Borderline personality disorder diagnosis in a new key

Abby L. Mulay; Mark H. Waugh; J. Parks Fillauer; Donna S. Bender; Anthony Bram; Nicole M. Cain; Eve Caligor; Miriam K. Forbes; Laurel B. Goodrich; Jan H. Kamphuis; Jared W. Keeley; Robert F. Krueger; John E. Kurtz; Peter Jacobsson; Katie C. Lewis; Gina M.P. Rossi; Jeremy M. Ridenour; Michael Roche; Martin Sellbom; Carla Sharp; Andrew E. Skodol

doi:10.1186/s40479-019-0116-1

Borderline personality disorder diagnosis in a new key

Abby L. Mulay, Mark H. Waugh, J. Parks Fillauer, Donna S. Bender, Anthony Bram, Nicole M. Cain, Eve Caligor, Miriam K. Forbes, Laurel B. Goodrich, Jan H. Kamphuis, Jared W. Keeley, Robert F. Krueger, John E. Kurtz, Peter Jacobsson, Katie C. Lewis, Gina M.P. Rossi, Jeremy M. Ridenour, Michael Roche, Martin Sellbom, Carla SharpAndrew E. Skodol

Psychology (Twin Cities)

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). Method: Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. Results: Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. Conclusions: Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

Original language	English (US)
Article number	18
Journal	Borderline Personality Disorder and Emotion Dysregulation
Volume	6
Issue number	1
DOIs	https://doi.org/10.1186/s40479-019-0116-1
State	Published - Dec 2 2019

Bibliographical note

Funding Information:
* Correspondence: mulay@musc.edu This work is the opinion of the authors and does not represent endorsement by UT-Battelle, LLC, ORNL, & the U.S, Department of Energy. This article has been authored by MHW employed by UT-Battelle, LLC, under Contract No. DE-AC05-00OR22725 with the U.S. Department of Energy. The United States Government retains and the publisher, by accepting the article for publication, acknowledges that the United States Government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this article, or allow others to do so, for United States Government purposes. The Department of Energy will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/down loads/doe-public-access-plan). Abby L. Mulay, Mark H. Waugh and J. Parks Fillauer share lead authorship roles for this manuscript. 1Medical University of South Carolina, 29C Leinbach Drive, Charleston, SC 29407, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Publisher Copyright:
© 2019 The Author(s).

Keywords

Alternative model for personality disorders
Borderline personality disorder
DSM-5
Personality assessment
Personality disorder

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Mulay, A. L., Waugh, M. H., Parks Fillauer, J., Bender, D. S., Bram, A., Cain, N. M., Caligor, E., Forbes, M. K., Goodrich, L. B., Kamphuis, J. H., Keeley, J. W., Krueger, R. F., Kurtz, J. E., Jacobsson, P., Lewis, K. C., Rossi, G. M. P., Ridenour, J. M., Roche, M., Sellbom, M., ... Skodol, A. E. (2019). Borderline personality disorder diagnosis in a new key. Borderline Personality Disorder and Emotion Dysregulation, 6(1), Article 18. https://doi.org/10.1186/s40479-019-0116-1

Mulay, AL, Waugh, MH, Parks Fillauer, J, Bender, DS, Bram, A, Cain, NM, Caligor, E, Forbes, MK, Goodrich, LB, Kamphuis, JH, Keeley, JW, Krueger, RF, Kurtz, JE, Jacobsson, P, Lewis, KC, Rossi, GMP, Ridenour, JM, Roche, M, Sellbom, M, Sharp, C & Skodol, AE 2019, 'Borderline personality disorder diagnosis in a new key', Borderline Personality Disorder and Emotion Dysregulation, vol. 6, no. 1, 18. https://doi.org/10.1186/s40479-019-0116-1

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abstract = "Background: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). Method: Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. Results: Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. Conclusions: Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.",

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T1 - Borderline personality disorder diagnosis in a new key

AU - Mulay, Abby L.

AU - Waugh, Mark H.

AU - Parks Fillauer, J.

AU - Bender, Donna S.

AU - Bram, Anthony

AU - Cain, Nicole M.

AU - Caligor, Eve

AU - Forbes, Miriam K.

AU - Goodrich, Laurel B.

AU - Kamphuis, Jan H.

AU - Keeley, Jared W.

AU - Krueger, Robert F.

AU - Kurtz, John E.

AU - Jacobsson, Peter

AU - Lewis, Katie C.

AU - Rossi, Gina M.P.

AU - Ridenour, Jeremy M.

AU - Roche, Michael

AU - Sellbom, Martin

AU - Sharp, Carla

AU - Skodol, Andrew E.

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PY - 2019/12/2

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N2 - Background: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). Method: Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. Results: Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. Conclusions: Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

AB - Background: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). Method: Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. Results: Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. Conclusions: Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

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KW - Personality assessment

KW - Personality disorder

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Borderline personality disorder diagnosis in a new key

Abstract

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