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Borderline personality disorder in clinical practice.

Carolyn Zittel Conklin1, Drew Westen

  • 1The Cambridge Hospital/Harvard Medical School, Cambridge, MA 02139, USA. carolyn_zittel@hms.harvard.edu

The American Journal of Psychiatry
|May 3, 2005
PubMed
Summary

This study examined borderline personality disorder (BPD) in community settings, finding patients experience significant distress and emotion dysregulation. Findings suggest refining diagnostic criteria for BPD to better reflect clinical reality.

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Area of Science:

  • Psychiatry and Clinical Psychology
  • Personality Disorders
  • Mental Health Research

Background:

  • Previous research on borderline personality disorder (BPD) primarily involved hospital inpatients or outpatients.
  • Understanding BPD in everyday clinical practice is crucial for refining the disorder's construct.
  • Community-based samples offer a more representative view of BPD than specialized clinical settings.

Purpose of the Study:

  • To investigate the characteristics of borderline personality disorder (BPD) patients in community clinical settings.
  • To compare BPD patients with dysthymic disorder patients on comorbidity and functioning.
  • To refine the BPD construct using data from a community-based sample.

Main Methods:

  • A national random sample of 117 psychiatrists and psychologists provided data on 90 BPD patients and 27 dysthymic disorder patients.

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  • Data collected included Axis I and Axis II comorbidity, adaptive functioning, and personality descriptions via the Shedler-Westen Assessment Procedure-200 (SWAP-200).
  • Analyses compared the two diagnostic groups and aggregated SWAP-200 data to create a composite portrait of BPD in the community.

    • Main Results:

    • The community BPD sample showed similarities to previous research samples regarding comorbidity and adaptive functioning.
    • The SWAP-200 revealed that BPD patients experience greater distress and emotion dysregulation than suggested by DSM-IV criteria.
    • Findings highlight the intense psychological pain characteristic of BPD, often underestimated in current diagnostic frameworks.

    Conclusions:

    • Borderline personality disorder (BPD) patients in community clinical practice closely resemble those in research samples.
    • The study confirms a pattern of intense psychological pain and emotion dysregulation in BPD, warranting consideration for diagnostic criteria refinement.
    • Results suggest potential candidate criteria for DSM-V, emphasizing the subjective distress experienced by individuals with BPD.