the other personality disorder (54.5%, N=30), schizophrenic (50.0%, N = 16), and normal control (65.2%, N=3O) subjects. Of the 55 subjects with other personality disorders, 36 (65.5%) met the criteria for a nonbordenline “dnamatic” cluster (histrionic, narcissistic, or antisocial) personality disorder, eight (14.5%) met the criteria for an “odd” cluster (paranoid, schizoid, on schizotypal)
personality
disorder,
Am
and
J
17 (30.9%)
Psychiatry
147:1,
met
the
January
criteria
1990
ZANARINI,
TABLE 1. Prevalence of Disturbed and Normal Control Subjects
Thought
During
Patients With Borderline Personality Disorder
Patients With Other Personality Disorders (N=SS)
(N=S0) Cognitive
Experience
Odd thinking Marked
N
%
N
%
34
68.0
13
23.6
15
30.0
17
34.0
15
30.0
1 S S
1.8 9.1 9.1
7 6
3 2 3 11 4 8
5.5 3.6 5.5 20.0 7.3 14.6 9.1
With Borderline
Schizophrenic Patients
Normal Control Subjects
(N=32)
(N=46)
N
AND
Personality
Significance
Disorder
of Difference
.
Borderline
Versus
FRANKENBURG
and in Patient
(p)a
.
Borderline
Other
Personality Disorders
.
Versus
Borderline
Schizophrenic
Versus Normal
%
N
%
6
18.8
1
2.2
0.0001
0.0001
0.0001
2 3 3 2
6.3 9.4 9.4 6.3
0 0 0 0
0.0 0.0 0.0 0.0
0.0002 0.004 0.01 n.s.
0.02 0.02 n.s. n.s.
0.0002 0.0001 0.0002 0.02
3 1
9.4 3.1 21.9 3.1 9.4 18.8
1 0 2 1 0 1
2.2 0.0 4.3 2.2 0.0 2.2
n.s. n.s. 0.0001 0.03 0.02 0.01
n.s. n.s. 0.0009 0.03 0.01 n.s.
n.s. 0.02 0.0001 0.005 0.0001 0.0007
supersti-
tiousness Magical
Sixth
the Past 2 Years in 50 Patients
GUNDERSON,
thinking
sense
Telepathy Clairvoyance
ideas
7
Unusual perceptions Recurrent illusions Depersonalization Dereatization Nondelusional paranoia
31 12 18 15
14.0 12.0 14.0 62.0 24.0 36.0 30.0
SO
100.0
36
65.5
20
62.5
2
4.3
0.0001
0.0001
0.0001
46 37
92.0 74.0
33 iS
60.0 27.3
17 14
53.1 43.8
1 1
2.2
0.0004
0.0001
0.0001
2.2
0.0001
0.01
0.0001
36
78.0
24
43.6
14
43.8
1
2.2
0.0007
0.003
0.0001
39
70.9
21
65.6
3
6.5
0.0001
Overvalued
Undue
1 3 6
suspicious-
ness Ideas of reference
Other
S
7
paranoid
ideation Any disturbed thought
SO
aSignificance
of
indicated
statistical
difference
was
100.0 determined
significance
by 2 x 2 chi-square
analysis.
as well as each of the thought: odd thinknondelusional paranoia. also significantly more subjects to have reof thought used to rate (marked superstitioussixth sense), two of the
three types of thought used to rate the presence of unusual perceptions (depersonalization and derealizalion), and all three of the types of thought used to rate the presence of nondelusional paranoia (undue suspiciousness, ideas of reference, and other paranoid ideation). The borderline patients were significantly more likely than the subjects with other personality disorders to have reported one type of odd thought (marked superstitiousness) and all three types of nondelusional paranoia. In addition, they were significantly more likely than the schizophrenic subjects to have reported one type of nondelusional paranoia (undue suspiciousness). The prevalence of psychotic thought is detailed in table 2. As can be seen, quasi-psychotic thought was almost pathognomonic for the borderline group and significantly distinguished them from each of the other groups. In addition, the percentages of borderline subjects reporting the main subtypes of this level of cognition (quasi-delusions and quasi-hallucinations) were significantly higher than those found in the other per-
147:1,January
of the Bonferroni
correction
0.0001
for multiple
0.0001
comparisons
at p
Features
Mary
of Borderline
C. Zanarini, Ed.D., John G. Gunderson, and Frances R. Frankenburg, M.D.
Of 50 patients with borderline personality disorder, 1 00% reported disturbed but nonpsychotic thought, 40% (N=20) reported quasi-psychotic thought, and none reported true psychotic thought during the past 2 years; only 14% (N= 7) reported ever experiencing true psychotic thought. Disturbed and quasi-psychotic thought was significantly more common among these patients than among patients with other axis II disorders or schizophrenia and normal control subjects; however, true psychotic thought was significantly more
common
among
schizophrenic
patients.
