Citation

Zimmerman M, Chelminski I, Young D, Dalrymple K, Martinez J. J. Clin. Psychiatry 2012; 73(1): 8-12.

Copyright

(Copyright © 2012, Physicians Postgraduate Press)

DOI

10.4088/JCP.10m06784

PMID

unavailable

Abstract

OBJECTIVE: In the draft proposal for DSM-5, the Work Group for Personality and Personality Disorders recommended that dimensional ratings of personality disorders replace DSM-IV's categorical approach toward classification. If a dimensional rating of personality disorder pathology is to be adopted, then the clinical significance of minimal levels of pathology should be established before they are formally incorporated into the diagnostic system because of the potential unforeseen consequences of such ratings. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the low end of the severity dimension and compared psychiatric outpatients with 0 or 1 DSM-IV criterion for borderline personality disorder on various indices of psychosocial morbidity.

METHOD: Three thousand two hundred psychiatric outpatients were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders. The present report is based on the 1,976 patients meeting 0 or 1 DSM-IV criterion for borderline personality disorder.

RESULTS: The reliability of determining if a patient was rated with 0 or 1 criterion for borderline personality disorder was good (κ = 0.70). Compared to patients with 0 borderline personality disorder criteria, patients with 1 criterion had significantly more current Axis I disorders (P <.001), suicide attempts (P <.01), suicidal ideation at the time of the evaluation (P <.001), psychiatric hospitalizations (P <.001), and time missed from work due to psychiatric illness (P <.001) and lower ratings on the Global Assessment of Functioning (P <.001).

CONCLUSIONS: Low-severity levels of borderline personality disorder pathology, defined as the presence of 1 criterion, can be determined reliably and have validity. © Copyright 2011 Physicians Postgraduate Press, Inc.

Language: en

Keywords

adult; human; female; male; suicidal ideation; suicide attempt; disease severity; Diagnostic and Statistical Manual of Mental Disorders; morbidity; outpatient; article; major clinical study; controlled study; functional assessment; clinical feature; psychologic test; priority journal; pathology; borderline state; Methods to Improve Diagnostic Assessment and Services