Am J Psychiatry 1991; 148:1371-1377
Copyright © 1991 by American Psychiatric Association
The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders
HG Nurnberg, M Raskin, PE Levine, S Pollack, O Siegel and R Prince
Department of Psychiatry, Queens Hospital Center, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Jamaica, NY 11432.
OBJECTIVE: This study examines the comorbidity of DSM-III-R borderline
personality disorder and the other axis II personality disorders. The
extent and direction of overlap provides a measure of the clarity of its
diagnostic boundaries and descriptive validity. METHOD: In 110 outpatients
without concurrent major axis I conditions, axis II diagnoses were assessed
in semistructured format and all DSM-III-R personality disorder criteria
were rated. Multiple diagnoses were recorded. RESULTS: Twenty-two patients
(20%) met criteria for borderline personality disorder; 18 (82%) had at
least one additional personality disorder diagnosis. Using measures of
frequencies and intercorrelation coefficients, the authors found that
overlap was extensive and not confined to any one of the three designated
axis II clusters. Factor analysis revealed 1) a group containing borderline
personality disorder with paranoid, histrionic, narcissistic, antisocial,
and passive-aggressive personality disorders and 2) another grouping of
schizoid, schizotypal, avoidant, obsessive-compulsive, and self-defeating
personality disorders. CONCLUSIONS: Borderline personality disorder appears
to constitute a broad, heterogeneous category with unclear boundaries that
embraces a general personality disorder concept. Both further refinement of
the borderline personality disorder construct and investigation into
alternative models to the DSM- III-R axis II classification system are
suggested.