While
disturbed thought was also common among axis II disorder and schizophrenic patients, quasi-psychotic thoughf was reported by only one of these subjects, suggesting that quasi-psychotic thought may be a marker for borderline personality disorder. (Am J Psychiatry 1990; 147:57-63)
S
tern (1) first introduced the term “borderline” SO years ago to describe patients who he thought manifested both neurotic and psychotic symptoms. Since that time, psychoanalytically oriented authors such as Knight (2), Frosch (3), Kernbeng (4), and Gunderson (5) have suggested that the tendency of bonderline patients to develop psychotic or psychotic-like symptoms when sufficiently stressed is a core feature of the disorder. Despite the widespread clinical acceptance of this observation and the intense research interest in this aspect of the phenomenology of bordenline personality disorder (6-30), the most chanactenistic and distinguishing cognitive features of the disorder are still unclear. There are three main reasons for this lack of clarity. First, most studies have failed to systematically assess the full range of cognitive features of the disorder. Some studies (13, 22, 25, 26, 28, 29), for example, have focused on the prevalence of chronic eccentnicities of thought associated with schizotypal personality disorder, while others (6, 7, 9-1 1) have focused on the
Received Dec. 27, 1988; revision receivedJune 26, 1989; July 13, 1989. From the Psychosocial Research Program, Hospital, and the Department of Psychiatry, Harvard School, Boston. Address reprint requests to Dr. Zanarini, Hospital, 1 15 Mill St., Belmont, MA 02173. Copyright © 1990 American Psychiatric Association.
Am
J
Psychiatry
147:1,
January
Personality
1990
accepted McLean Medical McLean
Disorder
M.D.,
prevalence of discrete psychotic episodes. Second, eithen formal comparison groups have not been used (6, 7, 24, 25) or they have usually been restricted to schizophrenic or depressed patients or general psychiatnic control subjects (8-20, 22, 27). Perhaps most important, only four studies (16, 21, 26, 29) have made
any
effort
to assess
the cognitive
distinctions
between
borderline personality disorder and a range of other DSM-III axis II disorders. Third, less than half of the studies (8, 13, 14, 21-26, 28-30) have presented the prevalence rates for each of the types of cognition they assessed. Most of the other studies (9-12, 15-20, 27) have presented mean scores or factor analytic results,
which tie light studied
delineate
between-group
on how characteristic really is. In addition,
differences
but shed
each cognitive interpretation
lit-
feature of the re-
suits of most of these earlier studies has been hampered by the tendency to use the terms “psychotic” or “psychotic-like” to describe all cognitive difficulties-a definition of psychosis that is far more encompassing than the clear-cut departure from consensual reality descnibed in DSM-III. The current study built upon these earlier studies in four important ways. First, diagnostic assessments were made by using semistructured interviews based on rigorous research criteria. Second, patients with personality disorders, schizophrenic patients, and normal control subjects were studied. Third, we investigated all of the types of cognition described in earlien studies. Fourth, the three main levels of cognition that we explored-disturbed thought, quasi-psychotic thought, and true psychotic thought-were systematically assessed by using clearly delineated clusters of symptoms.
