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
N1 - Funding Information:
This research was partially supported by the McNair Medical Institute, Cullen Foundation, Brown Foundation, and Menninger Clinic Foundation. At the time of study design and data collection Dr. Oldham held the Barbara and Corbin Robertson Jr. Endowed Chair for Personality Disorders, Drs. Madan and Frueh were McNair Scholars. The study follows the guidelines on good publication practices. The study sponsors were not involved in any aspect of the research activities and did not approve the specific protocol or manuscript. Thus, the authors were independent from study sponsors in the context of the research. Drs. Fowler, Madan, Allen, Oldham, and Frueh have no conflicts of interest to report.
Publisher Copyright:
© 2020
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
KW - Impulsive Behavior
KW - Fear
KW - Diagnostic and Statistical Manual of Mental Disorders
KW - Mass Screening
KW - Humans
KW - Adult
KW - Borderline Personality Disorder/diagnosis
UR - https://www.scopus.com/pages/publications/85092470867
UR - https://www.scopus.com/inward/citedby.url?scp=85092470867&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2020.09.138
DO - 10.1016/j.jad.2020.09.138
M3 - Article
C2 - 33059223
AN - SCOPUS:85092470867
SN - 0165-0327
VL - 279
SP - 203
EP - 207
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -