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Does the Presence of One Feature of Borderline Personality Disorder Have Clinical Significance? Implications for Dimensional Ratings of Personality Disorders

J Clin Psychiatry 2012;73(1):8-12
10.4088/JCP.10m06784

Objective: In the draft proposal for DSM-5, the Work Group for Personality and Personality Disorders recommended that dimensional ratings of personality disorders replace DSM-IV’s categorical approach toward classification. If a dimensional rating of personality disorder pathology is to be adopted, then the clinical significance of minimal levels of pathology should be established before they are formally incorporated into the diagnostic system because of the potential unforeseen consequences of such ratings. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the low end of the severity dimension and compared psychiatric outpatients with 0 or 1 DSM-IV criterion for borderline personality disorder on various indices of psychosocial morbidity.

Method: Three thousand two hundred psychiatric outpatients were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders. The present report is based on the 1,976 patients meeting 0 or 1 DSM-IV criterion for borderline personality disorder.

Results: The reliability of determining if a patient was rated with 0 or 1 criterion for borderline personality disorder was good (κ = 0.70). Compared to patients with 0 borderline personality disorder criteria, patients with 1 criterion had significantly more current Axis I disorders (P < .001), suicide attempts (P < .01), suicidal ideation at the time of the evaluation (P < .001), psychiatric hospitalizations (P < .001), and time missed from work due to psychiatric illness (P < .001) and lower ratings on the Global Assessment of Functioning (P < .001).

Conclusions: Low-severity levels of borderline personality disorder pathology, defined as the presence of 1 criterion, can be determined reliably and have validity.

J Clin Psychiatry

Submitted: December 13, 2010; accepted February 1, 2011.

Online ahead of print: October 18, 2011 (doi:10.4088/JCP.10m06784).

Corresponding author: Mark Zimmerman, MD, Bayside Medical Center, 235 Plain St, Providence, RI 02905 (mzimmerman@lifespan.org).