TY - JOUR
T1 - Diagnostic accuracy of DSM-5 borderline personality disorder criteria
T2 - Toward an optimized criteria set
AU - Fowler, J. Christopher
AU - Carlson, Marianne
AU - Orme, William H.
AU - Allen, Jon G.
AU - Oldham, John M.
AU - Madan, Alok
AU - Frueh, B. Christopher
PY - 2021/1/15
Y1 - 2021/1/15
N2 - Objective: The polythetic system used by the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for diagnosing borderline personality disorders (BPD) is far from optimal; however, accumulated research and clinical data are strong enough to warrant ongoing utilization. This study examined diagnostic efficiency of the nine DSM-IV BPD criteria, then explored the feasibility of an optimized criteria set in classifying BPD. Methods: Adults (N=1,623) completed the Structured Clinical Interviews for DSM-IV Axis II Disorders resulting in a BPD group (n=352) and an inpatient psychiatric control group (PC) with no personality disorders (n=1,271). Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of each DSM-5 BPD criterion in classifying BPD cases. Results: Affective instability (Criterion 6) evidenced the strongest capacity to differentiate the groups (AUC =.84, SE =.01, p <.0001). Abandonment fears (Criterion 1), unstable relationships (Criterion 2), identity disturbance (Criterion 3), impulsivity (Criterion 4), and chronic emptiness (Criterion 7) yielded good-to-moderate discrimination (AUC range =.75-.79). A composite index of these six criteria yielded excellent accuracy (AUC =.98, SE =.002, p <.0001), sensitivity (SN=.99), and specificity (SP=.90). Conclusions: The current findings add to evidence that affective instability is a useful gate criterion for screening, and the optimized criteria set evidences equivalent accuracy to the original 9 criteria, with a substantial reduction in estimated heterogeneity (from 256 combinations with the original set to 42 combinations with the optimized set).
AB - Objective: The polythetic system used by the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for diagnosing borderline personality disorders (BPD) is far from optimal; however, accumulated research and clinical data are strong enough to warrant ongoing utilization. This study examined diagnostic efficiency of the nine DSM-IV BPD criteria, then explored the feasibility of an optimized criteria set in classifying BPD. Methods: Adults (N=1,623) completed the Structured Clinical Interviews for DSM-IV Axis II Disorders resulting in a BPD group (n=352) and an inpatient psychiatric control group (PC) with no personality disorders (n=1,271). Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of each DSM-5 BPD criterion in classifying BPD cases. Results: Affective instability (Criterion 6) evidenced the strongest capacity to differentiate the groups (AUC =.84, SE =.01, p <.0001). Abandonment fears (Criterion 1), unstable relationships (Criterion 2), identity disturbance (Criterion 3), impulsivity (Criterion 4), and chronic emptiness (Criterion 7) yielded good-to-moderate discrimination (AUC range =.75-.79). A composite index of these six criteria yielded excellent accuracy (AUC =.98, SE =.002, p <.0001), sensitivity (SN=.99), and specificity (SP=.90). Conclusions: The current findings add to evidence that affective instability is a useful gate criterion for screening, and the optimized criteria set evidences equivalent accuracy to the original 9 criteria, with a substantial reduction in estimated heterogeneity (from 256 combinations with the original set to 42 combinations with the optimized set).
KW - Borderline Personality Disorder
KW - DSM 5 criteria
KW - Diagnostic Accuracy
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U2 - 10.1016/j.jad.2020.09.138
DO - 10.1016/j.jad.2020.09.138
M3 - Article
C2 - 33059223
AN - SCOPUS:85092470867
VL - 279
SP - 203
EP - 207
JO - J Affect Disord
JF - J Affect Disord
SN - 0165-0327
ER -