Assessment of borderline personality disorder: considering a diagnostic strategy

Authors

  • C. K. W. Schotte

    1. Department of Psychiatry, University Hospital of Antwerp, Belgium and
    2. Faculty of Psychology, Free University Brussels (V.U.B.), Belgium
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Dr C. Schotte, Department Psychiatry, University Hospital Antwerp (U.Z.A.), Wilrijkstraat 10, B-2650 Edegem, Belgium. Tel: 32 3 821 51 57; Fax: 32 3 825 16 41; E-mail: chris.schotte@uza.be

Abstract

Background:  Borderline personality disorder (BPD) represents a highly prevalent, severe and difficult-to-treat mental health problem.

Objective: This paper considers methods, instruments and strategies for assessing BPD as described within the frame of the DSM-IV classification.

Conclusions: Following the general diagnostic approach introduced by Van Praag in biological psychiatry, a two-tier diagnostic strategy for the descriptive diagnostic assessment of BPD is recommended. Axis one results in a DSM-IV Axis II categorical diagnosis, whereas axis two refers to a symptomatological, dimensional or functional approach, in which the psychological dysfunctions of the nosological syndrome are depicted. Moreover, in a clinical context a basic aim of the diagnostic evaluation is to obtain therapeutically valid information that leads to a constructive conceptual framework, to a case formulation in which therapeutic interventions are understood, selected and implemented. This framework should be based on a biopsychosocial theoretical model and its application in the clinical context involves feedback to the patient, in which the descriptive evaluation is integrated with etiological; and pathogenic elements using an idiographic approach. This therapeutically orientated diagnostic strategy is illustrated by the use of the ADP-IV (Assessment of DSM-IV personality disorders) questionnaire within a cognitive behavioral orientation.

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