Does the ICD 10 classification accurately describe subtypes of borderline personality disorder?

The aim of the paper is to explore whether the division of borderline personality disorder, as described in the DSM classification, into impulsive and borderline subtypes of emotionally unstable personality disorder in the ICD classification of personality disorder, is a valid division. The self-report questionnaire responses of 288 referrals to a personality disorder service were rated on each of the eight criteria for DSM-III-R diagnosis of borderline personality disorder. Factor analysis identified two factors; factor one closely corresponds with the borderline subtype of ICD10, whilst factor two closely corresponds with the impulsive subtype of ICD10. Criteria common to both factors unstable relationships and identity confusion - were considered core features of borderline personality disorder. The pattern of occurrence of the two factors was similar to the complex binary picture described by ICD10. However there were also differences. Firstly, identity confusion is found to be a core feature of both our factors, and this does not conform to the restriction of identity confusion to the borderline subtypes in ICD10. Secondly, we found a residual pool of undifferentiated borderline patients and a small group of pure non-impulsive borderline patients who are not currently accommodated within the ICD10 emotionally unstable personality disorder. We conclude that future classifications of this disorder should accommodate four subtypes, and suggest these subtypes have implications for treatment and further research.

Training general practitioners to improve their recognition of emotional disturbance in the consultation.

The detection of emotional disturbance by general practitioners in the consultation is known to be low. This study measured the detection rates of emotional disturbance among 10 established principals in general practice, as compared with the general health questionnaire, before and after 10 months of training. The training comprised a fortnightly seminar based around video recordings of ordinary consultations. The results showed that nine of the 10 doctors improved their ability to identify cases while one over-diagnosed cases following the training. The general health questionnaire detected emotional disturbance in 51.5% of the patients studied. During the seminars it became apparent that factors both within the doctor and the patient prevented detection of emotional disturbance and these are described. It is concluded that diagnostic accuracy depends on the interaction between doctor and patient, and that this has implications for the organization of general practice both in terms of longer consultation times and of adequate support for the doctor.