Differences between clinical and research practices in diagnosing borderline personality disorder

Objective: It has been reported that clinicians are less inclined than rese archers to use direct questions in ascertaining the presence of personality disorders, and questions have been raised about the validity of research o n personality disorders in which diagnoses are based on semistructured diag nostic interviews. This study examined the influence of assessment method o n the diagnosis of borderline personality disorder. Method: Diagnoses of bo rderline personality disorder derived from structured and unstructured clin ical interviews were compared in two groups of psychiatric outpatients seen in the same practice setting. Five hundred individuals presenting to a gen eral adult psychiatric practice for an intake appointment underwent a routi ne unstructured clinical interview. After the completion of that study, the method of conducting diagnostic evaluations was changed, and 409 individua ls were interviewed with the borderline personality disorder section of the Structured Interview for DSM-IV Personality. Results: Individuals in the s tructured interview group were significantly more often diagnosed with bord erline personality disorder than individuals in the clinical group. When in formation from the structured interview was presented to the clinicians, bo rderline 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 be nefit of detailed information from a semistructured diagnostic interview, c linicians rarely diagnose the disorder during a routine intake evaluation. Providing the results of a semistructured interview to clinicians prompts t hem to diagnose borderline personality disorder much more frequently. This is inconsistent with the notion that personality disorder diagnoses based o n semistructured interviews are not viewed as valid by clinicians.