Diagnosing Borderline Personality

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Abstract
The hypothesis that borderline personality organization can be differentiated from neurotic and psychotic levels of personality organization by means of 3 structural criteria: degree of identity integration, level of defensive operations and capacity for reality testing, was examined. To elicit these criteria, the structural interview was developed that focuses on the here-and-now patient-interviewer interaction. The patient''s responses to the interviewer''s attempts to clarify, confront and interpret various aspects of the patient''s interview behavior provide the basis for judgments as to the patient''s structural diagnosis. The differential diagnoses of 48 hospitalized patients in which structural diagnoses of borderline or psychotic personality organization were made according to this diagnostic interview approach were studied. These diagnoses were compared with those obtained from Gunderson''s Diagnostic Interview for Borderlines, with psychological test diagnoses and with clinical diagnoses based on past history and current illness. Substantial convergent agreement was shown among all of the diagnostic methods and support the utility of the structural interview. In most discrepant cases, other methods reflected disagreement among themselves despite the diagnoses obtained from the structural interview, suggesting that there are some cases difficult to classify by any means. The structural interview may be eliciting a different dimension of personality functioning in arriving at borderline diagnoses than do the other methods studied. Borderline structural diagnoses refer to patients described clinically as having severe character pathology and do not overlap with patients described as having schizophrenic disorders. The structural interview appears to warrant further study and, at the same time, shows promise as a research tool in further studies of structural diagnosis and relevance for prognosis and treatment.

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