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Compr Psychiatry. 2018 Jan;80:97-103. doi: 10.1016/j.comppsych.2017.09.003. Epub 2017 Sep 12.

Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5.

Author information

1
The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States. Electronic address: cfowler@menninger.edu.
2
The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
3
Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
4
University of Houston, United States.
5
Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; University of Hawaii, 200 West Kawili St., Hilo, HI 96720, United States.

Abstract

BACKGROUND:

With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD).

METHODS:

Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n=653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) and the Big Five Inventory (BFI), while Sample 2 (n=1,000) completed the SCID-II interviews, Personality Inventory for DSM5 (PID-5) and the BFI.

RESULTS:

BFI measure evidenced moderate accuracy for two composites: High Neuroticism+ low agreeableness composite (AUC=0.72, SE=0.01, p<0.001) and High Neuroticism+ Low+Low Conscientiousness (AUC=0.73, SE=0.01, p<0.0001). The SCID-II-PQ evidenced moderate-to-excellent accuracy (AUC=0.86, SE=0.02, p<0.0001) with a good balance of specificity (SP=0.80) and sensitivity (SN=0.78). The PID-5 BPD algorithm (consisting of elevated emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC=0.87, SE=0.01, p<0.0001) with a good balance of specificity (SP=0.76) and sensitivity (SN=0.81).

CONCLUSIONS:

Findings generally support the use of SCID-II-PQ and PID-5 BPD algorithm for screening purposes. Furthermore, findings support the accuracy of the DSM 5 alternative model Criteria B trait constellation for diagnosing BPD. Limitations of the study include the single inpatient setting and use of two discrete samples to assess PID-5 and SCID-II-PQ.

PMID:
29069625
DOI:
10.1016/j.comppsych.2017.09.003
[Indexed for MEDLINE]

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