An empirical examination of Gunderson's proposed revision of the diagnostic algorithm for borderline personality disorder.

Gunderson (2010) recently offered a sharp criticism of the draft proposal for diagnosing personality disorders in DSM-5. Based on a review of phenomenological, factor analytic, social psychology, family, neurobiological, and treatment studies of borderline personality disorder (BPD), he proposed an alternative revision of the BPD criteria. One of the suggested changes was a modification of the DSM-IV diagnostic algorithm. Gunderson did not, however, provide any data on the impact this new diagnostic algorithm would have on the prevalence of BPD, or the validity of this alternative approach compared to the DSM-IV algorithm. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we administered semi-structured diagnostic interviews to 3,081 psychiatric outpatients and examined diagnostic concordance between DSM-IV and Gunderson's proposal, and whether there is incremental validity in Gunderson's diagnostic approach. The results did not indicate that the alternative diagnostic algorithm improved validity, and, depending on the threshold used, could result in false negative diagnoses.