Discriminating Borderline Personality Disorder (BPD) From Major Depression and Refining Diagnostic Criteria for BPD.
Date of Award
Doctor of Philosophy (PhD)
Investigators have sought to clarify the Borderline Personality Disorder (BPD) category by comparing it with other personality disorders (e.g., Clarkin, Widiger, Frances, Hurt, & Gilmore, 1983; Zanarini, Gunderson, Grankenburg, & Chauncey, 1990), schizophrenia (see review by Siever & Gunderson, 1978), and major depression (see review by Gunderson & Phillips, 1991). The current study investigated the discriminative validity of the DSM-III-R (American Psychiatric Association, 1987) borderline criteria and qualitative differences in depression between borderlines (BPD) and patients diagnosed with major depressive episode (MDE). The 100 subjects were inpatients (n = 94) and outpatients (n = 6), assigned to one of three groups according to diagnosis. Subjects were diagnosed as borderline without major depression (BPD, n = 23), depressed borderline (BPD/MDE, n = 36), or non-borderline depressed (MDE, n = 41) by structured interview with the Personality Disorder Examination (Loranger, Susman, Oldham, & Russakoff, 1987) and the Structured Clinical Interview for DSM-III-R (Spitzer, Williams, Gibbon, & First, 1990). Qualitative differences in depression were assessed by the Clinical Interview for Depression (Paykel, 1985). Conditional probabilities analysis, chi-square, stepwise multiple regression were used to analyze differences between the groups. The results indicate that the DSM-III-R borderline criteria discriminate depressed and non-depressed borderlines from patients who are depressed, but that self-mutilation and suicide threats are unique features of BPD compared with MDE. "Identity disturbance" was the best criterion for discriminating borderlines from depressed subjects. Although the BPD "impulsiveness" criterion discriminated borderlines from depressed patients overall, driving while intoxicated, binge eating, and shoplifting as specific types of impulsiveness did not discriminate between groups. However, impulsive sexual behavior may be a type of impulsiveness specifically related to borderlines. Depression in borderlines was qualitatively different from depression in nonborderlines, as measured by the Clinical Interview for Depression (Paykel, 1985). It was characterized by reports of greater severity of depression, over-emphasis of symptoms, and paranoid ideas in borderlines. The findings contribute to a refinement of the borderline category, and suggest new directions for research on borderline personality disorder.
Head, Betty Susan, "Discriminating Borderline Personality Disorder (BPD) From Major Depression and Refining Diagnostic Criteria for BPD." (1991). LSU Historical Dissertations and Theses. 5242.