The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder.

Abstract

Relationships between personality organization, reflective functioning (RF), and the number of Axis I and Axis II disorders were examined. Ninety-two female patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) borderline personality disorder (BPD) were administered the Structured Interview of Personality Organization (STIPO), the Adult Attachment Interview for assessment of RF, and the Structured Clinical Interview for DSM Disorders. Significant correlations were found between the level of personality organization and the number of Axis I and Axis II diagnoses. In contrast, no association was found between RF and the severity of Axis I and Axis II pathology. RF and level of personality organization were moderately associated. The results indicate that the concept of personality organization is related to the descriptive approach of the DSM-IV-TR. The STIPO provides a differentiated picture of the severity of personality pathology and allows dimensional ratings of several domains central to personality functioning. The RF findings confirm previous studies indicating impairments of mentalizing capacity in BPD patients. The association between RF and level of personality organization supports both shared and divergent conceptual considerations underlying mentalization and personality organization. Further investigation of the relationship between these structural constructs would shed light on the complex interplay of an individual's capacity to mentalize and the personality structure shaped by identity integration, defense mechanisms, and reality testing. In addition to the psychiatric classification, measurements of RF and personality organization should be considered in psychotherapeutic treatment planning as well as evaluation of therapy response.