Differences Between Clinical and Research Practices in Diagnosing Borderline Personality Disorder

OBJECTIVE: It has been reported that clinicians are less inclined than researchers to use direct questions in ascertaining the presence of personality disorders, and questions have been raised about the validity of research on personality disorders in which diagnoses are based on semistructured diagnostic interviews. This study examined the influence of assessment method on the diagnosis of borderline personality disorder. METHOD: Diagnoses of borderline personality disorder derived from structured and unstructured clinical interviews were compared in two groups of psychiatric outpatients seen in the same practice setting. Five hundred individuals presenting to a general adult psychiatric practice for an intake appointment underwent a routine unstructured clinical interview. After the completion of that study, the method of conducting diagnostic evaluations was changed, and 409 individuals were interviewed with the borderline personality disorder section of the Structured Interview for DSM-IV Personality. RESULTS: Individuals in the structured interview group were significantly more often diagnosed with borderline personality disorder than individuals in the clinical group. When information from the structured interview was presented to the clinicians, borderline personality disorder was much more likely to be diagnosed by them. CONCLUSIONS: The method used to assess borderline personality disorder has a great impact on the frequency with which it is diagnosed. Without the benefit of detailed information from a semistructured diagnostic interview, clinicians rarely diagnose the disorder during a routine intake evaluation. Providing the results of a semistructured interview to clinicians prompts them to diagnose borderline personality disorder much more frequently. This is inconsistent with the notion that personality disorder diagnoses based on semistructured interviews are not viewed as valid by clinicians.