The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: A redundant addition to classification

Abstract

Objective: The International Classification of Diseases, 11th Revision classification of personality disorder removes all categories of disorder in favour of a single diagnostic spectrum extending from no personality dysfunction to severe personality disorder. Following concerns from some clinicians and Personality Disorder Societies, it was subsequently agreed to include a borderline pattern descriptor as a qualifier of the main diagnosis. We explore the value of this additional descriptor by examining personality data in patients with major depression. Method: We examined personality data obtained using the Structured Clinical Interview for Personality Disorder-II in 606 patients enrolled in five randomised controlled trials of depression. The Structured Clinical Interview for Personality Disorder-II uses the Diagnostic and Statistical Manual of Mental Disorders categorical system, which includes borderline personality disorder. The International Classification of Diseases, 11th Revision classification has five domain traits. Each of the Diagnostic and Statistical Manual of Mental Disorders personality disorder symptoms or behaviours from Structured Clinical Interview for Personality Disorder-II was reordered into the five domains independently by two assessors. The relationship between the two systems was examined by tabular and correlational analysis. Results: The findings showed that the symptoms of borderline personality disorder were associated with greater severity of personality disturbance in the International Classification of Diseases, 11th Revision classification ( p < 0.0001) and were associated primarily with the Negative Affective, Dissocial and Disinhibited domains. There was only a weak association with the other two domains, Anankastia and Detachment. Conclusion: The addition of a borderline pattern descriptor is likely to add little to the International Classification of Diseases, 11th Revision classification of personality disorder. Its features are well represented within the severity/domain structure, which allows for more fine-grained description of the personality features that constitute the borderline concept.

Development and initial evaluation of the ICD‐11 personality disorder severity scale: PDS‐ICD‐11

“…More generally, future studies on the PDS-ICD-11 should be accumulated to support whether a borderline pattern qualifier is a redundant addition to the ICD-11 PD guidelines. Preliminary research suggests that features of this pattern are sufficiently represented within the severity component (as well as the trait domain qualifiers) (Mulder et al, 2020). Future research may seek to investigate overlap of PDS-ICD-11 and the Borderline Pattern Scale (PDS) (Oltmanns & Widiger, 2019) including their incremental validity in terms of predicting clinically important outcome.…”

Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents

“…First, it reaffirms that BPD in adolescence is a matter of personality functioning, just as studies with adults have shown: rather than being distinct psychopathology, BPD is the strongest marker of the general PD factor ( 52 ) and “disappears” into it ( 37 ). As such, understanding borderline PD once again brings us closer to the level of personality organization as defined by Kernberg ( 53 ) and suggests that BPD criteria reflect the core features of PD severity ( 37 , 54 ). Secondly, the retention of the borderline qualifier in the ICD-11 raises the question of its possible redundancy with the PD severity criterion ( 54 ).…”

“…As such, understanding borderline PD once again brings us closer to the level of personality organization as defined by Kernberg ( 53 ) and suggests that BPD criteria reflect the core features of PD severity ( 37 , 54 ). Secondly, the retention of the borderline qualifier in the ICD-11 raises the question of its possible redundancy with the PD severity criterion ( 54 ). The high correlations between personality functioning, maladaptive traits, and borderline features found in the current study suggest that it is a relevant question in adolescence too.…”

ICD-11 Personality Disorders: Utility and Implications of the New Model

“…Nevertheless, the ICD-11 working group felt that the severity and trait model could fully account for the borderline pattern ( 27 ). The borderline pattern qualifier appears closely linked to the overall severity of the personality pathology and may be a redundant addition to the classification ( 41 ). It is hoped that research will reveal whether the borderline pattern qualifier provides useful or distinct information beyond that provided by the trait domains ( 26 ).…”