METHOD As part of a larger study of the validity of borderline personality disorder (3 1-34), 108 outpatients whose therapists felt that they met the DSM-III criteria for an axis II disorder had been recruited. Each of these patients was in treatment at one of three clinics in a metropolitan area. As part of an earlier study (35), two other groups of subjects had been recruited: 32 patients with definite clinical diagnoses of schizophrenia and 46 normal control subjects who had no history of serious psychiatric disturbance and who had no
57
BORDERLINE
PERSONALITY
DISORDER
knowledge of the purpose of the current study. Half of the schizophrenic subjects were outpatients at one of the three clinics we have mentioned, and half were inpatients at a hospital in a neighboring community. All of the normal control subjects were employees of these four institutions. All subjects gave written informed consent and were screened to determine that they 1 ) were between the ages of 18 and 40 years, 2) had normal or greater intelligence, and 3) had no history on current symptoms of an organic condition known to mimic on confound psychiatric symptoms. One of us (M.C.Z.), blind to the clinical diagnosis, then evaluated the diagnostic status of each patient with a personality disorder by administering three research instruments: 1) the Revised Diagnostic Interview for Borderlines (DIBR) (36), a semistructured interview that can reliably distinguish clinically diagnosed borderline patients from those with other axis II disorders, 2) the Diagnostic Interview for Personality Disorders (37), a semistructured interview that reliably assesses the presence of the 1 1 axis II disorders described in DSM-III, and 3) the Structured Clinical Interview for DSM-III (SCID) (38), a structured interview for 20 of the most common DSM-III axis I disorders. The DIB-R and the SCID were also administered by the same rater, blind to clinical diagnosis, to each schizophrenic subject and in nonblind fashion to each normal control subject. Of the 108 patients with axis II disorders, SO met both the DIB and the DSM-III criteria for borderline personality disorder as assessed by the DIB-R and the Diagnostic Interview for Personality Disorders; they were included in the borderline group. Fifty-five others did not meet the study criteria for borderline personality disorder but did meet the DSM-III criteria for some other type of axis II disorder as assessed by the Diagnostic Interview for Personality Disorders; they were included in the other personality disorder group. The three remaining patients with axis II disorders were excluded from further study, two because they met the DSM-III criteria for a concomitant psychotic disorder and one who did not meet the DSM-III cnitenia for any axis II disorder as assessed by the Diagnostic Interview for Personality Disorders. All 32 schizophrenic patients met the DSM-III criteria for schizophrenia as assessed by the SCID. In addition, no schizophrenic or normal control subject met the study criteria for borderline personality disorder as assessed
frequently recurring is it rated as present (e.g., the patient has had episodes of depersonalization off and on for most of the past 2 years). In addition, delusions and hallucinatitrns that are judged to be transient (of less than 2 days’ duration), circumscribed (affecting only one on two areas of the patient’s life), on atypical of psychotic disorders (possibly reality-based on totally fantastic in content) are rated as quasi-psychotic expeniences. In contrast, delusions and hallucinations that are judged to be prolonged (duration of 2 days on more), widespread (affecting many areas of the patient’s life), on bizarre on stereotypic of psychotic disorders (Schneidenian first-rank symptoms or other gross departures from reality) are rated as true psychotic experiences. The psychosis section of the SCID, which consists of 10 items that are also contained in the DIB-R, explicitly rates only true psychotic experiences. Each expenience that was rated as a true psychotic episode was further rated as to whether it was related to substance abuse on depression or was of another functional nature (i.e., characteristic of a major psychotic disorder). Between-group comparisons involving categorical data were computed using the chi-square statistic conrected for continuity (df= 1 for all comparisons). Between-group comparisons involving continuous data were computed using analysis of variance. The Bonfenroni correction for multiple comparisons was used where applicable.
by our
for an “anxious” cluster (avoidant, dependent, compulsive, or passive-aggressive) personality disorder. (These percentages add to more than 100% because some subjects met the criteria for disorders in more than one cluster.) Table 1 shows the percentage of those in each group who reported disturbed cognitive experiences. (Exact chi-squane values for each of the comparisons in this and the subsequent tables can be obtained from the first author.) As shown in table 1, a significantly higher percentage of the borderline patients than of those in each of the other three groups reported experiencing
research
instruments.
