Hierarchy of DSM-III-R Criteria Efficiency for the Diagnosis of Borderline Personality Disorder

This study identified 22 borderline personality disorder (BPD) patients in a sample of 110 outpatients with anxiety and other “minor,” predominantly affective spectrum, Axis I disorders. Some individual criteria and combinations of DSM-III-R criteria are more efficient predictors of BPD than others. The following diagnostic criteria were hierarchically discriminating: (1) disturbed interpersonal relations; (2) impulsivity; (3) feelings of chronic emptiness, boredom; (4) self-destructive behaviors; (5) intense anger; and (6) abandonment avoidance. Requiring any 3 of these 6 items, or certain specific combinations of 2 items, provided optimal measures of diagnostic efficiency considerations. Although affective instability and identity disturbance did not achieve significant discriminative power, they can still have an important role in the construct. These findings suggest further refinements to the DSM-III-R decision rules for BPD, which also pertain to current issues for personality disorder diagnosis.