Differences between clinical and research practices in diagnosing borderline personality disorder

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Research

Background:

• Clinicians may be less inclined than researchers to use direct questions for personality disorder assessment.
• Concerns exist regarding the validity of personality disorder research relying on semistructured diagnostic interviews.

Purpose of the Study:

• To investigate the influence of assessment methodology on the diagnosis of borderline personality disorder.
• To compare diagnoses of borderline personality disorder derived from structured versus unstructured clinical interviews.

Main Methods:

• Two groups of psychiatric outpatients were assessed using different methods.
• 500 patients underwent a routine unstructured clinical interview.
• 409 patients were interviewed using the Structured Interview for DSM-IV Personality (borderline personality disorder section).

Main Results:

• Borderline personality disorder diagnoses were significantly more frequent in the structured interview group.
• Clinicians were more likely to diagnose borderline personality disorder when presented with structured interview data.

Conclusions:

• The assessment method profoundly affects the frequency of borderline personality disorder diagnoses.
• Clinicians rarely diagnose borderline personality disorder during routine intake without detailed semistructured interview information.
• Providing structured interview results increases borderline personality disorder diagnoses, challenging notions of their invalidity.