Diagnostic efficiency and hierarchical functioning of the DSM-IV borderline personality disorder criteria

This study presents information regarding the diagnostic efficiency and hie rarchical functioning of the newly revised DSM-IV borderline personality di sorder (BPD) criteria. Past research using the DSM-III-R version of BPD sho wed that the individual BPD criteria differ greatly in their diagnostic uti lity and that in some clinical situations, fewer than five of eight criteri a could efficiently make the diagnosis. Two groups of inpatients, a BPD gro up (N = 33) and a non-BPD group (N = 43), were rated on the DSM-IV BPD crit eria. Acceptable interrater reliability (Kappa estimates) was obtained for the presence or absence of the nine individual BPD criteria. Diagnostic eff iciency statistics, sensitivity, specificity, false positive and false nega tive rates, positive predictive power, negative predictive power, overall c lassification rate and Kappa with the clinical diagnosis were obtained for all nine BPD criteria. The diagnostic efficiency data indicated that BPD cr iteria 1 (abandonment) and 2 (unstable relationships) functioned best in ou r inpatient sample, whereas criterion 9 (stress-related paranoia) performed the poorest. A stepwise logistic regression showed that the combination of BPD criteria 2, 1, 6 (unstable affect), and 3 (identity) (presented in the ir order of entry into the regression equation) provided the best predictio n of group membership (BPD or non-BPD). The results suggest that a further refinement of both the BPD criteria set and the diagnostic decision rules m ay be needed.