Lerner H D, Sugarman A, Gaughran J
J Nerv Ment Dis. 1981 Nov;169(11):705-11. doi: 10.1097/00005053-198111000-00004.
Historically unresolved diagnostic questions regarding the borderline diagnosis and its relationship to schizophrenia are explored. Is the borderline syndrome a subvariant of schizophrenia or does it constitute a distinct diagnostic entity in its own right with specific, common, and identifiable features which set this group of patients off from others? Based on recent developments in psychoanalytic object relations theory, a Rorschach scoring manual designed to assess the primitive defenses that are conceptualized to underlie as well as organize the borderline patient was applied to independently selected samples of hospitalized borderline (DSM-III criteria) and schizophrenic (Research Diagnostic Criteria) adolescent and young patients. Consistent and significant differences were found between groups on the basis of defensive functioning. Borderline patients were found to use test measures of splitting, primitive devaluation, idealization, denial, and projective identification significantly more than schizophrenic patients. The levels of inter-rater reliability and the direction of the results in discriminating borderline from schizophrenic patients on the basis of defensive functioning indicate that the Rorschach Scoring System is a reliable and valid instrument. The implications of the results in terms of the differential diagnostic issues, the nature of borderline defenses, and the utilization of the Rorschach as a research instrument are considered.
探讨了历史上关于边缘性诊断及其与精神分裂症关系的未解决的诊断问题。边缘性综合征是精神分裂症的一个亚型，还是其本身就构成一个独特的诊断实体，具有将这组患者与其他患者区分开来的特定、常见且可识别的特征？基于精神分析客体关系理论的最新发展，一个旨在评估被概念化为构成并组织边缘性患者基础的原始防御的罗夏测验计分手册，被应用于独立选取的住院边缘性（DSM-III标准）和精神分裂症（研究诊断标准）青少年及年轻患者样本。在防御功能的基础上，两组之间发现了一致且显著的差异。发现边缘性患者在分裂、原始贬低、理想化、否认和投射性认同的测验指标上的使用显著多于精神分裂症患者。评分者间信度水平以及基于防御功能区分边缘性患者与精神分裂症患者的结果方向表明，罗夏测验计分系统是一种可靠且有效的工具。考虑了这些结果在鉴别诊断问题、边缘性防御的性质以及将罗夏测验用作研究工具方面的意义。
