Can Borderline Personality Disorder Be Diagnosed Reliably?

Senin, 11 Januari 2010

Reliability refers to the reproducibility of a measurement or assessment from one assessor or occasion to another. It has often been claimed that two clinicians cannot agree on whether a patient has BPD or not (i.e., that it cannot be diagnosed reliably). This impression may result from the different meanings of the term borderline, because the concept has evolved from its psychoanalytic origins to its DSM-IV-TR definition. The combination of a definition by specific diagnostic criteria, making explicit the signs and symptoms of the disorder, with the standardized interview schedules developed to collect relevant symptom information should ensure the reliability of the BPD diagnosis.

The Collaborative Longitudinal Personality Disorders Study (CLPS), funded by the National Institute of Mental Health, used a standardized interview to assess all DSM-IV (American Psychiatric Association 1994) personality disorders (Zanarini et al. 2000). In this study and in another using an interview designed exclusively to assess BPD symptoms (Zanarini et al. 2002), the reliability of the BPD diagnosis and most of its individual symptoms was very good to excellent. The high levels of reliability found in both of these studies are consistent with the results of other studies using standardized interviews and diagnosis by criteria; they are as high as or higher than those for many other mental disorders for which the reliability of diagnosis is seldom questioned. Of course, standardized interviews and specified criteria are not synonymous with excellent clinical judgment, and unless clinicians are well trained in the diagnosis of BPD, reliability of the diagnosis will be less than optimal.