The borderline diagnosis I: Psychopathology, comorbidity, and personaltity structure

Andrew E. Skodol, John G. Gunderson, Bruce Pfohl, Thomas A. Widiger, W. John Livesley, Larry J. Siever

Research output: Contribution to journalReview articlepeer-review

654 Scopus citations

Abstract

Borderline personality disorder (BPD) is a complex and serious mental disorder associated with severe functional impairment, substantial treatment utilization, and a high rate of mortality by suicide. Recently, BPD has become a focus of intensifying study. In Part I of this three-part article meant to provide a foundation to researchers on the current status of the borderline diagnosis and prospects for its future development, we examine the psychopathology, comorbidity, and personality structure of BPD. Although the descriptive characteristics of BPD are well-represented by DSM-IV diagnostic criteria, other important aspects of BPD psychopathology are not included. The descriptive criteria in conjunction with semistructured interviews have, however, increased the ability of investigators to diagnose BPD as reliably as many Axis I disorders. Frequent comorbidity of BPD with Axis I disorders necessitates a broad assessment of psychopathology to help account for clinical heterogeneity. Because of the absence of evidence of the validity of the diagnostic threshold for a categorical diagnosis of BPD, and because of the heterogeneity within the diagnosis, investigators should also supplement their DSM-IV diagnoses with assessments of underlying personality trait structures. Although there are a number of competing models of personality structure, they have remarkable convergence on a set of three to five basic personality dimensions.

Original languageEnglish
Pages (from-to)936-950
Number of pages15
JournalBiological Psychiatry
Volume51
Issue number12
DOIs
StatePublished - Jun 15 2002

Bibliographical note

Funding Information:
This paper was commissioned by and written with the support of the Board of Trustees of the Borderline Personality Disorder Research Foundation (BPDRF) and aspects of this work were presented and discussed at the First Annual Scientific Meeting of the Foundation, July 13–14, 2000. The authors are or were members of or consultants to the Scientific Advisory Board of the BPDRF.

Funding Information:
Supported in part by the Borderline Personality Disorder Research Foundation and National Institute of Mental Health Grant MH 50839.

Keywords

  • Borderline
  • Comorbidity
  • Diagnosis
  • Personality disorder
  • Personality structure
  • Psychopathology

ASJC Scopus subject areas

  • Biological Psychiatry

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