OBJECTIVE: The main objective of this study was to determine the
congruence between DSM-III and DSM-III-R diagnoses of borderline
personality disorder derived through the use of semistructured research
interviews or given by experienced clinicians after lengthy consultations
with an interdisciplinary team. METHOD: The presence of the DSM-III and
DSM-III-R criteria sets for borderline personality disorder was assessed in
a study group of 253 patients with personality disorders (148 inpatients
and 105 outpatients) by raters who were blind to clinical diagnoses and who
used information from two semistructured interviews of proven reliability.
These diagnoses were then compared with "longitudinal expert all data"
(LEAD) standard clinical diagnoses provided by therapists specifically
asked to base their diagnoses on DSM criteria. RESULTS: Both criteria sets
were found to be overinclusive when compared with the LEAD standard. Most
criteria were also found to lack specificity. However, the three DSM-III-R
criteria that are new or revisions of DSM-III criteria were found to be
more specific, and raising the cutoff on the DSM-III-R criteria from five
to six improved specificity. CONCLUSIONS: Both the DSM-III and DSM-III-R
criteria sets for borderline personality disorder as assessed by
semistructured interview lack face validity because they are nonspecific
when compared with a rigorous but representative clinical standard, and the
results of studies using these criteria sets may prove misleading to
researchers and clinicians because they seem to define a nonspecific type
of serious character pathology.