Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5

James Chris Fowler, Alok Madan, Jon G. Allen, Michelle Patriquin, Carla Sharp, John M. Oldham, B. Christopher Frueh

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD). Methods Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n = 653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) and the Big Five Inventory (BFI), while Sample 2 (n = 1,000) completed the SCID-II interviews, Personality Inventory for DSM5 (PID-5) and the BFI. Results BFI measure evidenced moderate accuracy for two composites: High Neuroticism + low agreeableness composite (AUC = 0.72, SE = 0.01, p < 0.001) and High Neuroticism + Low + Low Conscientiousness (AUC = 0.73, SE = 0.01, p < 0.0001). The SCID-II-PQ evidenced moderate-to-excellent accuracy (AUC = 0.86, SE = 0.02, p < 0.0001) with a good balance of specificity (SP = 0.80) and sensitivity (SN = 0.78). The PID-5 BPD algorithm (consisting of elevated emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC = 0.87, SE = 0.01, p < 0.0001) with a good balance of specificity (SP = 0.76) and sensitivity (SN = 0.81). Conclusions Findings generally support the use of SCID-II-PQ and PID-5 BPD algorithm for screening purposes. Furthermore, findings support the accuracy of the DSM 5 alternative model Criteria B trait constellation for diagnosing BPD. Limitations of the study include the single inpatient setting and use of two discrete samples to assess PID-5 and SCID-II-PQ.

Original languageEnglish (US)
Pages (from-to)97-103
Number of pages7
JournalComprehensive Psychiatry
Volume80
DOIs
StatePublished - Jan 2018

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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