Premium
Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria
Author(s) -
Bayes A.J.,
Parker G. B.
Publication year - 2020
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.13133
Subject(s) - borderline personality disorder , abandonment (legal) , anger , clinical psychology , psychology , psychiatry , predictive value , medicine , political science , law
Objective We sought to determine the differential diagnostic efficiency of all DSM‐IV borderline personality disorder (BPD) criteria by studying a sample of those with BPD and a contrast group with a bipolar disorder (BP). Method Participants were clinically assessed and assigned diagnoses based on DSM criteria – with prevalence rates and diagnostic efficiency values calculated. Results Fifty‐three participants were assigned a BPD diagnosis, 83 a BP diagnosis, with comorbid participants excluded. The mean number of DSM BPD criteria assigned was 6.6 (SD = 1.0) in the BPD group and 1.9 (SD = 1.3) in the BP group. The most prevalent criterion in the BPD group was ‘affective instability’ (AI) (92.5%), with ‘inappropriate anger’ least endorsed (49%). The highest specificity criterion was ‘abandonment fears’, which displayed the greatest positive predictive value (PPV) = 0.9, and with AI offering the lowest specificity. ‘Unstable relationships’ had the highest overall negative predictive value (NPV) = 0.91. The highest percentage accuracy of classification was provided by ‘identity disturbance’ and ‘abandonment fears’ criteria, both 85%. Conclusion The transdiagnostic nature of ‘affective instability’ means it is less useful for diagnostic decisions, whereas ‘abandonment fears’ and ‘identity disturbance’ offer superior diagnostic efficiency in distinguishing BPD from BP.