The Use of the Term 'Borderline Patient' By Scottish Psychiatrists: Ii Conceptual and Descriptive Analysis

A descriptive and conceptual analysis of the use of the term 'borderline patient' by Scottish psychiatrists revealed that they view borderline patients as being near the psychotic end of the illness spectrum, with a marked propensity towards brief, reactive, reversible, paranoid or schizophrenic reactions. There is clear evidence that the term is not used to refer to patients who in the United States would be labelled borderline schizophrenic. Individual American diagnostic schemata would omit features held to be of major importance by Scottish psychiatrists when diagnosing borderline patients. In an earlier study, Macaskill and Macaskill (1981) found that the term 'border line patient' although not in the official nomenclature, was used by over one in four Scottish psychiatrists to delineate a syndrome which they felt should be included in contemporary diagnostic systems because of its prognostic and thera peutic implications. This study provided the first demographic information on the use of the term in the United Kingdom, but did not permit direct comparisons at conceptual and descriptive levels with studies in the United States where the term is widely used and recognised in the official nomenclature of the American Psychiatric Association's Diagnostic and Statistical Manual — III (1980). Research into the use of the term schizophrenia, for example by Cooper et al (1972), has shown that major differences in usage between the United Kingdom and the United States have occurred with serious implications for the cross-cultural valididty of research findings in schizophrenia. Without similar direct comparisons on the cross-cultural use of the term 'borderline patient' it is not possible to be certain that a similar situation does not exist with regard to this syndrome. The present study sought to address this issue by eliciting the descriptive features and conceptual meanings of the term 'borderline patient' as it is used by Scottish psychiatrists. From this it was hoped to establish the extent to which the major American diagnostic schemata of Gunderson and Kolb (1978), Kernberg (1975) and Spitzer, Endicott and Gibbon (1979) delineated the population defined as 'borderline' by Scottish psychiatrists. It was further hoped that this study could provide information to help explain the fact that Scottish psychiatrists use the term much less frequently than their American counterparts.