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Borderline personality disorder diagnosis in a new key

Journal article
Authors A. L. Mulay
M. H. Waugh
J. P. Fillauer
D. S. Bender
A. Bram
N. M. Cain
E. Caligor
M. K. Forbes
L. B. Goodrich
J. H. Kamphuis
J. W. Keeley
R. F. Krueger
J. E. Kurtz
Peter Jacobsson
K. C. Lewis
G. M. P. Rossi
J. M. Ridenour
M. Roche
M. Sellbom
C. Sharp
A. E. Skodol
Published in Borderline Personality Disorder and Emotion Dysregulation
Volume 6
Issue 1
Pages 16
ISSN 2051-6673
Publication year 2019
Published at Institute of Neuroscience and Physiology
Pages 16
Language en
Keywords Borderline personality disorder, Alternative model for personality, disorders, Personality assessment, DSM-5, Personality disorder, dsm-iv, conceptual models, section ii, criteria, traits, level, classification, interview, Psychiatry
Subject categories Neurosciences


Background Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). Method Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. Results Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. Conclusions Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

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