The cognitive status of each subject was evaluated by using two sets of items: 1) the cognition section of the DIB-R, which inquires about cognitive functioning in the past 2 years, and 2) the psychosis section of the SCID, which inquires about lifetime cognitive functioning. The cognition section of the DIB-R explicitly rates 27 types of cognition not associated with substance abuse. Twelve items are used to rate the presence of disturbed but nonpsychotic thought, and 15 items are used to rate the presence of psychotic thought. Only when disturbed thought is chronic or
58
RESULTS There were no significant differences in mean±SD age between the borderline subjects (29.2±6.4 years) and the other personality disorder (28.1 ±7.2), schizophrenic (26.2±5.4), and normal control (30.3 ±5.6) subjects. There was also no significant difference in the percentages of female subjects among the borderline subjects (66.0%, N=33) and the other personality disorder (54.5%, N=30), schizophrenic (50.0%, N = 16), and normal control (65.2%, N=3O) subjects. Of the 55 subjects with other personality disorders, 36 (65.5%) met the criteria for a nonbordenline “dnamatic” cluster (histrionic, narcissistic, or antisocial) personality disorder, eight (14.5%) met the criteria for an “odd” cluster (paranoid, schizoid, on schizotypal)
personality
disorder,
Am
and
J
17 (30.9%)
Psychiatry
147:1,
met
the
January
criteria
1990
ZANARINI,
TABLE 1. Prevalence of Disturbed and Normal Control Subjects
Thought
During
Patients With Borderline Personality Disorder
Patients With Other Personality Disorders (N=SS)
(N=S0) Cognitive
Experience
Odd thinking Marked
N
%
N
%
34
68.0
13
23.6
15
30.0
17
34.0
15
30.0
1 S S
1.8 9.1 9.1
7 6
3 2 3 11 4 8
5.5 3.6 5.5 20.0 7.3 14.6 9.1
With Borderline
Schizophrenic Patients
Normal Control Subjects
(N=32)
(N=46)
N
AND
Personality
Significance
Disorder
of Difference
.
Borderline
Versus
FRANKENBURG
and in Patient
(p)a
.
Borderline
Other
Personality Disorders
.
Versus
Borderline
Schizophrenic
Versus Normal
%
N
%
6
18.8
1
2.2
0.0001
0.0001
0.0001
2 3 3 2
6.3 9.4 9.4 6.3
0 0 0 0
0.0 0.0 0.0 0.0
0.0002 0.004 0.01 n.s.
0.02 0.02 n.s. n.s.
0.0002 0.0001 0.0002 0.02
3 1
9.4 3.1 21.9 3.1 9.4 18.8
1 0 2 1 0 1
2.2 0.0 4.3 2.2 0.0 2.2
n.s. n.s. 0.0001 0.03 0.02 0.01
n.s. n.s. 0.0009 0.03 0.01 n.s.
n.s. 0.02 0.0001 0.005 0.0001 0.0007
supersti-
tiousness Magical
Sixth
the Past 2 Years in 50 Patients
GUNDERSON,
thinking
sense
Telepathy Clairvoyance
ideas
7
Unusual perceptions Recurrent illusions Depersonalization Dereatization Nondelusional paranoia
31 12 18 15
14.0 12.0 14.0 62.0 24.0 36.0 30.0
SO
100.0
36
65.5
20
62.5
2
4.3
0.0001
0.0001
0.0001
46 37
92.0 74.0
33 iS
60.0 27.3
17 14
53.1 43.8
1 1
2.2
0.0004
0.0001
0.0001
2.2
0.0001
0.01
0.0001
36
78.0
24
43.6
14
43.8
1
2.2
0.0007
0.003
0.0001
39
70.9
21
65.6
3
6.5
0.0001
Overvalued
Undue
1 3 6
suspicious-
ness Ideas of reference
Other
S
7
paranoid
ideation Any disturbed thought
SO
aSignificance
of
indicated
statistical
difference
was
100.0 determined
significance
by 2 x 2 chi-square
analysis.
as well as each of the thought: odd thinknondelusional paranoia. also significantly more subjects to have reof thought used to rate (marked superstitioussixth sense), two of the
three types of thought used to rate the presence of unusual perceptions (depersonalization and derealizalion), and all three of the types of thought used to rate the presence of nondelusional paranoia (undue suspiciousness, ideas of reference, and other paranoid ideation). The borderline patients were significantly more likely than the subjects with other personality disorders to have reported one type of odd thought (marked superstitiousness) and all three types of nondelusional paranoia. In addition, they were significantly more likely than the schizophrenic subjects to have reported one type of nondelusional paranoia (undue suspiciousness). The prevalence of psychotic thought is detailed in table 2. As can be seen, quasi-psychotic thought was almost pathognomonic for the borderline group and significantly distinguished them from each of the other groups. In addition, the percentages of borderline subjects reporting the main subtypes of this level of cognition (quasi-delusions and quasi-hallucinations) were significantly higher than those found in the other per-
147:1,January
of the Bonferroni
correction
0.0001
for multiple
0.0001
comparisons
at p
