Diagnosis for borderline personality disorder

Senin, 04 Januari 2010

Borderline personality disorder, like other personality disorders (PDs), is most commonly diagnosed using a categorical approach (present vs absent) but personality in general is normally studied dimensionally assuming a more or less normally distributed set of underlying traits that best describe variation between individuals (Cloninger et al. 1993; Blais 1997; Wildgoose et al. 2001). There is no agreement that a categorical approach to the diagnosis of BPD is the most appropriate. Many favour a dimensional approach, which would do away with arbitrary thresholds, remove some of the heterogeneity that arises from categorical approaches, and limit the loss of information associated with categorical judgements of BPD (e.g. Clark et al. 1997).

Empirical support for diagnostic thresholds is problematic at best as it is impossible to distinguish clearly between ‘normal’ and ‘abnormal’ personalities. DSM-IV suggests that ‘when personality traits are inflexible and maladaptive and cause significant functional impairments or subjective distress do they constitute personality disorders’ (American Psychiatric Association 1994, p. 630). The problem with the categorical approach is not that the wrong individuals are being identified, since the individuals identified by criteria as having BPD are indeed normally different from comparison groups, but that this method of diagnosis is insufficiently sensitive. Many of those not meeting criteria, say amongst a group of depressed patients, will have three or more features of BPD, and this is likely to have an impact on the course and outcome of their treatment (e.g. McGlashan 1987).