Abstract
BackgroundConceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD).MethodRaters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined.ResultsInter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes.ConclusionsResults show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.
Highlights
Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches
Results show that traditional DSM borderline personality disorder (BPD) diagnosis reflects a common core of PD severity, largely composed of Level of Personality Functioning Scale (LPFS) and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity
The criteria for DSM-IV BPD diagnosis can yield a positive diagnosis in many ways (i.e., 256), we found that BPD Alternative Model for Personality Disorders (AMPD) profiles generated by (1) the grand mean of all nine criteria, (2) increasing numbers of criteria determined by base rate, (3) causal centrality, and (4) LPFS severity ratings of the BPD criteria resulted in highly similar AMPD profiles
Summary
Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The researcher often privileges scientific concerns (which may be studied with idiographic methods), like reproducibility and the statistical relationships between measurements of the phenomena of interest (i.e., construct validity [1]). Because these stakeholders tend to value and emphasize different elements and even models of diagnostic systems, conceptualizations of psychiatric disorders reflect tensions in the field. Concerns and debates about how to formulate the diagnosis of BPD often pivot on the current interest in dimensionalizing diagnostic systems
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