Am J Psychiatry 1991; 148:870-874
Copyright © 1991 by American Psychiatric Association
The face validity of the DSM-III and DSM-III-R criteria sets for borderline personality disorder
MC Zanarini, JG Gunderson, FR Frankenburg, DL Chauncey and JH Glutting
Psychosocial Research Program, McLean Hospital, Belmont, MA 02178.
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.
