Does the Presence of One Feature of Borderline Personality Disorder Have Clinical Significance?

Abstract

Low-severity levels of borderline personality disorder pathology, defined as the presence of 1 criterion, can be determined reliably and have validity.

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

“…In addition, the amount of impairment associated with these different BPD criteria was not always similar. This finding suggests that, although a minimal level of BPD symptomatology is clinically significant in general (Zimmerman et al, 2012), it is important to consider what specific symptom is present. The current findings also support the idea that the validity of diagnostic systems (whether categorical or dimensional) for research and practice can be improved by weighting different features of personality disorder constructs differently based on their implications for an individual's functioning (e.g., Cooper & Balsis, 2009;Evans, Herbert, Nelson-Gray, & Gaudiano, 2002).…”

“…The diagnostic assessment protocol for the MIDAS project has been described in detail elsewhere (e.g., Zimmerman et al, 2012). Briefly, all participants were interviewed by a trained diagnostic rater and completed the Borderline Personality Disorder section of the Structured Interview for DSM-IV Personality (SIDP-IV; Pfohl, Blum, & Zimmerman, 1997) and a modified version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 1995).…”

“…For example, a recent report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project suggested that outpatients meeting only one BPD criterion have significantly greater impairment in several domains than those meeting no criteria for the disorder (Zimmerman, Chelminski, Young, Dalrymple, & Martinez, 2012). In that study, nearly onefifth of the 3,069 individuals presenting for outpatient psychiatric treatment (n = 589, 18.4%) met only one DSM-IV BPD criterion.…”

Borderline Personality Disorder in Adolescence

“…92 An example of this appears in section 3 of the DSM-5 (conditions that require further research), 1 but at present there is no consensus among the field as to which dimensional model should be adopted. 93 Potential advantages of a dimensional approach are that (1) adolescents with BPD can be described much more in detail than previously possible, (2) subthreshold conditions can be easily identified and classified, (3) changes in BPD symptomatology over the course of illness can be more sensitively detected, and (4) therapeutic interventions could be more individually targeted.…”

Prescribing and borderline personality disorder

“…one criterion) are associated with substantial increases in psychosocial impairment. 19 Despite the evidence of the reliability and validity of the diagnosis, and the treatability of the condition, 20 many people with borderline personality disorder remain undiagnosed in clinical practice. This places them at risk of being given treatments that are ineffective or even harmful.…”