DSM-5 Borderline Personality Disorder: At the Border Between a Dimensional and a Categorical View

Abstract

Recently, the DSM-5 Personality Disorders Workgroup offered its proposed revision for borderline personality disorder (BPD) and other personality disorder types ( http://www.dsm5.org ). According to the workgroup, this revision reflects an attempt to address excessive comorbidity among personality disorders, place personality pathology on continua, and replace individual behavioral criteria with personality traits. Essentially, the committee proposes a hybrid model of BPD (ie, categorical and dimensional)-one that combines the notion of a borderline "type" with supplemental dimensional ratings of relevant personality traits. In this article, we review recent findings on the dimensionality of BPD from phenotypic, genetic, and endophenotypic perspectives. Finally, we evaluate the current DSM-5 proposal for diagnosing BPD-one that ostensibly combines a categorical and dimensional perspective-in light of these findings.

Subtypes of borderline personality disorder patients: a cluster-analytic approach

“…Results have been quite inconsistent, which may be due to differences in samples and measures of BPD used [18]. Moreover, correlations among the factors are typically very high, leading some authors to conclude that a more parsimonious one-factor model may fit the data best [19–24]. Elaborating on this knowledge, it has been suggested that BPD may be most adequately described by a one-dimensional model, with factors representing varying degrees of severity on the underlying continuum [21, 24].…”

“…Moreover, correlations among the factors are typically very high, leading some authors to conclude that a more parsimonious one-factor model may fit the data best [19–24]. Elaborating on this knowledge, it has been suggested that BPD may be most adequately described by a one-dimensional model, with factors representing varying degrees of severity on the underlying continuum [21, 24]. Taking into account the evidence demonstrating BPD to be a unidimensional construct, the additional value of investigating the differentiating multiple-factor structures has been noted to be more useful to understand BPD comorbidity and to plan treatment [25].…”

Comorbidity study of borderline personality disorder: applying association rule mining to the Taiwan national health insurance research database

“…This disorder constitutes 10% of mental health clients observed in outpatient clinical settings and 15–20% of those in inpatient settings [4, 5]. BPD is a severe and complex psychological disorder characterized by pervasive instability in regulating emotions, self-image, interpersonal relationships, and impulse control [6].…”

Oxytocin Receptor Gene Variation and Differential Susceptibility to Family Environment in Predicting Youth Borderline Symptoms

“…Moreover, numerous studies have shown that even mild borderline symptomatology in nonclinical populations is associated with significant impairment of functioning (e.g., Trull, Useda, Conforti, & Doan, 1997). Additionally, while controversies reign in the question of the utility of dimensional versus categorical (diagnostic) assessment of BPD and other personality disorders, a review of phenotypic and genetic studies generally supports the use of dimensional approaches (Trull, Distel, & Carpenter, 2011). Depression is highly comorbid with borderline personality disorder (Trull et al, 2010), and the present study controls for co-occurring depression at the time of BPD assessment.…”